Lecture 4: Abnormal Swallowing (2) : Aetiology & conditions; MDT

Question 1

What is neurological dysphagia?

Answer 1

Neurological dysphagia results from impairment of the SENSORIMOTOR CONTROL of the oral and/or pharyngeal stages of swallowing

Question 2

What are some examples of neurological causes of dysphagia? (8)

Answer 2

1) Unilateral cortical stroke
2) Brain stem stroke
3) Dementia
4) Parkinson’s Disease
5) MND
6) Huntington’s Disease
7) Myasthenia Gravis
8) TBI

Question 3

Stroke & Dysphagia

Answer 3

• 37-78% of dysphagia post stroke
• Brainstem lesions more strongly linked with dysphagia than hemispheric stroke
• Presence of dysphagia is a significant predictor of death at 30 days post stroke
• Associated with increased risk of pneumonia

Question 4

Predictors of prolonged dysphagia following cortical stroke

Answer 4

• Lesions anywhere in the motor pathways controlling swallowing may lead to dysphagia
• When primary motor cortex is involved dysphagia is more likely to persist
• Lesions affecting the insular can also be more severe & prolonged in nature
• Some evidence for LH dominance for swallowing & more severe dysphagia following left frontal cortical stroke

Question 5

What is a Lateral Medullary Stroke?

Answer 5

AKA Wallenberg’s Syndrome is a neurological disorder characterised by dysphagia & dysphonia.

Commonly caused by occlusion of the posterior inferior cerebral artery or one of its branches supplying the lower part of the brain stem.

Often is partial involvement of the cranial nerves IX, X & XI = impairment to the pharyngeal stage of swallow

Question 6

What is MND

Answer 6

MND is a Progressive neurological disease of unknown aetiology.
􏰀- Attacks brain & spinal cord nerve cells (UMN & LMN to varying degrees).
- Loss of LMNs causes respective muscles to atrophy & weaken resulting in paralysis.
- Patterns of dysphagia depend on the location of degenerative changes.

Question 7

What is structural dysphagia

Answer 7

When dysphagia results from structural changes to the anatomy and physiology of the aerodigestive tract.

Question 8

Head & Neck cancer and dysphagia

Answer 8

• Is the most common cause of structural dysphagia
• Surgical resection for cancer located in the head & neck region results in specific deficits consistent with the anatomical / neurological alteration.
• Prognosis is dependent

Question 9

What is an Iatrogenic Cause of dysphagia

Answer 9

Radiation therapy and Chemoradiation- Damage to tissues & muscle weakness and stiffness

Question 10

What are the four main effects medication can have on swallowing function

Answer 10

1) Depress the CNS
2) Tardive Dyskinesia - involuntary orofacial movements
3) Impact the oesophageal function
4) Affect the salivary flow

Question 11

What are the characteristics of an aged swallow?

Answer 11

• Decreased muscle strength and speed
  􏰀- Alterations in sensation
  􏰀- Reduced respiratory capacity and elasticity of the lungs