Lecture 3 – Abnormal Swallowing (1) : Signs & Symptoms

Question 1

Name some symptoms of dysphagia

Answer 1

􏰂- Drooling or anterior spillage of food / drink
􏰂- Pocketing in the cheek, oral residue or oral scatter
􏰂- Prolonged oral phase or preparation time
􏰂- Nasal regurgitation
- Multiple swallows or effortful swallow to clear
- Delayed swallow or difficulty initiating swallow
- Coughing on saliva
- Choking or coughing while eating or drinking
- Wet or moist voice after swallowing
- Absent or weak cough

Question 2

Name 3 medical consequences of dysphagia

Answer 2

• Aspiration
• Coughing
• Choking or asphyxiation

Question 3

Name 3 nutritional consequences of dysphagia

Answer 3

• Weight loss/anorexia
• Vitamin/ mineral deficiencies
• Dehydration

Question 4

Name 3 psychosocial consequences of dysphagia

Answer 4

• Depression
• Social isolation
• Reduced QoL

Question 5

What is aspiration?

Answer 5

The entry of secretions, food or any foreign material into the airway that passes below the level of the true vocal folds.

Question 6

3 clinical signs of aspiration

Answer 6

• Wet voice
• Coughing
• Low oxygen saturation

Question 7

Penetration vs Aspiration

Answer 7

Material that enters the airway but does not extend beyond the true vocal cords is ‘penetration’

Question 8

Name some factors that can influence whether aspiration leads to pneumonia

Answer 8

• Volume of aspirated material
• Toxicity / nature of aspirated material 􏰂 ph of aspirated material
• Mobility of patient
• Health and immunity of patient
• State of patient’s lungs

Question 9

Name some risk factors for aspiration pneumonia

Answer 9

• Medical / Health status (e.g. heart disease, GI disease, respiratory disease)
• Use of multiple medications (particularly sedatives)
• Poor oral hygiene / number of decayed teeth
  􏰂- Dependent for oral care
• Feeding dependence
  􏰄-􏰂 Bedbound state
  􏰂- Use of suctioning
  -􏰂 Smoking
  􏰂- Feeding tube insitu
  -􏰂 Prior history of aspiration pneumonia
  -􏰂 Neck hyperextension when eating / drinking
  -􏰂 Dysphagia

Question 10

Label non-physiological factors that can further compromise swallow safety & function and can increase risk of aspiration

Answer 10

• Attention/alertness
• Fatigue
• Behavioural problems
• Postural problems
• Upper limb mobility
• Environmental factors/ distraction
• Available support

Question 11

What is Dementia?

Answer 11

Chronic progressive disorder that is associated with dysphagia.

Question 12

What are the dysphagia symptoms of dementia?

Answer 12

• May present with agnosia for food – giving little reason to swallow the food or drink in their mouth.
• Significant delays in oral preparation & delays between swallows may be encountered (e.g. 3-4 minutes to initiate a swallow) – long & slow meal times. 􏰂
• See reduced hyolaryngeal excursion & inefficient pharyngeal clearance.
• Leads to significant nutritional & hydrational concerns.

Question 13

What is Parkinson’s Disease?

Answer 13

• Parkinson’s is a neurodegenerative disease affecting dopaminergic neurons of the extrapyramidal system.
• Disturbance of the control of movement and posture
• Abnormalities of cognition & mood
• Disturbance of the autonomic nervous system

Question 14

What are the dysphagia (oral stage) symptoms of Parkinson’s Disease?

Answer 14

• Poor oral stage function is a defining feature.
• Impairment in mastication & oral preparation are the most common presentations of dysphagia in PD.
• Bradykinesia reduces tongue movement & oral mobility 􏰅 piecemeal deglutition, tongue pumping, oral residue & premature spillage into the pharynx (poor bolus control & misdirection, with overall slowness).
• Drooling & pooling of saliva in the oral cavity.

Question 15

What are the dysphagia (pharyngeal) symptoms of Parkinson’s Disease?

Answer 15

• Delay in swallowing reflex / initiation.
• Reduced pharyngeal motility may cause pharyngeal residue.
• Aspiration not an early feature of the disease; however, silent aspiration is a concern.