Lecture One

Question 1

FUN FACTS ABOUT SWALLOWING!

Answer 1

Swallowing frequency:
* The average frequency of swallowing is approximately 580 swallows
daily (Logemann, 1998).
* A swallow is elicited once every minute.
* Complex, coordinated, perfectly timed & frequent.

Question 2

NORMAL SWALLOWING

Answer 2

• Rapid & overlapping sequence of movements involving muscles of oral cavity, pharynx,
  larynx, esophagus, and stomach (Murray et al. 2022, p.2)
• Everyone will experience an “abnormal” swallow at some point in life…but resolved
  quickly with cough or throat clea

Question 3

ABNORMAL SWALLOWING

Answer 3

• Abnormal swallowing includes difficulty with swallowing (dysphagia) or total inability to swallow
  (aphagia).
• Dysphagia is a swallowing disorder may occur as a result of various medical conditions.
• Dysphagia is defined as problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.
• *Not a primary medical diagnosis but rather a symptom of underlying disease

Question 4

INCIDENCE & PREVALENCE

Answer 4

• Annually in the U.S., 300,000 to 600,000 people are diagnosed with significant
  dysphagia (US Dept. Of Health & Human Services, 1999).
• 70% of these patients are older than 60 years of age.
• Dysphagia is more common among older individuals (Barczi, Sullivan, & Robbins, 2000; Cabré et al., 2014; Roden & Altman, 2013; Sura, Madhavan, Carnaby, & Crary, 2012).
• Prevalence is highest in individuals with neurologic disease (Groher & Crary, 2010).

Question 5

POSSIBLE CONSEQUENCES OF DYSPHAGIA

Answer 5

• Malnutrition and dehydration
• Weight loss
• Aspiration pneumonia
• Compromised general health
• Chronic lung disease
• Choking
• Death

Question 6

Adults with dysphagia may also experience:

Answer 6

• disinterest and/or less enjoyment of eating or drinking
  *Unexplained weight loss
  *Recurrent pneumonia
• embarrassment or isolation in social situations involving eating
• Dysphagia may increase caregiver burden and may require significant lifestyle alterations for the patient and the patient’s family

Question 7

Functional Limitations

Answer 7

• Limits on types of food patient can safely swallow
• Limited to a specific diet of foods they do not like/want
• Time required to finish a meal may take longer
• Oral structures may limit types of food able to swallow
• Some foods may cause patient to choke

Question 8

Activity & Participation

Answer 8

• Patients on nonoral or restricted diets may be reluctant to attend events
  where food is served
• Foods related to culture or religion may not be available to patient
• Ability to hold/use straw or utensils may limit eating/drinking
• Ability to eat in group setting may limit activities
• Ability to prepare meals may reduce food intake

Question 9

Environmental Factors

Answer 9

• Proper eating arrangements may be limited due to room spaces
• Eating in public may present unwanted attention
• Use of personal care providers may be needed during mealtimes
• Ability to prepare food may be limited

Question 10

CONDITIONS THAT MAY CONTRIBUTE TO
DYSPHAGIA

Answer 10

Neurological Diagnoses:
*Stroke
* TBI
* Dementia
* Motor Neuron Disease
* GBS, CP, Myasthenia Gravis
* Age related changes
* Progressive Diseases:
* Parkinson’s; Huntington’s, Progressive Supranuclear Palsy (PSP)

Structural Diagnoses:
* Any tumor involving the alimentary tract

Question 11

CONDITIONS THAT MAY CONTRIBUTE TO
DYSPHAGIA (CONTINUED)

Answer 11

Connective Tissue/Rheumatoid Disorders:
* Scleroderma
* Polymyositis
* Sjogren’s Disease

Iatrogenic Diagnoses:
* Radiation/Chemotherapy
* Intubation/Tracheostomy
* Cervical Spinal Fusion
* Medication-related

Other or Related Diagnoses:
* Severe respiratory compromise
* Psychogenic conditions

Question 12

TEAM APPROACH TO DYSPHAGIA MANAGEMENT

Answer 12

• Potentially involve many members of the medical team
• SLP- lead role in management related to impaired oral/pharyngeal mechanics; coordinator of swallow team
• Primary physician/Nurses
  *OT/PT
• Otolaryngologist Pulmonologist
• Gastroenterologist Dietician
• Neurologist Dentist
• Radiologist Respiratory Therapist
• Pharmacists

Question 13

Deglutition

Answer 13

The act of swallowing; the passage of food from mouth to stomach.

Question 14

Penetration

Answer 14

Food/water going into the larynx but not below the vocal cords.

Question 15

Aspiration

Answer 15

Food/water going below the vocal cords.

Question 16

Residue

Answer 16

Left over food/water in the vallecula/ pyriform sinuses