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Dysphasia Flashcards

1
Q

Disorder of swallowing

A

SLP’s who treat dysphagia are part of a team  Swallowing disorders increase risk of choking  **May lead to aspiration and pneumonia
 GASTROESOPHAGEAL REFLUX

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2
Q

Lifespan perspective

A

Problems occur in children and adults
 Newborns, may be unable to such/ingest
nutriment
 May refuse food, develop unhealthy habits
 Outcomes of swallowing disorders include
 *Malnutrition and ill health
 *Weight loss
 *Fatigue
 *Frustration
 *Respiratory Infection
 *Aspiration
 *Death

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3
Q

Swallowing process

A

Anticipatory Phase
Oral phase
Pharyngeal phase
Esophageal phase

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4
Q

Anticipatory Phase

A

Anticipatory Phase
*Salivating, positioning, response to aroma, personal rituals

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5
Q

Oral phase

A

Oral Phase
*Oral Preparatory
*Preparedliquid/solidboluspositioned *Oral transport
*Moved to back of mouth *Swallow reflex triggered

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6
Q

Oral phase

A

Oral Phase
*Oral Preparatory
*Preparedliquid/solidboluspositioned *Oral transport
*Moved to back of mouth *Swallow reflex triggered

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7
Q

Pharyngeal phase

A

 Pharyngeal Phase
 *Velum stops bolus from entering nasal cavity  *Creation of pressure
 *Pharynx contracts and squeezes
 *Hyoid bone rises, larynx up and forward
 *Vocal folds close, epiglottis lowered
 *Cricopharyngeal sphincter opens

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8
Q

Esophageal phase

A

Esophageal Phase
 *Muscles of esophagus move bolus down in peristaltic contractions

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9
Q

Disorder of swallowing
Anticipatory phase

A

Anticipatory Phase
 *Lack of interest in food
 *Sensory Impairment
 *Poor positioning

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10
Q

Disorder of swallowing
Oral phase

A

Oral Phase
 *Poor Lip Seal
 *Difficulty Chewing
 *Insufficient saliva production  *Reduced tongue function

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11
Q

Disorder of swallowing
Pharyngeal phase

A

Pharyngeal Phase
 *If swallow delayed or not triggered,
aspiration can occur
 *Open velopharyngeal port allow food into the nasal cavity.
 *Insufficient pharyngeal pressure

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12
Q

Disorder of swallowing
Esophageal phase

A

Esophageal Phase
 *Incomplete bolus movement
 *Residue can cause infection and nutritional problems.

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13
Q

Pediátric dysphasia

A

 *Inadequate growth, ill health, difficulty learning, poor parent-child relationships
 Can be due to:
 *Cerebral Palsy
 *Spinal Bifidia
 *Mental Retardation/Developmental Delay
 *Autism spectrum disorders
 *HIV/AIDS
 *Structural/Physiological abnormalities

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14
Q

Cerebral palsy and swallowing

A

Cerebral Palsy
 *Most common cause
 *Muscle tone, coordination, posture, discoordination, gag
 *May require gastrostomy tube feedings

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15
Q

Spina Bífida and swallowing

A

Spina Bifida
 *limited sensation and motor difficulties
 *Can affect all phases of swallow

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16
Q

Mental Retardation/Developmental Delay

A

Mental Retardation/Developmental Delay
 *Delayed motor coordination
 *Inability to express food preferences.

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17
Q

Adult dysphasia

A

 Dysphagia in Adults
 *Over 6 million Americans over age 60  DUE TO:
 *Stroke
 *Cancer of the mouth, throat, larynx
 *HIV/AIDS
 *Multiple Sclerosis
 *Amyotrophic Lateral Sclerosis
 *Parkinson’s Disease
 *Spinal Cord Injury
 *Medication and nonfood substances
 *Dementia
 *Depression and Social Isolation

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18
Q

Stroke

A

Stroke
 *All phases likely to be slow, impaired
 *Poor coordination of swallowing/breathing

19
Q

Cancer

A

Cancer of the mouth, throat, larynx
 *Likely after cancer treatment, depends on treatment type

20
Q

HIV and AIDS

A

HIV/AIDS
 *Esophageal ulcers, esophagitis

21
Q

 *Multiple Sclerosis

A

 *Multiple Sclerosis
 *Delayed swallow reflex, reduced pharyngeal peristalsis

22
Q

 Amyotrophic Lateral Sclerosis (ALS)

A

 Amyotrophic Lateral Sclerosis (ALS)
 *Reduced tongue mobility, laryngeal elevation, pharyngeal peristalsis

23
Q

Parkinson’s Disease

A

Parkinson’s Disease
 *Rolling tongue pattern, Pharyngeal swallow delayed, poor
laryngeal closure, esophageal abnormalities.

24
Q

Spinal cord injury

A

Spinal Cord Injury
 *Esophageal dysphagia, sometimes oral phase/pharyngeal
weakness

25
 Medications and Nonfood Substances
 Medications and Nonfood Substances  *Medication side effects, tardive dyskinesia  *Smoking, excessive caffeine
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Dementia
Dementia  *Attention/orientation to food, oral prep/transport impaired, delayed pharyngeal swallow, reduced laryngeal elevation
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Depression and Social Isolation
Depression and Social Isolation  *Diminished interest in food, cooking for self, restlessness, fatique
28
Evaluation of swallowing
 Silent Aspiration  Screening for Dysphagia  *Failure to Thrive  *Non-Instrumental Clinical Evaluation  *Checklist for older adults are available  *3-ounce water swallow test  *Inappropriate weight Case History and Background Information  Three areas of concern:  *Observe difficulties during eating and drinking  *Client appears to be at risk for aspiration  *Client appears not to be receiving adequate nourishment  OBTAIN INFORMATION ABOUT:  *Location of swallowing problem  *Consistencies that are easiest/hardest to swallow  *Nature and Severity of Disorder
29
Evaluation of swallowing g cont
Clinical Assessment  *Caregiver and environmental factors  *Cognitive and communicative functioning  *Head and body posture  *Oral mechanisms  *Laryngeal functioning  *Bedside Swallow evaluations  *Managing a tracheostomy tube Caregiver and Environmental Factors  *Caregiver attentiveness, distractions, position, expressing food preferences  Cognitive and Communicative Functioning  *Alertness/wakefulness, ability to follow directions, general functioning  Head and Body Posture  *Note position and whether patient can change position as directed.
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Evaluation Oral mechanism
Oral Mechanism  Note Abnormalities, asymmetry, sagging, motor difficulties, oral reflexes, sensation, drooling, infection, upper airway obstruction
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Evaluation Pharyngeal function
Laryngeal Function  Hoarse, gurgly, breathy voice  If voice problems, may need to refer to otolaryngologist
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Bedside evaluation
 Reaction to food/drink  Oral mechanisms throughout swallow  Inability to cough/poor airway protection  Nasal regurgitation  Observe movement of hyoid bone/thyroid cartilage  Record number of swallows  Vocal quality changes  Difficult and safe consistencies  Preferred Placement
33
 Managing a Tracheostomy Tube
 Managing a Tracheostomy Tube  *Swallowing evaluation may still be completed  *Physician approval  Procedure  *Cuff is deflated  *Secretions are suctioned  *Patient covers tube before each swallow to normalize tracheal pressure
34
Modified Barium Swallow Study  *Videofluoroscopy
Modified Barium Swallow Study  *Videofluoroscopy  *Barium on food or in liquid  *X-Ray recorded for later analysis  Used for determining  *Oral vs. Nonoral feeding  *Safest food textures  *Appropriate therapy
35
Fiberoptic Endoscopic Evaluation of Swallowing
Fiberoptic Endoscopic Evaluation of Swallowing  *For adults too ill for MBSS  *Flexible-laryngoscope through nose into pharynx  *Swallow dyed food  *May reveal premature spillage, airway closure  *Provides information about desirable posture, preferred food types.
36
Scintigraphy
Scintigraphy *Computerized technique *Measures amount of aspiration  *Radioactive tracer mixed with food * SLP positions, suggests swallow procedures, interprets results
37
Ultrasound/Ultrasonography
Ultrasound/Ultrasonography  *Transducer placed externally  **Generatesandreceivessoundwaves  *Acoustic Images are taped  *Assesses  *Oralphaseduration  *Structure/movementofhyoidboneand tongue
38
Feeding Environment
Feeding Environment *Minimize Distraction *Relaxed and Unhurried *Develop self-feeding skills if possible *Appropriate utensils
39
Body and Positioning
Body and Positioning  *Upright, 90 degree hip angle, symmetrical  *Reduce extraneous movement  *Chin Tuck  *Head back  *Head tilt and head rotation  May lie on one side if pharyngeal residue is present
40
Modification of Foods and Beverages
Modification of Foods and Beverages  *Textures, Quantities, and Temperatures  *May only tolerate certain consistencies  *Straws usually not recommended  *Swallow twice  *Vary temperatures  Placement  *Place where intact sensation and adequate muscle strength
41
Behavioral Swallowing Treatment
Behavioral Swallowing Treatments *Strengthening Exercises *Effortful and double swallows *Supraglottic swallow *Mendelsohn Maneuver
42
Medical and Pharmacological Approaches
Medical and Pharmacological Approaches  *Drug Treatments  **Medications can either help or cause/contribute to swallowing disorders  Prostheses and Surgical Procedures  *Prosthetic devices if swallowing mechanism not intact  *Remove cervical growths, increase vocal fold dimension, elevate larynx, suture vocal folds closed  Nonoral Feeding  *Nasogastric tube, Pharyngotomy, Esophagostomy, Gastrostomy
43
Nonoral Feeding
Nonoral Feeding  *Nasogastric tube, Pharyngotomy,  Esophagostomy, Gastrostomy
44
Objective
Objectives  *Improve food and drink intake  *Prevent Aspiration  * Success determined by cause, severity, onset of treatment  *Treatment beneficial at least 80% of the time  *Sometime preventable  *Can be related to poor dentition  *Avoid certain substances

Organic Disorders (6 decks)

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