Etiology of dysphagia and overview of assessment

Question 1

If a patient c/o food sticking to the roof of the mouth, then what is the impairment?

Answer 1

reduction of tongue to palate movement; reducted range of tongue motion

Question 2

If a patient has remnants of food in their mouth after swallowing food, then what is the impairment?

Answer 2

reduced buccal tone or reduced labial tone

Question 3

If a person’s voice sounds hoarse and they exhibit other signs of dysphagia, then what is the impairment?

Answer 3

There’s material on the true VFs

Question 4

If a person is a slow eater, then what is that indicative of?

Answer 4

increased oral transport time; pocketing of food may be occurring; damage to the glossopharyngeal nerve

Question 5

If a person is coughing before swallowing, then what is that indicative of?

Answer 5

early breakage of retro-oral seal due to premature spillage

Question 6

If a person is constantly wiping their chin, then what is that indicative of?

Answer 6

Reduced antero-oral seal

Question 7

If food is not going down a person’s throat, then what is that indicative of?

Answer 7

difficulty with triggering the pharyngeal swallow or absence of the pharyngeal swallow

Question 8

If food is stuck on the throat upon observation, then what is that indicative of?

Answer 8

residue on the posterior pharyngeal wall, vallecula, and pyriform sinuses

Question 9

If a person is only coughing, then what may that be indicative of?

Answer 9

aspiration or penetration

Question 10

If liquids exit a person’s nose, then what may that be indicative of?

Answer 10

VPI or nasal penetration

Question 11

What can etiologies of dysphagia be categorized under?

Answer 11

Neurological Disease: acquired or (stroke or TBI) and progressive/degenerative (e.g., ALS, HD, or PD)
Mechanical/structural factors (e.g., tumors, surgical complication, edema, xerostomia, and inflammation)

Question 12

Regarding neural control of swallowing, damage to the afferent pathway results in

Answer 12

neuropathy to CNs involved, such as CN V and CN IX, and subsequent deficits in functions performed by the CNs involved in swallowing.

Question 13

Regarding neural control of swallowing, damage to the brainstem results in

Answer 13

severe swallowing impairment

Question 14

Regarding neural control of swallowing, damage to the efferent pathway results in ________

Answer 14

Problems with executing movements; so, there may be a delay or absence of movement

Question 15

What degenerative diseases would impact the efferent pathway and subsequently the neural control of swallowing?

Answer 15

ALS and Myasthenia Gravis

Question 16

Regarding neural control of swallowing, damage to the subcortical and cortical inputs of swallowing results in __________

Answer 16

delay or issue with initiating the swallow or issue with coordination of muscles or issues with motor execution.

Question 17

What acquired diseases can impact the subcortical and cortical inputs of swallowing?

Answer 17

unilateral or bilateral anterior cortical CVA

Question 18

What degenerative diseases can impact the subcortical and cortical inputs of swallowing?

Answer 18

Parkinson’s Disease, dystonia, UMN disease

Question 19

What are examples of mechanical/structural factors that cause mechanical/structural dysphagia?

Answer 19

Surgery for oral, pharyngeal, laryngeal cancer (either removal or reconstruction); fibrosis due to radiation therapy for cancer; cervical spine disease; acute inflammation of the oropharyngeal tissues; obstruction from a tumor; pharyngoesophageal diverticulum; systemic disease (lupus, Crohn’s disease, rheumatoid arthritis)

Question 20

What is phagophobia?

Answer 20

fear of swallowing so there’s a refusal to eat; may be associated with a panic disorder or PTSD

Question 21

What is globus?

Answer 21

sensation of something stuck in your throat

Question 22

Regarding oral dysphagia, what drugs reduce the output of saliva?

Answer 22

anticholinergics, antidepressants, antispasmodics

Question 23

Regarding oral dysphagia, what drugs cause sedation?

Answer 23

anticholinergics, antidepressants, antipsychotics

Question 24

Regarding pharyngeal dysphagia, what drugs interfere with the dopaminergic systems?

Answer 24

antipsychotics: antidepressants, antianxiolytics, and mood stabilizers

Question 25

Regarding pharyngeal dysphagia, what drugs suppress brainsteam regulation?

Answer 25

benzodiazepines: used as sedatives, anticonvulsants

Question 26

Oropharyngeal dysphagia can stem from _________ and ___________ .

Answer 26

aspiration and penetration

Question 27

What do SLP do when working with individuals with dysphagia?

Answer 27

participate in management; screen patients (may not do so directly but help create the screening); conduct swallowing assessment; perform swallowing therapy; participate in instrumental swallowing assessment (FEES with ENT and VFSS with radiologist)

Question 28

What is a cricopharyngeal bar?

Answer 28

a prominence (i.e., something sticking out) of the cricopharyngeal muscle due to an issue with the timing or magnitude of UES relaxation, or unusual

Question 29

What is gastroesophageal reflux?

Answer 29

ingested material goes up from the stomach to the esophagus

Question 30

What is gastroesophageal reflux disease?

Answer 30

chronic symptoms or mucosal damage due to the reflux of gastric contents

Question 31

What are the common mechanisms of GER?

Answer 31

TLESR (Transient Lower Esophageal sphincter relaxation); hypotensive LES; hiatal hernia

Question 32

The dysphagia assessment model is a __________. Thus, what does an SLP do in dysphagia assessment?

Answer 32

team approach; SLP assesses factors related to the swallowing disorder, not diagnosing underlying disease

Question 33

What are the steps in a clinical/bedside assessment?

Answer 33

history —-> observations —– OME ——> Trial swallows

Question 34

Formal dysphagia screening procedures are associated with _______ and __________ .

Answer 34

increased adherence rater to actually performing dysphagia screens and decreased pneumonia risk (this is according to Hinchey et al., 2005

Question 35

What are the key features of a swallow screen?

Answer 35

quick, easy, and inexpensive; high sensitivity and specificity, with low numbers of false positives and false negatives

Question 36

What are the obvious goals of a clinical assessment?

Answer 36

determine if further tests are needed; determine the possibility of aspiration;gather information to help you determine possible etiology, obtain relevant health history; observe oral/pharyngeal/laryngeal sensorimotor and swallowing function

Question 37

What are the less obvious goals of a clinical assessment?

Answer 37

considering the patient’s posture; selecting best swallowing instructions (e.g., posture and strategies); determine risk of malnutrition, dehydraion, and aspiration pneumona; determine if they need additional nutritional support