Module 1 Flashcards
Dysphagia:
impairment in emotional, cognitive, sensory and/or motor acts transferring food from mouth to stomach
Swallowing disorder
Any difficulty swallowing
Difficulty moving food from mouth to stomach
“dysphagia”…. How do we say that?
Not to be confused with dysphasia
Childhood aphasia (developmental)
Aspiration:
anything going below the level of the VF (food, liquid, saliva)
FTT:
Failure to thrive not commuting enough nutritions for your body’s needs
Bolus:
latin for ball: anything we swallow
Regurgitation:
Spitting food back up
Odynophagia:
pain when swallowing
Stricture:
closing off of throat?
Alimentation:
how you eat and drink
PO:
Per oral
NPO:
Nothing per oral
Penetration:
Things stating to go the wrong way almost aspirated
Peristalsis:
How muscles contract to move things down
PNA:
Pneumonia
GERD:
Gastro-esphogeal reflux disease
Hypernatremia:
too much sodium and not enough water
Swallowing
is a response that triggers a sequence of muscle contractions that propels prepared food to the stomach
The mechanism of swallowing is a timed series of events.
Muscle contractions/relaxations must take place smoothly.
Swallowing requires:
large area of brain stem
—-sequence is preprogrammed by neural ——–circuitry in the brain stem called the “swallowing center”.
6 cranial nerves (paired= 1 for each side)
—–5,7,9,10,and 12
numerous receptors
——Sensory
——taste and the swallow trigger and cough reflex
31 pairs of muscles
—–face, mouth, pharynx, esophagus
Reflexive Swallow
swallowing can be reflexively evoked (involuntary swallowing)
Several regions of the brain can be stimulated and evoke a swallow that is not a part of voluntary deglutition
Swallowing occurs ~ 600 - 1000 times a day (one time a min)
»»most times during a meal
»»least while sleeping
We all probably aspirate some while we’re sleeping
That’s OK – we’re normal (hopefully)
.5 ml of saliva produced per minute in adults
Incidence
160,000 to 573,000 new cases of dysphagia each year caused by stroke.
25%-50% of stroke patients
Overall incidence? 6-10 million (ASHA)
13-14% of all patients hospitalized in major medical centers
30-35% of pts in rehab centers
up to 59% of pts in SNFs
Acute Care (ICU, step down unit, floor)
Shorter stay Medically involved, notable medical complications 13-33% prevalence within the hospital i.e. CVA, TBI, SCI, brain tumor patients Inpatient Rehab Setting usually a floor of a hospital Stable but still needing medical assistance Typical length of stay: 14-21 days 3 hours or more of tx per day ----1 speech ----1 occupation ----1 physical
Long-term Care/SNF
Can’t live independently
Can get discharged if they get better
Home health
You go to the patients house
Outpatient
You are in your clinic and they come to you
45min to 1hr 1-3 times per week
Who is on the dysphagia team?
SLP Must get referral from DR Pt/Family Dietician OT/PT Nurses CNAs MDs (i.e. primary care physician, GI, otolaryngologist, neurologist) Radiologist (swallow study) RT (respiratory therapy)
Neurologic disorders (most common)
caused by a change in the neurology of the brain
CVA: Stroke
Motor Neuron Diseases (ALS): changes in motor movement and function
Parkinson’s: motor and sensory component
Alzheimer’s/Dementia: cognitive change in function
MS: Coordination issue or feeling things in their mouth
Pulmonary complication (quick track to dying)
Choking episodes
Asphyxia: solid getting lodged
Laryngospasm: constriction in the larynx
Bronchospasm: a sudden constriction of the muscles in the walls of the bronchioles.
Chronic bronchitis
Aspiration pneumonia
Structural Impairments
Vertebre calcification
Extra bone forming, making area more ridged and bulky
Tumors
Traumatic injuries: broken jaw
Webs: Pieces of tissue connecting one side to the other that causes things to get stuck
Diverticulum
Cleft lip/palate
Micrognathia (Pierre-Robin syndrome)
Inflamation of the oral/pharyngeal/esophageal tract
Psychiatric
Bulimia related
This can lead to burning away the muscles of the larynx or pharynx
Psychogenic dysphagia
phagophobia: scared to swallow
maybe it hurts when they swallow
other causes of dysphagia
Infectious diseases
Muscular disorders
Iatrogenic: caused by treatment of diagnostic procedures
Normal Aging
Malnutrition
Inadequate dietary intake Involuntary weight change Decreasing functional status Dizziness Fatigue Decreased immune response
Dehydration
Dryness of lips Dryness or thickened oral secretions Sunken eyeballs Elevated temperature Hypotension: changes in blood pressure (lower) Decreased urine output and UTI Constipation Decreased cognitive status and confusion Nausea and vomiting Non-oral feeding Increased dependence, cost, and time consuming care.
Anatomic Structures of Swallowing
Oral Cavity
lips teeth hard/soft palate mandible uvula floor of mouth (FOM) tongue, base of tongue
Pharynx
Pharyngeal constrictor muscles Wavelike motion of muscles to move food down superior medial inferior
Vllecula
a wedge-shaped space formed between the BOT and epiglottis
Pyriform sinuses:
the space formed by the attachment of the fibers of the inferior pharyngeal constrictor to sides of thyroid cartilage
Pyriform sinuses & valleculae are the pharyngeal recesses into which food can fall and get trapped
Larynx:
Purpose is to keep things out of the lungs when you swallow Begins at the base of the tongue epiglottis aeryepiglottic folds laryngeal vestibule FVF TVF subglottic space
Esophagus
About 22 cm long
Flaccid collapsed tube (flat at rest/ closed)
Bounded by 2 tonically contracted spitter muscles
UES: about 1 inch long
LES: about 1.5 inches long
Cricopharyngeus muscle
UES, PE segment, CP segment
Most inferior structure of the pharynx
pyriform sinuses end here
valve at the top of the esophagus
designed to keep air from entering esophagus
prevents material from refluxing into pharynx
3 sections of the esophagus
- Cervical esophagus
runs from suprasternal notch to thoracic inlet - Thoracic esophagus
from inlet, around aortic notch to level of 8th thoracic vertebrae - Abdominal esophagus
mainly the LES
Layers
epithelium laminae propria muscularic mucosae Esophageal muscles ---inner circular ---outer longitudinal ---1/3 striated, 1/3 striated/smooth, 1/3 smooth
Feeding
is placement of food in the mouth through the oral stage of swallowing when food is propelled posteriorly.
Generally discussed when talking about newborns or infants
Therapy for feeding:
positioning of food
tongue manipulation excercises
chewing varying consistencies
organizing lingual peristalsis
Swallowing
involves all stages Therapy for swallowing stimulation of swallowing response improving pharyngeal transit of material airway protection strengthening swallowing musculature all feeding techniques
Gag
Noxious stimulus or motorically triggered
Gag is a reflex
Purpose of gag is to eliminate foreign substances anteriorly
Absent gag reflex with poor cough trigger= dysphasia
Volumes Swallowed
Varies with viscosity of food
Saliva: 1 ml Cup drinking: 20+ ml Pudding: 6 cos Thick paste: 5 cos Meat: 2 ccs
