Dysphagia Flashcards
Impact of Dysphagia on Nutrition Status
- Impaired feeding efficiency (length of time to finish a meal)
- Decreased food & fluid intake
- Altered taste sensation
- Decreased appetite
- Weight loss
Important Anatomical Structures in Swallow
- Oral cavity
- Pharynx: Nasopharynx, Oropharynx, Hypopharynx
- Larynx
- Esophagus
Important Anatomical Structures in the Oral Cavity
- Tongue
- Teeth
- Lips
- Palate
- Anterior & Lateral Sulci
Infant swallow
- Oral & Pharyngeal Cavities Smaller
- Tongue size rel. larger
- Fat pads in cheeks (creates buffer and gives muscle strength for BF)
- Larynx / hyoid elevated under tongue (anterior)
- Pyriform sinuses-smaller & elevated
- Soft palate, pharyngeal wall & tongue base closer together
Stages of Swallowing
- Oral Preparatory /Oral Stage
- Pharyngeal Stage
- Esophageal (May have problem with reflux since motility is still developing but usually doesnt bug them)
What can be observed to see if swallowing?
Wath for hyoid bone going up and forward
Oral preparatory stage
- Lip Closure (important for BF technique)
- Rotary, lateral jaw & tongue movement (developed 12-18 months)
- Facial Tone (extra fat pads)
- Anterior pulling of soft palate
- Salivation
- Can last for as long as you wish…
What is the oral preparatory phase negatively affected by?
- poor salivary gland function (lubrication)
- surgical or anatomical defects
- neurological disorders (biggest challenge)
- poor dentition
Oral stage
voluntary - 1 sec
* Tongue elevation in anterior to posterior direction to trigger swallow
* bolus movement through oral cavity
What can the oral stage be effected by?
- surgical defects (tongue weakness)
- neurological disability
- cognitive status/LOA
Pharyngeal phase
1 second
* shortest but most complex
* soft palate elevates (velar elevation): Closes off nasopharynx and prevents nasopharyngeal regurgitation
* The superior constrictor muscle contracts (pharyngeal peristalsis)
* tongue base drives the bolus posteriorly
Esophageal phase
3-6 seconds for infant (8-20 for adult)
* bolus is propelled about 25 cm from the cricopharyngeus through the thoracic esophagus via peristaltic contractions.
* The lower esophageal sphincter relaxes and the bolus moves into the gastric cardia.
What phase is the biggest risk for aspiration?
esophageal phase
treatment strategies for abnormal swallow
You have to understand the underlying cause and the anatomy/physiology to understand what treatment modality to consider
* positional (best strategy)
* dietary texture (6-12 months thickening BM; consistent texture)
* Assistive feeding devices
* Tube feeding
Common causes of dysphagia
- Neurological impairment caused by stroke, neurological disorders (eg Cerebral Palsy, Muscular Dystrophy)
- Structural abnormalities of the oral cavity (eg cleft palate), head and neck cancers
- Psychogenic (rare)
