Signs And Symptoms Of Dysphagia Flashcards
What factors impact swallowing function and how?
Most dysphagic symptoms are related to sensori-motor dysfunction of the swallow mechanism
Also caused by problems in - motor planning, integration/execution of commands and faulty judgment
What are warning signs of dysphagia
Reports problem Drooling Poor oral hygiene Dysarthria +/- dysphonia Gurgly voice Increased time with meals or refusal to eat and drink Coughing on food/fluids Recurrent chest infections/unexplained temperature spikes Fluctuating level of consciousness Primitive oral reflexes Weight loss Confused mental state Diminished/absent cough Certain medications
What are the four oral phases?
Reduced labial closure
Reduced range of tongue movement
Reduced buccal tension
Reduced oral sensitivity
Which disorders of the oral stage cause aspiration before the swallow?
Reduced range of tongue movement
Reduced oral sensitivity
What are the 6 disorders of the pharyngeal phase?
Delayed/absent swallow reflex Inadequate pharyngeal closure Reduced laryngeal closure Reduced pharyngeal contraction Reduced laryngeal elevation Cricopharyngeal dysfunction
Which pharyngeal disorder causes aspiration before the swallow?
Delayed/absent swallow reflex
What pharyngeal disorder causes aspiration during the swallow reflex
Reduced laryngeal closure
Which 3 pharyngeal disorders cause aspiration after the swallow reflex
Reduced pharyngeal contraction
Reduced laryngeal elevation
Cricopharyngeal dysfunction
What disorder of the swallow occurs in the oesophageal phase?
Weak cricopharyngeus
When does a weak cricopharyngeus cause aspiration?
After the swallow
What four disorders of the swallow cause aspiration after the swallow reflex?
Reduced pharyngeal contraction
Reduced laryngeal elevation
Cricopharyngeal dysfunction
Weak cricopharyngeus
What other factors influence the swallow?
Age Volume Viscosity Delivery of bolus Impaired respiratory support Saliva, taste, flavour perception
How does the swallow change when you get old?
Longer oral stage
Extra hyoid gestures
Small increase in oral and pharyngeal residue
Pharyngeal stage triggered later
Larynx elevated just enough to open UES
Slower and less efficient oesophageal transit and clearance
Reduction in smell and taste
The thicker the food…
Increased pharyngeal contraction
Increased transit time from oral to pharyngeal phases
Increased total swallow duration
No change to laryngeal closure time
What is the problem with straws?
If you don’t have a good swallow, they can deliver the bolus before you are ready for it - can be inhaling at the same time and then it will go straight down the larynx.
Key clinical populations in dysphagia…
Acute neurological - stroke, head injury Degenerative neurological - Parkinson's, MND, dementia Critical care and trauma Mechanical/structural Pulmonary Iatrogenic
What are some effects of left CVA
Unilateral weakness Oral transit delays Delays in triggering pharyngeal swallow Pharyngeal deficits Impact of associated Aphasia on dysphagia management
What are signs of a right CVA.
Mild (but variable) oral transit delays Delay in pharyngeal trigger/reflex Unilateral weakness Behavioural issues impacting as well as motor deficits - verbose - decreased attention, poor new learning - impulsive - left neglect
What are some problems caused by multiple strokes
More significant problems
Slow oral transit
More severe delays in triggering pharyngeal swallow
Decreased laryngeal elevation and decreased ability to protect airway
Increased likelihood of residue in pharynx post swallow
Increased risk of aspiration
Swallow patterns of a head injury
Oral disorders - lip closure, tongue functions, oral reflexes
Pharyngeal - triggering swallow, decreased laryngeal elevations and CP opening; decreased airway closure
Cognitive overlay - impulsiveness, too much food in, decreased new learning
Possible problem with compliance with food recommendations
Pulmonary complications may be present
Dysphagia is an early feature of Parkinson’s - true/false
False
Do all sufferers of Parkinson’s exhibit severe swallowing disorders?
No
What are the effects of Parkinson’s on the oral stage
Repetitive tongue pumping Lingual tremor Inefficient mastication Piecemeal deglutition, premature spill Buccal retention
What are some issues in the pharyngeal stage of sufferers of Parkinson’s?
Delayed swallow initiation
Pharyngeal residue secondary to poor BOT and PPW
Later stages - decreased pharyngeal excursion
