Dysphagia

Question 1

Penetration

Answer 1

Material enters larynx and remains above the vocal folds

Question 2

Aspiration

Answer 2

Material goes below level of the vocal folds and is not coughed out
May be audible or silent

Question 3

Instrumentation to test for dysphagia

Answer 3

Fees
Modified barium swallow study (MBSS)
Endoscope goes up the nose and down the back of the throat
X-ray machine gives real time

Question 4

Oral preparatory phase deficits

Answer 4

1. Decreased awareness of food
2. Difficulty holding food in mouth
3. Pocketing food in cheeks
4. 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

Question 5

Oral transport phase deficits

Answer 5

1. Anterior spillage
2. Premature spillage into airway
3. 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

Question 6

Pharyngeal phase deficits

Answer 6

1. Delayed swallow response
2. Impaired coordination of oral and pharyngeal structures
3. Weak elevation of velum
4. Inadequate closure of vocal folds
5. Reduced hyolaryngeal elevation

Question 7

Esophageal phase deficits

Answer 7

1. Upper esophageal sphincter does not open
2. Slow or absent esophageal peristalsis
   Can fix with proton pump inhibitor

Question 8

Signs/symptoms of dysphagia

Answer 8

1. Coughing, throat clearing, wet vocal quality during or right after eating or drinking
2. Extra effort or time needed to chew or swallow
3. Food or liquid leaking from the mouth or getting stuck in the mouth
4. Recurring pneumonia or chest congestion after eating

Question 9

Secondary effects of dysphagia

Answer 9

Poor nutrition or dehydration
Risk of aspiration which can lead to pneumonia and chronic lung disease
Less enjoyment of eating or drinking

Question 10

Aspiration pneumonia

Answer 10

Acute inflammation caused by material entering the lungs through the airway
Symptoms include spiked temperatures, myalgia (muscle pain), and productive cough

Question 11

Etiologies

Answer 11

1. CVA - cerebral vascular accident
   TIAs - transient ischemic attacks
2. TBI - traumatic brain injury
3. Tumors
4. Progressive neurological diseases
5. Surgery

Question 12

Bedside swallow eval

Answer 12

1. Evaluate all speech systems
2. Patient drinks and eats selected consistencies of liquids and foods
   Looking at strength and movement, posture, behavior while eating
3. Monitor for signs of aspiration
   Coughing, wet voice quality
   done in an upright position

Question 13

Purpose of swallowing screen

Answer 13

1. Presence of dysphagia
2. The safety of any oral medications or food
3. The need for a full swallowing assessment
4. The need for a nutritional assessment

Question 14

Modified barium swallow study MBSS

Answer 14

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

Question 15

Fiberoptic Endoscopic Evaluation of swallowing (fees)

Answer 15

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

Question 16

IDDSI Liquids

Answer 16

1. Thin (0) - water, coffee
2. Slightly thick (1) - orange juice with some pulpit
3. Mildy thick (2) - full pulp, nectar consistency
4. Moderately thick (3) - smoothie consistency
5. Extremely thick (4) - can’t drink with a straw

Question 17

IDDSI Foods

Answer 17

1. Liquidised (3)
2. Pureed (4) - blender
3. Minced and moist (5) - meatloaf
4. Soft and bite sized (6) - fish
5. Regular (7) - all other foods

Question 18

Know the IDDSI pyramids

Answer 18

IDDSI website

Question 19

Intervention

Answer 19

1. Intervention should first be behavioral/postural
2. Specific swallowing treatment (e.g., exercises to improve muscle movement)
   Where is the breakdown happening, which stage?
3. Specific food and liquid textures that are easier and safer to swallow
   Last recommended change

Question 20

Postural techniques

Answer 20

Positions or strategies to help the individual swallow more effectively
Head rotation, head tilt, chin tuck (down)
May alter feeding utensils as well (smaller)

Question 21

Swallow maneuvers used for pharyngeal phase

Answer 21

1. double or dry swallow
   After swallow food, swallow again, least restrictive
2. Effortful or hard swallow
   Increase tongue movement to help clear the bolus. Increases duration of hyoid elevation and laryngeal closure. Imagine you’re swallowing a grape whole
3. Supraglottal swallow
   Hole your breath right before you swallow, swallow, then cough
4. Super supraglottic swallow
   Similar to supraglottal but holding breath entire time and bearing down
5. Mendelssohn maneuver
   Help with high low laryngeal excursion. Helps with movement of bolus. Normal swallow, elevate larynx and squeeze muscles with fingers. Open the esophagus to prevent anything from falling into airway. Hold elevated larynx 5 seconds
6. Shaker exercises - lying flat on bed. Lift head up and pull heard to chest, swallow and release

Question 22

Oral motor exercises

Answer 22

Must be used with focus
Can help increase muscle tone and strength
Develop a plan and give to patient