Intro to Dysphagia PPT 1 Flashcards
What is dysphagia?
Difficulty swallowing and/or difficulty moving bolus from the mouth to the stomach
T/F Dysphagia only affects adults
False; Not age-specific (newborn-elderly)
What are the etiologies for dysphagia?
Infection
Structural malformations
Surgery (thyroid/RLN/cervical)
Conditions that weaken/damage muscles/nerves (CVA, PD, TBI)
T/F Dysphagia is always secondary to something else
True!
Name 4 consequences of dysphagia
Dehydration
Malnutrition
Aspiration pneumonia
Quality of life
Name the types of dysphagia
Oral
Pharyngeal
Oropharyngeal
Esophageal
Oral dysphagia can result in difficulties with (4 things)
Tongue movement
Lip closure
Pocketing
Transport
Pharyngeal dysphagia can result in difficulties with (4 things)
Airway closure
Residues (stasis)
Motility
UES
Esophageal dysphagia can result in difficulties with (5 things)
Motility LES Fistula Diverticulum HCI-reflux; ulcer
What are the stages of swallowing?
Oral Prep/Oral Stage
Pharyngeal Stage
Esophageal Stage
How long is the oral stage of swallowing?
Time varies with bolus consistency
Describe the oral stage of swallowing.
Involves labial movement, lingual movement, sensory receptors, buccal muscle, and nose breathing.
Mastication of food occurs with rotary lateral movement of jaw and tongue.
Bolus is formed when tongue mixes food/drink with saliva.
The bolus is then transported from the oral cavity to the pharynx through the tongue’s posterior movement of the bolus.
When the bolus head reaches the faucial pillars is when the pharyngeal stage is ready.
With INCREASED viscosity= ? volume, ? pressure, and ? muscle activity.
DECREASED volume, INCREASED pressure, and INCREASED muscle activity.
How long is the pharyngeal stage of swallowing?
~ 1 second
Describe the pharyngeal stage of swallowing
Velum elevates & retracts for VP closure
Bolus transport occurs with tongue base retraction and pharyngeal wall constriction
Epiglottis inverts over the laryngeal vestibule
Larynx and hyoid bone are pulled anteriorly and superiorly to open the pharynx, relax (open) the cricopharyngeus (UES) muscle, and assist the vocal folds in closing off the glottis
Bolus is propelled through the pharynx toward the esophagus by action of pharyngeal constrictors
CP closes, larynx rests.
When the UES closes, the esophageal stage begins.
What is a delayed pharyngeal swallow?
If pharyngeal stage not triggered when bolus head passes between faucial arches and tongue base
Describe the esophageal stage of swallowing
Bolus flow through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall
Relaxation of LES allows bolus to flow into the stomach
How long does the esophageal stage last and how is it measured?
8-20 seconds
~ 10 seconds
Transit time is measured from UES through LES
What are the signs and symptoms of oral or pharyngeal dysphagia?
Coughing or choking with swallowing Difficulty initiating swallowing Food sticking in the throat Sialorrhea/xerostomia Drooling or spillage Unexplained weight loss Change in dietary habits Penetration Aspiration Recurrent pneumonia Change in voice or speech (wet voice) Nasal regurgitation Wet, gurgly voice quality
What are the signs and symptoms of esophageal dysphagia?
Sensation of food sticking in the chest or throat Oral or pharyngeal regurgitation Change in dietary habits Recurrent pneumonia Reflux Aspiration
What is an esophageal stricture?
Narrowing of the esophagus
What are the signs and symptoms of silent aspiration?
NO SIGNS OR SYMPTOMS
Possible signs may include: tearing and/or runny nose
What is the difference between feeding and swallowing?
Feeding: placement of food in the mouth before initiation of swallow (oral prep stage; salivation, presentation)
Swallowing: transfer of food/drink from mouth to stomach (oral, pharyngeal, and esophageal stage)
What is a swallow screening?
A 10-15 minute administration/observation of a small bolus
What does the swallow screening consist of?
Bedside clinical assessment
Signs and symptoms
Pre-diagnostic
T/F The A&P can be assessed in a swallow screening
FALSE; A&P cannot be assessed
What are the components of the bedside clinical assessment?
Medical history Level of alertness Pt Interview Oral motor exam Assess swallow with small bolus
What signs and symptoms do you look for in the swallow screening?
Spillage? Oral residue? Long transit time? Cough? Throat clear? Gurgly voice? Tearing? Runny nose? Wrong sound (stethoscope)?
T/F the swallow screening is a pre-diagnostic.
TRUE; the swallow screen is a pre-diagnostic.
What does the diagnostic procedure do? (3 things)
- ID symptoms to explain abnormalities in anatomy or physiology causing dysphagia (etiology)
- Examines Physiology (timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity
- Examines immediate effects of tx’s
Name the 5 diagnostic procedures involving imaging.
- FEES/FEESST
- Videofluroscopy
- Ultrasound
- Videoendoscopy
- Scintography
Name the 4 diagnostic procedures that do not involve imaging (non-imaging).
- EMG
- EGG
- Acoustic (accelerometer or stethoscope)
- Pharyngeal manometry
What are the 8 treatments for dysphagia listed in the first PPT?
- Diet modification (volume, viscosity, texture, temperature, NPO diet-NG tube, G tube, PEG, J tube, TPN)
- Compensatory (Positional: posture, chin tuck, head rotation; Multiple swallows)
- Maneuver (Supraglottic, Super-supraglottic, Mendelsohn, Effortful)
- Exercise (Shaker, Masako, oral muscle strengthening)
- Stimulation (Thermal/Tactile Stim)
- Experimental (Neuromuscular electrical stimulation [NMES: VitalStim], Deep Pharyngeal Neuromuscular Stimulation [DPNS], Myofascial release [MFR], Botox)
- Prosthetic (Palatal lift or obturator)
- Surgery (CP myotomy, diverticulectomy, dilation)
Who is part of the multidisciplinary team?
SLP Physician/Neurologist/ENT Nursing Dietician OT PT Radiologist Pharmacist Social worker Psychologist
