1
Q
What is dysphagia?
A
Difficulty swallowing
Difficulty moving bolus from the mouth to the stomach
2
Q
What is the age range of people affected by dysphagia?
A
Not age specific
3
Q
Name some etiologies of dysphagia.
A
- infection
- structural malformations
- surgery (thyroid/RLN/cervical)
- conditions that weaken/damage muscles/nerves (CVA, PD, TBI)
4
Q
Dysphagia is a ______ issue and it is seen as _______; something else causes dysphagia.
A
chronic
secondary
5
Q
What are the consequences of dysphagia?
A
- malnutrition
- decreased quality of life
- dehydration
- aspiration pneumonia
6
Q
Name the types of dysphagia.
A
- Oral
- Pharyngeal
- Oropharyngeal
- Esophageal
7
Q
What may be involved in oral dysphagia?
A
- Tongue movement
- lip closure
- pocketing
- transport
8
Q
What may be involved in pharyngeal dysphagia?
A
- airway closure
- residues
- motility
- Upper esophageal sphincter (UES)
9
Q
What may be involved in oropharyngeal dysphagia?
A
- tongue movement
- lip closure
- pocketing
- transport
- airway closure
- residues
- motility
- Upper esophageal sphincter (UES)
10
Q
What may be involved during esophageal dysphagia?
A
- motility
- Lower esophageal sphincter (LES)
- fistula
- diverticulum
- HCI - reflux
- Ulcer
11
Q
What does it mean if it is classified as oropharyngeal dysphagia?
A
At least one component of each has to be present; one for oral one for pharyngeal.
12
Q
What can cause pneumonia?
A
Repeated bouts of aspiration of food/liquids.
13
Q
How can aspiration cause pneumonia?
A
Repeated bouts of food or liquids accumulate at the bottom of the lungs causing bacteria to grow in it, hence the pneumonia.
14
Q
What is a bolus?
A
Ball of food or drink made during the oral stage. The bolus is transported back-which is when the pharyngeal stage begins.
15
Q
What is involved in the oral prep stage?
A
- It’s more about feeding
- presentation
- salivating
16
Q
What is the difference between Dr. Carmichael’s oral prep stage and oral stage?
A
- Oral prep stage is more about feeding. How food is presented which causes salivating (salivating is part of oral stage for Dr. Carmichael)
- -Oral stage involves food and drink in mouth.
17
Q
What is the duration of the oral stage?
A
Time varies with bolus consistency.
18
Q
What occurs in the oral stage?
A
- Mastication
- bolus formation
- Bolus transport from the oral cavity to the pharynx
19
Q
What is the duration of the pharyngeal stage?
A
One second
20
Q
Describe what occurs during the pharyngeal stage.
A
- Epiglottis inverts over the laryngeal vestibule.
- larynx and hyoid bone are pulled anteriorly and superiorly to open the pharynx, relax the cricopharyngeus (UES) muscle, and assist the vocal folds in closing off the glottis.
- Bolus is propelled through the pharynx toward teh esophagus by action of pharyngeal constrictors.
21
Q
How is the bolus propelled through the pharynx toward the esophagus?
A
Action of pharyngeal constrictors.
22
Q
What helps the pharynx open, relaxes the cricopharyngeus (UES) muscle, and assist the vocal folds in closing of the glottis during the pharyngeal stage?
A
Larynx and hyoid bone are pulled anteriorly and superiorly.
23
Q
What is the duration of the esophageal stage?
A
About 10 seconds. It’s typically anywhere from 8-20 seconds.
24
Q
What occurs during the esophageal stage?
A
- Bolus flows through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall.
- Relaxation of LES allows bolus to flow into the stomach.
25
What causes the bolus to flow through the esophagus during the esophageal stage?
The peristaltic contractions of striated and smooth muscle along the esophageal wall.
26
What allows the bolus to flow into the stomach during the esophageal stage?
The relaxation of lower esophageal sphincter (LES).
27
Name the people who are part of the multidisciplinary team treating a patient with dysphagia.
- SLP
- Physician/Neurologist/ENT
- Nurse
- Dietician
- OT
- PT
- Radiologist
- Pharmacist
- Social worker
- Psychologist
28
What is the difference between a modified barium swallow study and a barium swallow study?
- MBSS: Done by an SLP who can test a variety of consistencies.
- Barium swallow is done by a gastroenterologist with only barium.
29
What are signs and symptoms of oral or pharyngeal dysphagia? There are 14 bullets.
- Coughing or chocking with swallowing
- Difficulty initiating swallowing
- Food sticking in throat
- Sialorrhea/Xerostomia
- Drooling or spillage
- unexplained weight loss
- Change in dietary habits
- Penetration
- Aspiration
- Recurrent pneumonia
- Change in voice (wet, gurgly voice quality)
- Nasal regurgitation
- Tearing and or/nose running
- sore throat
30
What is sialorrhea?
Too much saliva, but cannot swallow the saliva.
31
What is Xerostomia?
Dry, not producing saliva.
32
What problem does Xerostomia cause in dysphagia?
Dry, not producing saliva. It crates problems during oral and pharyngeal stage because texture will be chalky.
33
Define penetration.
Bolus or part of bolus, even saliva that passes the epiglottis and laryngeal vestibule into larynx, but not beyond the vocal folds. However, it can land on vocal folds.
34
Define aspiration.
Bolus or part of bolus passes the larynx and vocal folds into the trachea.
35
It the bolus passes the level of the vocal folds, is it penetration or aspiration?
Aspiration
36
What can happen if the patient has difficulty swallowing?
It can cause premature spillage during swallow and after swallow.
37
What happens to the pharyngeal stage if the oral stage is prolonged?
The pharyngeal stage won't start.
38
Name the signs and symptoms of esophageal dysphagia. 7 bullets.
- sensation of food sticking in the chest or throat
- chest pain
- oral or pharyngeal regurgitation
- change in dietary habits
- recurrent pneumonia
- reflux
- aspiration
39
Is penetration at 76 normal?
Yes.
40
Penetration at 76 is normal, but what should you do if the patient is 76 and coughing?
Check for aspiration.
41
What should an SLP do if a patient has recurrent bouts of pneumonia?
Do a dysphagia screening.
42
When should an SLP do a dysphagia screening with a patient who has pneumonia?
If the patient has had 2-3 bouts of pneumonia in a year.
43
Recurrent bouts of pneumonia may be a sign that something is happening with ______.
swallowing
44
If the bolus or something got into the larynx and is sitting on vocal folds it may cause your voice to sound ______ and _______.
Wet
| gurgly
45
Why does the voice sound wet and gurgly when bolus sits on vocal folds (penetration)?
Vibration of vocal folds move the mucosal wave.
46
What may cause nasal regurgitation during oral/pharyngeal/oropharyngeal dysphagia?
- velum not closing
| - VP port, UES not working
47
Which nerve is responsible for reflexive cough
Vagus nerve
48
Not everybody has the _____ _______.
reflexive cough
49
What are the signs and symptoms for silents aspiration?
Usually there are no signs or symptoms, but patient may start tearing up when swallowing becomes difficult or patient may have a runny nose.
50
Which is the primary nerve that controls swallowing?
Vagus
51
Dr. Carmichael mentioned a priest that had a car accident and suffered from TBI and a spinal cord injury. She mentioned that the priest would _____ every time he would aspirate.
yawn
52
Define Feeding.
Placement of food in the mouth before initiation of swallow
| Involves the oral prep stage: salivation, presentation
53
Define swallowing.
Transfer of food/drink from mouth to stomach
| It involves the: oral, pharyngeal, and esophageal stage.
54
What is involved in a bedside clinical assessment of dysphagia?
- Medical history
- level of alertness
- patient interview
- oral motor exam
- assess swallow with small bolus
55
What is the duration of a swallow screening?
10-15 minute administration/observation of a small bolus
56
What are the signs and symptoms that an SLP needs to observe during the swallow screening?
- spillage
- oral residue
- long transit time
- cough
- throat clear
- gurgly voice
- tearing
- runny nose
- wrong sound (auscultation)
57
The swallow screening is a _______ tool that can be useful, however, it does not assess _______.
per-diagnostic
| A & P
58
The diagnostic procedure assist in the following ways:
- ID symptoms to explain abnormalities in anatomy or physiology causing dysphagia (etiology)
- Examines physiology: (timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity.)
- Examines immediate effects of tx's.
59
The diagnostic procedure examines the physiology of:
- timing
- tongue base motion
- epiglottic dysfunction
- laryngeal excursion
- UES dysfunction
- peristalsis
- paralysis
- sensitivity
60
List the various imaging diagnostic tools:
- FEES/FEESST
- Videofluroscopy (MBSS)
- ultrasound
- videoendoscopy
- scintigraphy
61
List the various non-imaging diagnostic tools:
- EMG
- EGG
- acoustic (accelerometer or stethoscope)
- pharyngeal manometer
62
List the eight treatments listed on the power point.
1. Diet modification
2. compensatory
3. Maneuver
4. Exercise
5. Stimulation
6. Experimental
7. Prosthetic
8. Surgery
63
What can the diet modification treatment entail?
- volume
- viscosity
- texture
- temperature
- NPO (nothing by mouth)
- NG tube (nasogastric tube)
- G tube (gastrostomy tube)
- PEG (Percutaneous endoscopic gastrostomy)
- J tube (jejunostomy feeding)
- TPN (total perenteral nutrition)
64
Name the positional compensatory strategies listed on the power point.
- posture
- chin tuck
- head rotation
- multiple swallows
65
Name the maneuver treatment strategies listed on power point.
- Supraglottic
- super-supraglottic
- mendelsohn
- effortful
66
Name the exercise treatment strategies listed on power point.
- Shaker
- Masako
- oral muscle strengthening
67
Name the stimulation treatments listed on the power point.
-Thermal/tactile stim
68
Name the experimental treatments listed on the power point.
- Neuromuscular electrical stimulation
- NMES: Vital Stim
- Deep pharyngeal neuromuscular stimulation (DPNS)
- Myofascial release (MFR)
- Botox
69
Name the prosthetic treatments listed on the power point.
- palatal lift
| - orburator
70
List the surgical treatments listed on the power point.
- CP myotomy
- diverticulectomy
- dilation
Dysphagia
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