Neurogenic Dysphagia Flashcards
Sudden or acquired Neurological conditions with at least partial recovery: (9)
1) CVA
2) TBI
3) Spinal cord injury
4) Anterior cervical fusion
5) Neurosurgery
6) Poliomyelitis
7) Guillain-Barré
8) CP
9) Dysautonomia (Riley-Day)
Degenerative conditions with gradual decline (10):
1) PD
2) ALS
3) MS
4) MG
5) MD
6) Alzheimer’s
7) Werdnig-Hoffman
8) Postpolio
9) Dystonia
10) Dermatomyositis
Other types of Neurological conditions (not sudden or degenerative):
1) RA
2) COPD
Neurologic Dysphagia S+S:
1) Decreased sensation to aspiration (SILENT)
2) Weak cough (if any)
3) Anosognosia (lack of awareness, deny they are having problems)
4) Cognitive probs
5) Language probs
6) Fatigue
Neurologic Evaluation of Swallowing: Comatose PT
3
1) 5 finger test (5-10 minutes) or sEMG
2) Stimulate pharyngeal swallow (stroke faucial pillars)
3) Videofluoro if able (99.9% not gonna happen)
Neurologic Evaluation of Swallowing: Noncomatose (Acute but good comprehension) PT:
3
1) Oral exam, oral mech
2) Bedside w/3cc (or 9oz for acue CVA) – minute amts
3) Videofluoro
If pt is intubated, wait _____ after extubation.
~1 wk
Sudden Neurologic Disorders
CVA-Medulla (lower brainstem)
Absent/weak pharyngeal swallow (1st wk post-stroke), severely delayed pharyngeal swallow (after 1st wk post), valleculae & U pyriform residues, reduced laryngeal excursion, reduced CP opening, U vf paresis
Sudden Neurologic Disorders
CVA-Pontine (high brainstem)
Pharyngeal hypertonicity, delayed/absent pharyngeal swallow, pharyngeal wall paresis/paralysis, reduced laryngeal elevation, cp dysfxn
Sudden Neurologic Disorders
CVA-Subcortical
Delayed oral transit time, delayed pharyngeal swallow, incoordination/ lack of neurom. control for pharyngeal swallow
Sudden Neurologic Disorders
CVA-Cerebral Cortex (L or R)
LEFT: apraxia (delayed oral, no tongue motion/fasciculations), delayed triggering of pharyngeal swallow
RIGHT: oral transit delay, pharyngeal delay, delayed laryngeal elevation
Sudden Neurologic Disorders
CVA-Multiple Strokes
Delayed oral, repetitive tongue mvmts, delayed triggering pharyngeal, reduced laryngeal elevation & closure, pharyngeal & pyriform residues on weak side
Sudden Neurologic Disorders
TBI (11)
1) Delayed/absent triggering of pharyngeal swallow
2) Reduced lip closure
3) Reduced tongue ROM
4) Poor bolus control
5) Abnormal oral reflexes
6) Reduced tongue base motion
7) Reduced vp closure -nasal regurgitation?
8) Reduced laryngeal elevation
9) Reduced laryngeal closure
10) Reduced cp opening
11) Unilateral or Bilateral pharyngeal wall paresis/paralysis
*Other issues: pt putting too much food in mouth, cognition, sensation
Sudden Neurologic Disorders:
Spinal Cord Injury (6)
1) Delayed triggering of pharyngeal swallow
2) Reduced laryngeal excursion
3) Reduced cp opening
4) Reduced tongue base motion
5) U or B pharyngeal wall dysfxn
6) Reduced airway closure (intubation/prolonged trach)
*May need a brace or a halo to stabilize while they heal
Sudden Neurologic Disorders:
Anterior Cervical Fusion (5)
1) U vf paralysis (reduced closure) –>due to damage to the RLN during the surgery
2) reduced laryngeal excursion
3) reduced cp opening
3) U or B pharyngeal wall dysfxn
4) oral dysfxn
5) delayed triggering of pharyngeal swallow
Sudden Neurologic Disorders:
Neurosurgery
Medulla (2)
1) Absent pharyngeal swallow
2) Tongue & tongue base “struggle”
Sudden Neurologic Disorders:
Neurosurgery
CN (cranial nerves?) (5)
1) U pharyngeal wall paresis/paralysis
2) U vf paralysis
3) U soft palate weakness
4) U tongue paresis
5) Delayed pharyngeal swallow
Sudden Neurologic Disorders:
Poliomyelitis (Polio)
1) Reduced lingual control
2) Reduced mastication
3) Reduced bolus propulsion by tongue
4) Reduced pharyngeal contraction
5) Reduced vp closure (nasal regurgitation)
6) U pharyngeal paralysis
Sudden Neurologic Disorders:
Guillain-Barré
1) Weak oropharyngeal swallow
2) Reduced tongue
3) tongue base
4) larynx ROM
Acquired Neurologic Disorders:
CP
1) Oral dysfunction (reduced lip closure, inappropriate oral reflexive behaviors, non-cohesive bolus, incoordinated tongue mvmts)
2) premature spillage
3) pharyngeal delay
4) reduced tongue base retraction
5) reduced laryngeal elevation, pharyngeal residue
Acquired Neurologic Disorders:
Dysautonomia (Riley-Day)
Tongue incoordination, reduced tongue base contraction, reduced pharyngeal wall contraction, delayed pharyngeal, LES dysfxn (reflux), reduced esophageal motility
Degenerative Neurologic Disorders:
PD
Tongue pumping or rolling, delayed pharyngeal swallow, reduced pharyngeal wall contraction, reduced tongue base motion, valleculae & pyriform residues (increasing w/ each swallow), reduced laryngeal elevation & closure (bowed vf’s), cp dysfxn, tremor
Degenerative Neurologic Disorders:
ALS
Corticobulbar tract
Reduced tongue mobility, tongue fsciculations, loss of bolus control, reduced lip closure, vp weakness, reduced laryngeal elevation
Corticospinal tract
Reduced velar mvmt, reduced pharyngeal wall contraction
Degenerative Neurologic Disorders:
MS (7)
1) Reduced lingual control
2) reduced chewing
3) delayed oral transit
4) reduced tongue base mvmt
5) reduced pharyngeal wall mvmt
6) reduced laryngeal fxn
7) delayed pharyngeal
Degenerative Neurologic Disorders:
MG (5)
1) Tongue weakness
2) velar weakness
3) lack of chewing
4) laryngeal dysfunction
5) progressive use reduction of pharyngeal contraction
Degenerative Neurologic Disorders:
MD (4)
1) Myotonic dystrophy
2) Prolonged contraction of cp & muscles of mastication
3) Oculopharyngeal dystrophy
4) Reduced pharyngeal contraction, cp dysfunction
Degenerative Neurologic Disorders:
Alzheimer’s (6)
1) Agnosia for food (continue to cue to keep chewing etc.)
2) feeding & swallowing apraxia
3) oral tactile agnosia
4) delayed oral & pharyngeal
5) pharyngeal weakness
6) reduced laryngeal elevation
Degenerative Neurologic Disorders:
Werdnig-Hoffman (pediatric motor neuron disease) (3)
1) Pharyngeal dysfxn (delayed pharyngeal swallow
2) severely reduced pharyngeal wall contraction
3) reduced laryngeal elevation
Degenerative Neurologic Disorders:
Postpolio (polio in 1950’s epidemic) (3)
1) Pharyngeal wall weakness
2) reduced tongue base retraction
3) reduced laryngeal elevation & closure
Degenerative Neurologic Disorders:
Dystonia (5)
1) Reduced labial seal
2) premature spillage
3) delayed oral transit
4) incoordinated lingual propulsion
5) usually normal pharyngeal swallow (besides the delay)
*mostly an oral issue
Degenerative Neurologic Disorders:
Dermatomyositis (DM) (2)
*skin condition tht can effect the muscles of swallowing
1) Reduced pharyngeal contraction
2) cp dysfxn
Other Disorders: Rheumatoid Arthritis (RA) (3)
1) Cricoarytenoid joint>reducing arytenoid mvmt (reduced glottic closure), airway residues
2) Cervical vertebrae>pharyngeal wall impingement
3) Temporomandibular joint>painful/reduced chewing
Other DIsorders:
Chronic Obstructive Pulmonary Disease (COPD) (2)
1) Airway closure problems
2) incoordination/weak respiration/dyspnea (wear, clavicular breathers, need help with deep breathing)
