Dysphagia Flashcards
Penetration
Material enters larynx and remains above the vocal folds
Aspiration
Material goes below level of the vocal folds and is not coughed out
May be audible or silent
Instrumentation to test for dysphagia
Fees
Modified barium swallow study (MBSS)
Endoscope goes up the nose and down the back of the throat
X-ray machine gives real time
Oral preparatory phase deficits
- Decreased awareness of food
- Difficulty holding food in mouth
- Pocketing food in cheeks
- Premature spillage of food into airway
Chewing but don’t swallow
Difficulty chewing and forming a bolus
May be a problem with dentition
Don’t have buckle or the orbicularis oris musculature is weak
Oral transport phase deficits
- Anterior spillage
- Premature spillage into airway
- Difficulty moving bolus back towards pharynx
No swallow trigger or delayed swallow response
Impaired coordination of oral and pharyngeal structures
Weak elevation of the velum
Inadequate closure of the vocal folds
Reduced high, low laryngeal elevation
Weak elevation of the tongue
Pharyngeal phase deficits
- Delayed swallow response
- Impaired coordination of oral and pharyngeal structures
- Weak elevation of velum
- Inadequate closure of vocal folds
- Reduced hyolaryngeal elevation
Esophageal phase deficits
- Upper esophageal sphincter does not open
- Slow or absent esophageal peristalsis
Can fix with proton pump inhibitor
Signs/symptoms of dysphagia
- Coughing, throat clearing, wet vocal quality during or right after eating or drinking
- Extra effort or time needed to chew or swallow
- Food or liquid leaking from the mouth or getting stuck in the mouth
- Recurring pneumonia or chest congestion after eating
Secondary effects of dysphagia
Poor nutrition or dehydration
Risk of aspiration which can lead to pneumonia and chronic lung disease
Less enjoyment of eating or drinking
Aspiration pneumonia
Acute inflammation caused by material entering the lungs through the airway
Symptoms include spiked temperatures, myalgia (muscle pain), and productive cough
Etiologies
- CVA - cerebral vascular accident
TIAs - transient ischemic attacks - TBI - traumatic brain injury
- Tumors
- Progressive neurological diseases
- Surgery
Bedside swallow eval
- Evaluate all speech systems
- Patient drinks and eats selected consistencies of liquids and foods
Looking at strength and movement, posture, behavior while eating - Monitor for signs of aspiration
Coughing, wet voice quality
done in an upright position
Purpose of swallowing screen
- Presence of dysphagia
- The safety of any oral medications or food
- The need for a full swallowing assessment
- The need for a nutritional assessment
Modified barium swallow study MBSS
Patient eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
Gold standard of instrumental assessment
A dynamic imaging of the bolus from entering the mouth to entering the stomach
Fiberoptic Endoscopic Evaluation of swallowing (fees)
Scope is inserted through the nose, and the patient’s swallow can be observed on a screen
Can’t see oral stage
1. Provides information about pharyngeal phase
2. Endoscope is passed through nose into nasopharyngeal
3. Laryngopharynx can be viewed while patient eats
4. Whiteout swallow - look for residue