Etiology of dysphagia and overview of assessment Flashcards
If a patient c/o food sticking to the roof of the mouth, then what is the impairment?
reduction of tongue to palate movement; reducted range of tongue motion
If a patient has remnants of food in their mouth after swallowing food, then what is the impairment?
reduced buccal tone or reduced labial tone
If a person’s voice sounds hoarse and they exhibit other signs of dysphagia, then what is the impairment?
There’s material on the true VFs
If a person is a slow eater, then what is that indicative of?
increased oral transport time; pocketing of food may be occurring; damage to the glossopharyngeal nerve
If a person is coughing before swallowing, then what is that indicative of?
early breakage of retro-oral seal due to premature spillage
If a person is constantly wiping their chin, then what is that indicative of?
Reduced antero-oral seal
If food is not going down a person’s throat, then what is that indicative of?
difficulty with triggering the pharyngeal swallow or absence of the pharyngeal swallow
If food is stuck on the throat upon observation, then what is that indicative of?
residue on the posterior pharyngeal wall, vallecula, and pyriform sinuses
If a person is only coughing, then what may that be indicative of?
aspiration or penetration
If liquids exit a person’s nose, then what may that be indicative of?
VPI or nasal penetration
What can etiologies of dysphagia be categorized under?
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)
Regarding neural control of swallowing, damage to the afferent pathway results in
neuropathy to CNs involved, such as CN V and CN IX, and subsequent deficits in functions performed by the CNs involved in swallowing.
Regarding neural control of swallowing, damage to the brainstem results in
severe swallowing impairment
Regarding neural control of swallowing, damage to the efferent pathway results in ________
Problems with executing movements; so, there may be a delay or absence of movement
What degenerative diseases would impact the efferent pathway and subsequently the neural control of swallowing?
ALS and Myasthenia Gravis
Regarding neural control of swallowing, damage to the subcortical and cortical inputs of swallowing results in __________
delay or issue with initiating the swallow or issue with coordination of muscles or issues with motor execution.
What acquired diseases can impact the subcortical and cortical inputs of swallowing?
unilateral or bilateral anterior cortical CVA
What degenerative diseases can impact the subcortical and cortical inputs of swallowing?
Parkinson’s Disease, dystonia, UMN disease
What are examples of mechanical/structural factors that cause mechanical/structural dysphagia?
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)
What is phagophobia?
fear of swallowing so there’s a refusal to eat; may be associated with a panic disorder or PTSD
What is globus?
sensation of something stuck in your throat
Regarding oral dysphagia, what drugs reduce the output of saliva?
anticholinergics, antidepressants, antispasmodics
Regarding oral dysphagia, what drugs cause sedation?
anticholinergics, antidepressants, antipsychotics
Regarding pharyngeal dysphagia, what drugs interfere with the dopaminergic systems?
antipsychotics: antidepressants, antianxiolytics, and mood stabilizers
Regarding pharyngeal dysphagia, what drugs suppress brainsteam regulation?
benzodiazepines: used as sedatives, anticonvulsants
Oropharyngeal dysphagia can stem from _________ and ___________ .
aspiration and penetration
What do SLP do when working with individuals with dysphagia?
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)
What is a cricopharyngeal bar?
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
What is gastroesophageal reflux?
ingested material goes up from the stomach to the esophagus
What is gastroesophageal reflux disease?
chronic symptoms or mucosal damage due to the reflux of gastric contents
What are the common mechanisms of GER?
TLESR (Transient Lower Esophageal sphincter relaxation); hypotensive LES; hiatal hernia
The dysphagia assessment model is a __________. Thus, what does an SLP do in dysphagia assessment?
team approach; SLP assesses factors related to the swallowing disorder, not diagnosing underlying disease
What are the steps in a clinical/bedside assessment?
history —-> observations —– OME ——> Trial swallows
Formal dysphagia screening procedures are associated with _______ and __________ .
increased adherence rater to actually performing dysphagia screens and decreased pneumonia risk (this is according to Hinchey et al., 2005
What are the key features of a swallow screen?
quick, easy, and inexpensive; high sensitivity and specificity, with low numbers of false positives and false negatives
What are the obvious goals of a clinical assessment?
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
What are the less obvious goals of a clinical assessment?
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
