Swallowing Disorders

Question 1

Dysphagia

Answer 1

The impaired movement of material from the mouth through the pharynx (back of the throat) and into the stomach
In simple terms = dysphagia mean swallowing disorder

Question 2

The Normal Swallow

Answer 2

Four phases of swallowing
Two are volitional
Oral Preparatory Phase
Oral Phase
Two are reflexive (automatic)
Pharyngeal Phase
Esophageal Phase
Recent literature cites a 5th phase
Anticipatory Phase

Question 3

The 4 phases of swallowing are:

Answer 3

Interdependent –rely on one another

Dynamic – constant movement

Overlap – appear simultaneously

Question 4

Anticipatory Phase

Answer 4

The 5th Phase
Getting ready to eat
Includes:
The sights, 
The sounds, 
The smells of food
Often diminished in the elderly

Question 5

Oral Preparatory Phase

Answer 5

First the person has to grab food off the fork/spoon; close lips around utensils, cup
Food is manipulated and chewed (masticated)
Food mixes with saliva to form a bolus
At the end of the oral preparatory phase the bolus is compressed and held against the hard palate

Question 6

Oral Phase

Answer 6

Tongue cups the bolus and pushes the food backward through the oral cavity
Bolus starts to get squeezed itself and the soft palate
Groove becomes evident in the tongue
Pressure pulls the bolus back
As the bolus reaches the faucial arches the swallow reflex is triggered

Question 7

Pharyngeal Phase

Answer 7

Complex set of muscular activities occur
Soft palate raises and closes o the nasal cavity
Vocal folds close – momentarily hold breath
Muscles under the neck pull the area surrounding the vocal folds upward
Epiglottis folds over and forms a chute to deflect the food into the esophagus
Muscles of the throat squeeze the food down to the upper esophageal sphincter muscle, which relaxes
Combination of oral and phyrangeal phases = 1- 1 ½ seconds

Question 8

Esophageal Phase

Answer 8

Once in the esophagus the bolus slows down
A series of waves move the bolus down the esophagus into the stomach
Takes 8 – 20 seconds

Question 9

Causes of Dysphagia

Answer 9

Neurological causes
Cerebral Vascular Accident (stroke)
Parkinson’s disease
Lou Gehrigs Disease (ALS)
Multiple Sclerosis
Huntingtons disease
Cerebral Palsy

Question 10

Causes of Dysphagia 2

Answer 10

Structural/Anatomical Changes
Oral cancer
Head/neck trauma
Reflux disease
Hiatal hernia
Long periods of intubation
Pediatric Population
Premature babies
Oral/facial deformities
MR/Downs Syndrome
Genetic Syndromes

Question 11

Abnormal Swallowing

Answer 11

Aspiration – occurs when the food enters the respiratory system below the level of the vocal folds
Penetration – when the food enters the airway above the level of the vocal folds
A protective cough often clears the material out of the airway in normal person.
Some patients may have silent aspiration (i.e., the patient is unaware of aspirated material and therefore does not clear the material)
Frequent aspiration can cause infection and aspiration pneumonia.

Question 12

Role of the Speech-Language Pathologist

Answer 12

A clinical or bedside examination
Recommend least restrictive diet texture (solids) and consistency (liquids)
Recommend/Perform Modified Barium Swallow Study
Monitor diet tolerance
Teach Compensatory Swallow Techniques

Question 13

Modified Barium Swallow Study

Answer 13

Videofluoroscopy or Modified Barium swallow (MBS)
Moving radiographic image recorded on a tape/DVD
Both a diagnostic and therapeutic tool to assess swallowing function