Overview and intro to swallowing

Question 1

Swallowing/Deglutition

Answer 1

All processes, functions and acts associated with introduc0on of food/material to be swallowed, including preparing, transferring, and transporting to stomach

Question 2

Bolus

Answer 2

Food, liquid, or material placed in mouth for inges0on

Question 3

Dysphagia

Answer 3

The result of a physiologic change in the muscles needed for swallowing
• Delay in the propulsion of a bolus as it transits from the
mouth to the stomach
• Misdirection of a bolus

Question 4

Signs of Dysphagia

Answer 4

A swallowing disorder that may involve signs and symptoms of mouth, pharynx, larynx, or/and esophagus

Question 5

Feeding Disorder

Answer 5

Impairment in the process of food transport outside the

alimentary system

Question 6

Reason for feeding disorder

Answer 6

Weakness or incoordination in hands/arms
• Children failing to develop or demonstrate developmentally
appropriate eating/drinking behaviors

Question 7

Aspiration

Answer 7

Entry of secretions, food or any foreign objects into airway below the level of the true vocal folds
• Aspiration pneumonia

Question 8

Penetration

Answer 8

Entry of bolus into laryngeal vestibule, above the level of the true vocal folds, which are then ejected from the airway

Question 9

How common are swallowing problems?

Answer 9

47% of all SLPs report regular service to dysphagic patients
• 91% of SLPs working in hospitals and residential health care seangs report regular service to dysphagic patients

Question 10

What adult populations are affected?

Answer 10

Stroke, head injury, progressive neurological diseases (e.g., ALS, Parkinson’s), Alzheimer’s, head and neck cancers, tracheostomy, vocal fold dysfunction (paralysis/paresis)
• Aging: Individuals 85 and older were 18 times more likely to have a diagnosis of dysphagia compared to those under age 25

Question 11

What children populations are affected?

Answer 11

Prematurity/low birth weight, cerebral palsy, craniofacial anomalies, failure to thrive/pediatric undernutrition, developmental disability
• Estimated that 85-90% of children with CP have swallowing disorder at some point

Question 12

Health risks of swallowing disorder

Answer 12

– Aspiration
– Malnutrition
– Dehydration

Question 13

Normal adults have ___ swallows per day

Answer 13

580

Question 14

When is oral feeding not an appropriate goal?

Answer 14

Patients aspirating 10% or more of bolus despite all possible adjustments should be NPO

• medical complications
• severity of dysphagia

Question 15

levels of care

Answer 15

• acute (hospital)
• subacute- short term (rehab), long term (skilled nursing)
• home health

Question 16

Acute care setting

Answer 16

• 13% of swallowing disorders

- issue must be addressed rapidly

Question 17

subacute care setting

Answer 17

-patient not ready for strenuous rehab
-5-28 days
1-2hrs therapy per day

Question 18

acute/intensive rehab setting

Answer 18

• intensive rehab usually in inpatient clinic

- must have physical stamina for full day of tasks

Question 19

Long term care

Answer 19

• dont respond to attempts at rehab or not candidates

- initiating an advance directive usually required

Question 20

Home health

Answer 20

patients who left hospital or rehab may require additional monitoring
-consultation with patient and family is important

Question 21

NICU

Answer 21

• integrated developmental care (coordinated efforts of all care providers)
• cluster care (allows infant to regularize his schedule)

Question 22

ultimate goal for dysphagia therapy

Answer 22

to maintain skills, improve swallowing function/safety, re-eval oral intake
*patient will tolerate the least restrictive diet to maintain the maximum/adequate nutrition and hydration without overt s/s of aspiration