Neurologically Impaired Patients

Question 1

What type of swallowing issue will most stoke patients experience?

Answer 1

Paryngeal sensory issues

Question 2

Describe the oral phase of patients with lower brainstem/medulla strokes:

Answer 2

Their oral phase can be normal; Sometimes, right after their stroke, the pharyngeal swallow might absent, then as the patient begins to heal it becomes just delayed. These patients typically improve over time.

Question 3

Describe a CP myotomy:

Answer 3

This is when they remove the muscles of the CP. It is very common in stroke population, especially when this is the only swallowing issue they experience.

Question 4

Describe the possible swallowing impairments for upper brainstem/pontine stroke patients:

Answer 4

They can have various oral and pharyngeal deficits including delayed, absent, or spastic. They typically have reduced laryngeal elevation and often have severe CP dysfunction. Sensory stimulation works well with these patients because they have multiple sensory issues.

Question 5

Describe the possible swallowing impairments for subcortical stroke patients:

Answer 5

Their issues can be motor and sensory. They usually have mild delays in oral transit & pharyngeal swallow trigger. Sometimes you will see aspiration before the swallow due to delayed swallow.

Question 6

Where might you see a lesion for someone experiencing swallow apraxia?

Answer 6

Anterior left hemisphere (think about apraxia of speech)

Question 7

List some swallowing issues seen in left hemisphere strokes:

Answer 7

Mild delays in oral transit time

Mild delays in pharyngeal swallow time

Question 8

List some swallowing issues seen in right hemisphere strokes:

Answer 8

Mild delays in oral transit time
Mild delays in pharyngeal swallow trigger
Delayed laryngeal elevation
Aspiration before or during the swallow

Question 9

Swallowing impairments in patients with Alzheimer’s:

Answer 9

food agnosia
apraxia
oral tactile agnosia
physiological swallow impairments

Question 10

Should you do exercises with patients diagnosed with ALS?

Answer 10

No, because it is too fatiguing for them and will do more harm since their disease is degenerative.

Question 11

Describe the swallowing impairments for patients diagnosed with Parkinson’s Disease:

Answer 11

It is difficult for them to transition to subsequent phases during swallowing. They usually have delayed oral prep phase time because it’s hard for them to stop chewing and move on to the next step.