Neurogenic Swallowing Disorders

Question 1

What is the most common cause of neurogenic disorder that results in Dysphagia?

Answer 1

Stroke

Question 2

With respect to swallowing, what would we see if someone had a stroke in their frontal lobe? (1)

Answer 2

Pre-swallow pooling (lack of swallow initiation)

Question 3

What might we see if there is a lesion to the cerebellum?

Answer 3

Motor issues

Question 4

What causes flaccidity?

Answer 4

LMN lesions

Question 5

What nerve damage causes spasticity?

Answer 5

Bilateral UNN damage

Question 6

What would a unilateral UMN lesion cause?

Answer 6

Problems with the lower half of the face.

Question 7

List the swallowing impairments seen in patients with Multiple Sclerosis. (7)

Answer 7

*Mostly motor impairments:

1) oral motor issues
2) reduced velopharyngeal seal
3) BOT to PPW approx
4) epiglottic deflection
5) hyolaryngeal excursion
6) pharyngeal constriction
7) UES opening

*Some sensory impairments depending on nerve affected.

Question 8

List the swallowing impairments in a patient with myasthenia gravis (2)

Answer 8

*LMN disease

1) flaccidity in specific motor movements.
2) general fatigue of muscles

Question 9

Parkinson’s Disease

Affects on swallowing (11)

Answer 9

• Movement disorder (voluntary & autonomic) causes by the degeneration of dopamine neurons in the substantia nigra in the subcortical region.
• Cognitive & mood also affected
• Symptoms include:
  1) Resting tremor
  2) Rigidity (stiffness)
  3) Bradykinesia = slowness of movement —> Hyokinetic Dysarthria
  4) Postural impairments - affects coordination & balance
• Swallowing deficits include: [oral & pharyngeal]
  1) Poor lip closure
  2) Lingual tremor
  3) Repetitive lingual pumping*
  4) Drooling
  5) Oral residue
  6) Piecemeal deglutition
  7) Poor velopharyngeal seal
  8) Delayed swallow initiation/reflex
  9) Vallecular & pyriform residue*
  10) Penetration/Aspiration - silent aspiration is a concern
  11) Reduced hyolaryngeal excursion

Question 10

What is the Prognosis of Dysphagia in patients with PD?

Answer 10

PD is a progressive disease and therefore —> ability to swallow worsens over time.