Week 11 - Speech Pathology and Dysphagia in the acute setting

Question 1

What is dysphagia?

Answer 1

Disorder of swallowing

Question 2

What age group does dysphagia affect?

Answer 2

All ages, from pre-term infants to very elderly.

Question 3

True or false, dysphagia can be a life-long condition?

Answer 3

True eg. cerebral palsy, stroke

Question 4

What is presbyphagia?

Answer 4

Swallowing changes associated with aging.

Question 5

What 3 stages can Dysphagia occur at?

Answer 5

Oral, pharyngeal and oesophageal

Question 6

What disorders have a high rate of associated dysphagia?

Answer 6

Parkinson’s, MND, stroke, head and neck cancer

Question 7

What can dysphagia result in?

Answer 7

Aspiration
Aspiration pneumonia
Choking
Dehydration/Malnutrition

Question 8

What type of dysphagia does SP treat?

Answer 8

Oral and Pharyngeal

Question 9

What are the phases of swallowing?

Answer 9

Pre-oral stage
Oral stage
Pharyngeal Stage
Oesophageal stage

Question 10

What is the pre-oral stage?

Answer 10

Before food enters the oral cavity - using cutlery, smelling and seeing food, putting food to the mouth

Question 11

What is the oral stage?

Answer 11

eating - using lips to take food off fork, chewing food, tongue cupping bolus

Question 12

What is the Pharyngeal stage?

Answer 12

Food is pushed into the back of the throat, epiglottis covers airway and wave of pharyngeal contraction.

Question 13

What is aspiration?

Answer 13

Food/drink/saliva passing below vocal fold and entering the lungs

Question 14

What is the usual response to aspiration in a healthy person?

Answer 14

Coughing

Question 15

What is overt aspiration?

Answer 15

Occurs with symptoms such as coughing/throat clearing

Question 16

What is silent aspiration?

Answer 16

No symptoms noticeable at bedside

Question 17

What are the biggest predictors for aspiration pneumonia?

Answer 17

Dependence for feeding
Dependence for oral care
Number of decayed teeth
Tube feeding
More than 1 medical diagnosis
Number of medications
Smoking
Dysphagia

Question 18

What are the reasons for referral of SP?

Answer 18

Stroke
Coughing with food or drink
Aspiration pneumonia
Patient or family report swallowing difficulties

Question 19

What are the 2 types of SP assessments?

Answer 19

Bedside assessments and instrumental assessments

Question 20

What does a bedside assessment look at?

Answer 20

Case history
Current presentation/results of respiratory observations
Cranial nerve assessment
Swallowing trials for diet and fluids

Question 21

What are types of instrumental assessment?

Answer 21

Videofluoroscopy

Fibreoptic endoscopic evaluation of swallowing

Question 22

Which instrumental assessment requires barium?

Answer 22

Videofluoroscopy

Question 23

What influences dysphagia treatment?

Answer 23

Aetiology
Patient’s medical plan
Patient’s preferences

Question 24

What are acute treatment options?

Answer 24

Physical/environment modifications
Swallow techniques/modifications
Texture/fluid modifications

Question 25

How long do rehabilitation exercises take?

Answer 25

weeks to months

Question 26

What are physical/environmental treatment options?

Answer 26

Positioning
Reducing distractions
Mealtime set-up cues

Question 27

What do swallowing techniques/modifications involve?

Answer 27

Bolus size and bolus delivery

Question 28

What happens if someone cannot swallow safely?

Answer 28

Nasogastric tube

PEG

Question 29

When is a PEG considered?

Answer 29

If someone can’t swallow in the long term (years)