Dysphagia

Question 1

What are the 4 phases of a swallow?

Answer 1

1. Oral Preparatory Phase
2. Oral (Voluntary) Phase
3. Pharyngeal Phase
4. Esophageal Phase

Question 2

Swallow phase: Food is manipulated in the mouth. Lip seal is maintained. The food is chewed. Prior to the swallow, the food is generally pulled together into a cohesive bolus, and is held between the tongue and the anterior palate. The velum is pulled anteriorly and rests against the back of the tongue to keep materials in the oral cavity. The pharynx and larynx are at rest, and the airway is open.

Answer 2

oral preparatory phase

Question 3

Swallow phase: The tongue moves anteriorly and posteriorly, propelling the food posteriorly until the swallow reflex is triggered. The swallow reflex is triggered when the bolus passes the anterior facial arches. This usually occurs within 1 second.

Answer 3

oral (voluntary) phase

Question 4

Swallow phase: The reflexive swallow carries the bolus through the pharynx. The bolus divides when flowing through the pyriform sinuses and joins again at the opening of the esophagus. This usually occurs within 1 second.

Answer 4

pharyngeal phase

Question 5

Swallow phase: Esophageal peristalsis carries the bolus through esophagus into the stomach.

Answer 5

esophageal phase

Question 6

What cranial nerve? jaw movements for chewing and sensing of the bolus

Answer 6

5 (trigeminal)

Question 7

What cranial nerve? lip closure and negative pressure

Answer 7

7 (facial)

Question 8

What cranial nerve? sensing the bolus at the palate, and moving the larynx in and up

Answer 8

9 (glossopharyngeal)

Question 9

What cranial nerve? elevating the soft palate to close off the nose

Answer 9

10 (vagus)

Question 10

What cranial nerve? tongue movements, move the bolus anterior-posterior (bolus transit)

Answer 10

12 (hypoglossal)

Question 11

performed by an SLP to assess the patient’s swallowing skills and determine if further testing is needed; can identify approximately 70% of the patients as having or not having aspiration, pharyngeal delay or pharyngeal swallowing problem; specifically assesses the oral phase

Answer 11

bedside swallow study

Question 12

what are signs of aspiration?

Answer 12

1. temperature
2. drooling
3. pocketing
4. multiple swallows
5. limited laryngeal movement
6. wet sounding voice
7. throat clearing
8. coughing
9. pneumonia
10. reflux
11. dehydration
12. weight loss
13. patient complaint
14. changes in diet

Question 13

What are some medication considerations?

Answer 13

1. cause confusion or sedatin
2. antibiotics may suppress lung infection 2* to aspiration
3. cause dysphagia
4. cause rymouth or xerostomia
5. cause gastroesophageal reflux disease

Question 14

Specifically assesses pharyngeal phase of swallowing; performed by SLP and radiologist

Answer 14

modified barium swallow study

Question 15

terminology: anything through the vocal folds

Answer 15

aspiration

• frank = horrible amount
• trace = tiny amount

Question 16

terminology: anything above the level of the vocal folds - sounds gurgly

Answer 16

penetration

- flash = anything that enters and comes back out without a trace

Question 17

terminology: accumulation in the valleculae or pyriform space that can be measured, other than a trace coating

Answer 17

stasis

Question 18

terminology: bolus comes out the nose

Answer 18

Nasal reflux

Question 19

At the level of the vocal cords (recurrent laryngeal nerve)

Answer 19

power cough reflex

Question 20

At the level of the laryngeal trachea (vagal nerve)

Answer 20

delayed tracheal cough reflex

- material is in your lungs if this is all you have

Question 21

When patient is “NPO” what should they not have?

Answer 21

Water
Ice Chips
Ice cream, sherbert, Jello and ice chips can turn into thin liquids in the mouth.

Question 22

Postural changes can increase airway protection and/or can direct food down the stronger side of the throat. What is a good position if someone is at risk of aspirating food?

Answer 22

pt should tuck chin or turn head to one side

- food can fall over the back of the tough and risk entering airway

Question 23

What are S and S of oral phase difficulties?

Answer 23

1. Pocketing
2. Drooling
3. Poor lip closure

• Support lip
• Apply pressure to the cheek
• Remind the patient to sweep his mouth with his tongue and/or finger

Question 24

What are residue compensatory techniques?

Answer 24

1. Effortful swallow
2. Alternate bite with sip
3. Dry swallow between bites

Question 25

What are delayed swallow compensatory techniques?

Answer 25

1. Thermal/tactile stimulation- Dip the mirror in ice; Rub the mirror along the anterior faucial arches; Have the patient swallow
2. Eat cold or sour foods

Question 26

What are decreased lifting of the larynx compensatory techniques?

Answer 26

Mendelssohn Maneuver

• Place your finger lightly on your larynx when swallowing
• When you feel your larynx reach its highest point, hold it up by pushing your tongue against the roof of your mouth and keeping it there

Question 27

What are decreased closure of the larynx compensatory techniques?

Answer 27

1. Super-supraglottic Swallow - Take a breath; Let a little out then hold your breath as tightly as possible; Swallow, squeezing hard; Cough; Then swallow again
2. Periodic Cough/Throat Clear