Neurogenic Dysphagia

Question 1

Causes of Neurogenic Dysphagia:

...
-P
-H
-H
-M
-A
-G
-A
B
-B
-M
-N

Answer 1

cerebrovascular accident/stroke

parkinson’s disease

huntington’s

head injury/TBI

Multiple Sclerosis

amyotrophic lateral sclerosis/ALS/ Lou Gherig

guillan barre syndrome

alzheimers

brain tumors

bulbar /pseudobulbar palsy

myasthenia gravis

neurotoxins

Question 2

Sources:

-

-

Answer 2

Brain/CNS
-cerebral cortex/cortical motor areas
-midbrain/basal ganglia
-corticobulbar tract 
-brainstem 
cerebellum 
-medulla 

meninges

• PNS/cranial nerves
• disease vs acute insult ?

Question 3

CVA/stroke

Answer 3

hemorrhagic

ischemic

Question 4

Site of lesion: 
-
-
-
-

Answer 4

cerebral cortex

subcortical (basal ganglia, thalamus, cerebllum)

higher brainstem/pons

lower brainstem/medulla

Question 5

Sequelae:

dependent on ?

Answer 5

site and extent of lesion

Question 6

sequelae:
-h
-oral
-….. coordination
-…impairments
-…. timing
-reduced
-reduced
…..disturbances

Answer 6

hemiparesis

oral acceptance

lingual/labial/velum strength

sensory impairments (including reactive/non-reactive aspiration)

pharyngeal swallow timing

reduced contraction

reduced laryngeal excursion

cognitive disturbances

Question 7

Brain Injury: 
often very complex with considerations including: 
-severity of 
-... injury 
-... trauma 
-type of ? 

limited ?

often dysphagia is

can be

Answer 7

• damage
• open or closed injury (meninges/intraparenchymal)
• multi-system trauma
• type of force causing damage

evidence to assist in predictive outcomes

secondary

• respiratory status
• behavioral issues
• impulsivity

difficult to plan treatment

Question 8

Treatment/Considerations: 
most often ? 
-
-
-

-
-

-
-ability to actively ?

Answer 8

adaptive in nature during most acute phases

• positioning
• assistance, orthopedic injuries
• diet modifications
• strengthening
• sensory
• presence of partial/total nerve damage

supervision
impulsivity
ability to actively participate in compensations/exercises (family particiaption)

Question 9

Multiple Sclerosis: 
-
-immune? 
-...disease
-not ? but ? 
-near ? will exhibit dysphagia

Answer 9

demyelination

• immune-mediated disorder
• inflammatory disease
• not hereditary but genetics can impact
• 30%

Question 10

Sequelae of MS: 
dependent on ? 
-
-
-
-

oral?
pharyngeal ?

Answer 10

site of lesions

• brainstem
• cerebellum
• corticospinal tracts
• cranial nerves

oral dysphagia (motor)

pharyngeal dysphagia (sensory/constriction/delay)

Question 11

Classifications of MS: 
-
-
-
-

Answer 11

progressive-relapsing

secondary progressive

primary progressive

relapsing -remitting

Question 12

Treatment/considerations MS;
medical

• E
• P
• T
• M
• Supplemental

Answer 12

medical management

education (insight)

positioning

thermal/tactile stimulation

maneuvers (supraglottic,cough, etc)

supplemental/non-oral nutrition

Question 13

Parkinsons's disease: 
degenerative disorder of the ?
cell death in the ? 
reduction in> 
-
-
-
-
-
63-81% of patients will experience

Answer 13

CNS 
substantia nigra (part of the midbrain and basal ganglia) 

dopamine

• neurotransmitter
• movement disorder
• difficulty initiating /slowed movements
• tremors
• cognition, mood, behavior

dysphagia

Question 14

Sequelae of PD: 
oral movement ? 
-
-
-

-
-

-

Answer 14

deficits

• tremors
• bolus formation/containment
• tongue rocking/pumping

pharyngeal deficits:

• some delay
• reduced pharyngeal wall contraction
• reduced laryngeal excursion
• dementia
• rigidity

Question 15

Huntington's disease: 
... disease
-... dominant mutation 
-mutation causes? 
-excessive ? 
-life expectancy: 
pneumonia is the primary cause of ?

Answer 15

neurogenic genetic disorder

autosomal dominant mutation

gradual damage

involuntary movements

20 years post Dx

death in patients with HD

Question 16

Sequelae Huntingtons:
involuntary

-
-
difficulty ? 
deceased? 
decreased? 
delayed ? 
uncoordinated ?

Answer 16

movements

• rigidity
• chorea (writhing/rhythmic motions)
• difficulty self feeding
• decreased bolus control
• decreased effective mastication
• delayed pharyngeal swallow onset
• uncoordinated oropharyngeal swallow

Question 17

ALS 
form of? 
-no 
-both ? 
-....
-...
-intact 
-... effect 
-ever-decreasing: 
-all patients will exhibit

Answer 17

motor neuron disease (MND)

no known cause

upper and lower motor neurons that control voluntary movement (may attack any at first)

progressive

fatal

intact cognition

pseudobulbar affect (40-45%)

respiratory function

dysphagia at some point

Question 18

Sequelae ALS: 
... involvement 
-reduced
-decreased ? 
-decreasing ability to ? 
-reduced? 
.... involvement 
-later developments: 
1. reduced
2. reduced
3. reduced
4. delayed

Answer 18

corticobulbar/corticospinal tract involvement

tongue mobility

bolus formation/intraoral pressures

orally handle more viscous liquids/foods

labial seal/drooling

velopharyngeal port involvement

BOT
pharyngeal contraction
airway protection
pharyngeal swallow initiation

Question 19

Myasthenia Gravis: 
autoimmune: 
antibodies ? 
decrease function of 
easily 
.../....
normal  ?

Answer 19

neuromuscular disease
block post-synpatic receptors from accepting acetylcholine 
nAChR
fatigued musculature 
remissions/exacerbations 
life expectancy (in length)

Question 20

Sequelae MA: 
dysphagia is often ? 
-often 
-flaccid 
-hyper
-... symptoms (...,...,...) 
-... muscles ? 
oral dysphagia is usually ? 
reduced? 
delayed ?
decreased?

Answer 20

sentinel presentation

• silent
• dysarthria
• hypernasality
• bulbar symptoms (pons,cerebellum, medulla)
• striated muscles: lips, mandible, tongue, velum, hypopharynx
• pharyngeal contraction
• pharyngeal swallow
• BOT retraction

Question 21

Important considerations: 
these pts may appear less ? 
-.. is primary concern 
-.... status 
-collab with ? 
-generally higher risk for ?

Answer 21

effected under a 2-3 min MBS/VFSS/FEES -sensitive eval

• fatigue
• respiratory status
• physicians
• aspiration pneumonia than persons after a stroke