Session 20 - Dysphagia Management

Question 1

name the 4 phases of swallowing.

Answer 1

• oral preparatory phase
• oral phase
• pharyngeal phase
• esophageal phase

Question 2

bolus formation and mastication

Answer 2

oral preparatory phase

Question 3

anterior to posterior transit of bolus

Answer 3

oral phase

Question 4

pharyngeal swallow triggered and bolus moves through pharynx

Answer 4

pharyngeal phase

Question 5

bolus travels down esophagus and into stomach

Answer 5

esophageal phase

Question 6

name an example of soft and bite sized food.

Answer 6

boiled potatoes

Question 7

name an example of minced and moist food.

Answer 7

minced canned fruit, meat, vegetables

Question 8

name an example of pureed food/extremely thick liquids.

Answer 8

pudding

Question 9

name an example of liquidized food/moderately thick liquids.

Answer 9

honey

Question 10

name an example of mildly thick liquids.

Answer 10

nectar

Question 11

name an example of slightly thick liquids.

Answer 11

thin nectar

Question 12

name an example of thin liquids.

Answer 12

water

Question 13

-can drink through any type of teat/nipple, cup or straw as appropriate for age and skills

Answer 13

thin flows like water; fast flow

Question 14

• requires a little more effort to drink than thin liquids
• flows through a straw, syringe, teat/nipple
• similar to the thickness of most commercially available ‘Anti-regurgitation’ (AR) infant formulas

Answer 14

slightly thick, thicker than water

Question 15

• sippable, pours quickly from a spoon, but slower than thin drinks
• mild effort is required to drink this thickness through standard bore straw (standard bore straw = 0.209 inch or 5.3 mm diameter)

Answer 15

mildly thick flows off a spoon

Question 16

• moderate effort is required to suck through a standard bore or wide bore straw (wide bore straw = 0.275 inch or 6.9 mm)
• cannot be piped, layered or molded on a plate because it will not retain its shape
• cannot be eaten with a fork because it drips slowly in dollops through the prongs
• can be eaten with a spoon
• no oral processing or chewing required – can be swallowed directly
• smooth texture with no ‘bits’ (lumps, fibers, bits of shell or skin, husk, particles of gristle or bone)

Answer 16

moderately thick /liquidized can be drunk from a cup

Question 17

• cannot be drunk from a cup because it does not flow easily
• cannot be sucked through a straw
• does not require chewing
• can be piped, layered or molded because it retains its shape, but should not require chewing if presented in this form
• shows some very slow movement under gravity but cannot be poured
• falls off spoon in a single spoonful when tilted and continues to hold shape on a plate
• no lumps
• not sticky
• liquid must not separate from solid

Answer 17

extremely thick/pureed usually eaten with a spoon (a fork is possible)

Question 18

• could be eaten with chopsticks in some cases, if the individual has very good hand control
• can be scooped and shaped (e.g. into a ball shape) on a plate
• small lumps visible within the food (Paediatric, equal to or less than 2 mm width and no longer than 8mm in length)Adult, equal to or less than 4mm width and no longer than 15mm in length
• lumps are easy to squash with tongue

Answer 18

minced and moist can be eaten with a fork or spoon

Question 19

-can be eaten with a fork, spoon or chopsticks
-can be mashed/broken down with pressure from fork, spoon or chopsticks
-a knife is not required to cut this food, but may be used to help load a fork or spoon
-soft, tender and moist throughout but with no separate thin liquid
-chewing is required before swallowing
- ‘Bite-sized’ pieces as appropriate for size and oral processing skills
(Paediatric, 8mm pieces (no larger than)
Adults, 15 mm = 1.5 cm pieces (no larger than)

Answer 19

soft + bite-sized