L6: Dysphagia

Question 1

organic dysphagia =

Answer 1

symps of underlying disease or structural deficits

neurogenic or structural/mechanical

Question 2

functional dysphagia =

Answer 2

perceived by pts w/o known underlying disease or structural deficits

Question 3

neurogenic =

Answer 3

acquired conds (acute onset) - ex stroke, TBI, CP

neurologic diseases (progresssive_ - ex. PD, ALS, HC

Question 4

mechanical/structural =

Answer 4

altered movement of swallowing structures

altered bolus flow

ex. surgery, head and neck cancer, cervical spine disease, xerostomia

Question 5

neurogenic: profile of dysphagia symps depends upon which aspect(s) of swallow-related neural circuity is(are) damaged, including… (4)

Answer 5

afferent pathways

brainstem swallow centre

efferent pathways

cortical and subcortical inputs

Question 6

afferent pathways: disruption of sensory inputs from oral cavity, pharynx, larynx and eso can be caused by…

Answer 6

cranial nerve damage

V, VII, IX, and X may disrupt or impair the sensory inputs required for swallowing

Question 7

CN V neuropathology =

Answer 7

reduced ability to perceive bolus characs - “bolus readiness”

Question 8

CN IX neuropathy =

Answer 8

imp oropharyngeal sensation resulting in delayed triggering of pharyngeal swallow

Question 9

brainstem can be damaged by…

results in…

Answer 9

damage to medullary swallow centre

dysfunction in dorsal and/or ventral swallowing group

may result in severe imp or absence of the pharyngeal swallow

Question 10

occlusion of the posterior inferior cerebellar artery (PICA) can lead to

Answer 10

lateral medullary syndrome

due to involvement of NTS and NA in this area

swallowing imp

Question 11

disruption to motor output can occur in 4 places

give an example

Answer 11

motor n (ex. brainstem CVA)
motor neurons (ex. bells palsy, ALS)
neuromuscular junction (ex. MG)
muscles

Question 12

if the motor output is disrupted….

Answer 12

movement patterns may be programmed appropriately w/i the swallow centre but cannot be executed

Question 13

disruption of descending cortical and subcortical inputs to brainstem can…

specifically (4 things)…

Answer 13

lead to a number of diverse disorders involving the oral, pharyngeal, and eso phases of swallowing

specifically deficits in initiation, sensorimotor integration, coordination, and motor execution

Question 14

dysphagia may arise from structural abnormality or insufficiency in…

Answer 14

the oral cavity, phayrnx, larynx, or eso

imp biomechnical aspect of swallowing

movement of musculoskeletal sys and movement of the bolus

Question 15

what are the 5 causes of mechanical/structural dysphagia

Answer 15

surgery (spine, maxillofacial, oncologic)

head and neck cancer (tumour effects, surgical effects, post radiation effects)

cervical spine disease (disc degen = osteophytes, cervical spondylosis)

edema (acute inflammation of tissues)

xerostomia (dry mouth/reduced salivary flow … commonly caused by radiation)

Question 16

some prescription drugs can…

Answer 16

cause neurogenic or mechanical dysphagia

Question 17

oral dysphagia can result from medications for 2 reasons:

Answer 17

drusg that reduce salivary flow (mechnical)

drugs that cause sedation (neurogenic)

Question 18

drugs that reduce salivary flow include

Answer 18

anticholinergics

antidepressants

antispasmodics

Question 19

drugs that cause sedation include

Answer 19

anticholinergics

antidepressants

antipsychotics

Question 20

pharyngeal dysphagia can result from prescription meds for 2 reasons (what drugs?)

Answer 20

drugs that interfere w dopaminergic sys (antipsychotics)

drugs that suppress brainstem reg (benzodiazepines)

Question 21

functional dysphagia falls under umbrella of functional neurological disorders which are

common patho phys features?

neural circuits exert influence on…

Answer 21

an intersection of neurology and psychiatry w dysfunction w/i and across diff brain circuits

common pathophys features include deficits in emo processing, self agency, attention reg, interoception, and/or perceptual inferencing

neural circuits exert influence on sensorimotor function(s)

Question 22

functional dysphagia was originally used to describe ____, how was it diagnosed?

what would a pt experience?

Answer 22

idiopathic esophageal dys

Rome III diagnostic criteria = swallowing imp present for prior 3m w onset at least 6m prior to diagnosis

sense of food sticking or passing w diff through the esophagus

absence of objective evidence of GERD

failure to improve w empiric treatment for GERD

Question 23

Functional dysphagia can be considered a ____ of dysphagia and requires…

Answer 23

class

multiple assessments to elucidate the underlying pathophys

Question 24

function dysphagia could be related to 5 things

Answer 24

psychological stress/anxiety

inc laryngeal muscle tenison

inc laryngeal hypersensitivity

ARFID

global functional neurological disorder

Question 25

psychological stress/anxiety related FD should be treated w

Answer 25

psychologic treatment approaches

Question 26

inc laryngeal muscle tension related FD should be treated w

Answer 26

treatments to dec muscle tension

Question 27

inc laryngeal hypersensitivity related FD should be treated w

Answer 27

treatments to modulate neural sensitivity, supress cough

Question 28

ARFID related FD should be treated w

Answer 28

treat underlying etiologies

Question 29

muscle tension dysphagia likely sits on a ...... and includes... (3) early data suggests...

Answer 29

continuum of laryngeal disorders muscle tension dysphonia (voice disorder w/o VF pathology or vagus imp) refractory chronic cough (persistant cough in absense of stim, recalcitrant to treatment of potential causes) globus pharyngeus (feeling of something in one's throat w no known cause) early data suggests improvement of swallowing symps w treatment of laryngeal MT

Question 30

caveat of FD...

Answer 30

in some cases underlying neurological or mechanical causes of dysphagia can be found in pts w previous diagnosis of psychogenic D

Question 31

how can we describe the imp swallow profile? (3)

Answer 31

gathering clinical or radiographic symps detailing imp in swallowing phys relating these findings to neuromuscular or structural deficits (clues for intervention)

Question 32

clinical or radiographic signs or symps that indicate swallowing phys is impaired tells us what? (2)

Answer 32

alerts clinician that swallowing is disordered (ex. coughing) give indication of the nature of the dysfunction but are not specific - result from a variety of physiological imp (ex. coughing could be bc of either impaired bolus hold or reduced laryngeal vestibule closure)