SLT Flashcards
What is oropharyngeal dysphagia?
- Oro-pharyngeal dysphagia describes swallowing disorders which occur in the mouth and/or throat.
- If an individual has oro-pharyngeal dysphagia, there is a risk that food and drink can enter the lungs, which can result in aspiration pneumonia
Briefly outline the ‘normal swallow’
- Neuromuscular control
- Complex sequence of events
- Involves 6 cranial nerves and 26 oro-facial, pharyngeal and oesophageal muscles
Outline stage 1 of the normal swallow (pre-oral)
• Recognition and anticipation of food and
drink
• Under voluntary control
• CN I, CN II
Outline stage 2 of the normal swallow (oral)
- Contain bolus in mouth
- Masticate (chew) bolus
- Transfer bolus
- CN V, CN VII, CN XII,
Outline stage 3 of the normal swallow (pharyngeal)
• Bolus is propelled through the pharynx
• Hyolaryngeal excursion
• Airway protection – vocal folds close and
epiglottis deflects. Breathing and swallowing
require good coordination here
• Bolus moves into oesophagus
• CN V, CN VII, CN IX, CN X(XI), CN XII
List factors which may impact on swallow ability?
- General ill health
- Dependence on others
- Fluctuating levels of alertness
- Mental health
- Acute illness
- Reduced cough reflex
- Delirium
- Infection
- Cognitive impairment
- Fatigue
List congenital disorders associated with dysphagia
- Learning difficulty
- Physical disability (cerebral palsy)
List acquired conditions associated with dysphagia
• Head Injury/hypoxic injury
• Stroke
• Brain Tumour
• Cancer (e.g. lung, head and neck)
• Surgery (e.g. facial, head and neck)
• Post radiotherapy (1 year +)
• Trismus
• Respiratory difficulties (e.g. COPD,
lung cancer)
• Reflux, gastro oesophageal issues
• Tracheostomy
• Cervical osteophytes
List degenerative causes of dysphagia
- Multiple Sclerosis
- Parkinson’s Disease
- Motor Neurone Disease
- Dementia
- Huntington’s Disease
- Muscular Dystrophy
- Spinal muscular atrophy
- Metabolic conditions
- Multi systems atrophy
- Progressive supra-nuclear palsy
- Guillain-Barré syndrome
- Myasthenia gravis
How does ageing affect the swallow at each stage
- Oral preparation stage – decreased taste & smell, decreasing triggers to prepare the body to digest food, decrease in the feelings of pleasure associated with eating and drinking
- Oral stage – reduced chewing strength, reduced movement & bolus control, increased oral transit time, reduced oral clearance, changes in dentition
• Pharyngeal stage – reduced pharyngeal pressure, delayed hyolaryngeal excursion, smaller cricopharyngeal sphincter, reduced sensation to pharyngeal residue and airway penetration /
aspiration
What are the complications?
- Aspiration pneumonia
- Silent aspiration
When should you refer a patient?
- A risk that that person’s swallow may become unsafe
- When the patient has a lack of insight into their swallow
Outline obvious signs of dysphagia
- Choking or coughing
- Eye Watering
- Keeping food in the mouth for too long, or losing
- food or drink from the mouth/drooling
- Wet voice or wet breathing, wheeze, change in
- breathing rate
- Inability to swallow medication
Outline subtle signs of dysphagia
Loss of weight/ malnutrition:
THINK: Why have they reduced intake? Fear?
Discomfort? Ask them
Dehydration:
THINK: Why have they stopped drinking? Fear?
Discomfort? Stop and watch
Recurrent chest infections:
THINK: How many before we consider aspiration as
a cause?
Communication disorders: what is aphasia?
Multi-modality condition affecting one or all communication abilities: understanding, speaking, reading, writing,
gesture. Language centers of the brain cannot send or receive signals
Communication disorders: what is dysarthria?
Motor speech disorder resulting from disturbances in muscular control of the speech mechanism, resulting in
reduced intelligibility due to impairment of one or more of the following: respiration, resonance, phonation,
articulation, prosody
Communication disorders: what is dysfluency?
It is an interruption of the flow of articulation when speaking for example: part word repetitions, prolongations,
blocking. Also known as stammering
Communication disorders: what is dyspraxia?
• A disorder of motor speech planning – messages from the brain to the mouth are disrupted, articulation is impaired
even though the muscles are not weak
• Errors in sequencing, timing, coordination, initiation and articulating resulting in groping for the correct sounds
when speaking
Communication disorders: what is dysphonia?
Both vocal cords are not moving efficiently causing disturbances to the quality of voice heard
• Abnormal pitch, volume, resonance or quality
• Dysphonia – partial loss of phonation
• Aphonia - complete absence of voice
