copyright © 2008 delmar. all rights reserved. unit ten dysphagia

Copyright © 2008 Delmar. All rights reserved.

Unit Ten

Dysphagia


Chapter 40

Normal Swallow

Function and Dysphagia


3

Dysphagia

• Difficulty swallowing that occurs when impairments affect any of the four phases of swallowing that puts a person at risk for aspiration


4

Dysphagia

• Team approach is required: – SLP– Dentist– Dietician, PT, RT, OT, ENT– Neurologist– Gastroenterologist– Pharmacist


5

Four Phases of the Normal Swallow

• Oral preparatory phase

• Oral phase

• Pharyngeal phase

• Esophageal phase


6

Oral Preparatory Phase

• Thinking about food/liquid and how to get it to the mouth

• Chewing the food in our mouth


7

Oral Phase

• Begins when chewing stops

• Tongue pulls the food to the back of the mouth

• Takes one second


8

Pharyngeal Phase

• Bolus contacts anterior faucial pillars and initiates the swallow response

• Soft palate rises

• Peristalsis moves the bolus down

• Vocal folds close tightly

• Esophageal sphincter pulled open


9

Esophageal Phase

• Bolus carried to lower esophageal sphincter to enter stomach


10

Oral Preparatory Phase Problems

• Decreased awareness of food

• Difficulty holding food in mouth

• Pocketing food in cheeks

• Premature spillage of food into airway


11

Oral Phase Problems

• Anterior spillage

• Premature spillage into airway

• Difficulty moving bolus back towards pharynx


12

Pharyngeal Phase Problems

• Delayed swallow response

• Impaired coordination of oral and pharyngeal structures

• Weak elevation of velum

• Inadequate closure of vocal folds


13

Esophageal Phase Problems

• Upper esophageal sphincter does not open

• Slow or absent esophageal peristalsis


14

Penetration and Aspiration

• Penetration – Material enters larynx and remains above

the vocal folds

• Aspiration – Material goes below level of the vocal folds


15

Aspiration Pneumonia

• Acute inflammation caused by material entering the lungs through the airway

• Symptoms include spiked temperatures, myalgia, and productive cough


Chapter 41

Diagnosis of Dysphagia


17

Evaluation of Adults

• Review medical chart

• Screen patient– Behavioral observations– Interview– Check for protective cough


18

Bedside Evaluation

• Evaluate all speech systems

• Patient drinks and eats selected consistencies of liquids and food

• Monitor for signs of aspiration– Coughing, wet voice quality


19

Modified Barium Swallow Study

• “Gold standard” of instrumental assessment

• A dynamic imagining of the bolus from entering the mouth to entering the stomach


20

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)• Provides information about pharyngeal

phase

• Endoscope is passed through nose into nasopharynx

• Laryngopharynx can be viewed while patient eats


21

Ultrasound Imaging

• Noninvasive imaging that uses sound waves to view the oral and laryngeal structures


22

Evaluating Infants and Children

• Review medical chart

• Assess postural control and muscle tone

• Note respiratory function/endurance

• Evaluate oral structures

• Complete feeding/swallowing evaluation

• Instrumental assessment


Chapter 42

Treatment of Dysphagia


24

Feeding Environment

• Environment for eating will affect the experience with meals

• SLPs can be limited in modifying many aspects of the hospital environment and its distractions


25

Textures and Consistencies of Food and Liquid

• Foods• Regular• Dysphagia -

advanced• Dysphagia -

mechanical soft• Dysphagia pureed

• Liquid• Thin• Nectar-like• Honey-like• Spoon-thick


26

Postural Techniques

• Chin-tuck (down)

• Head rotation

• Head tilt


27

Oral-Motor Exercises

• Can help increase muscle tone and strength


28

Swallow Maneuvers

• Used for the pharyngeal phase:– Double or dry swallow– Effortful or hard swallow– Supraglottic swallow– Mendelsohn maneuver– Thermal/tactile stimulation


29

NPO – Nothing by Mouth• Patients who cannot eat orally receive

nutrition through entereal feeding:– Nasogastric (NG) tube – Gastrostomy tube (G-tube)– Percutaneous endoscopic gastrostomy

(PEG) tube


30

Goals of Treating Infants and Children

• Promote adequate nutrition and hydration

• Develop age-appropriate feeding skills


31

General Areas of Management for Children

• Establish optimal feeding readiness

• Organize oral feeding

• Establish nonnutritive suck

• Establish external pacing

• Establish optimal position


32

General Areas of Management for Children

• Develop oral stimulation program

• Reduce oral aversion

• Alter consistency, taste, temperature

• Develop chewing skills

• Choose feeding utensils


Chapter 43

Emotional and

Social Effects of Dysphagia


34

Emotional and Social Effects

• Eating is a a social event

• Diet modifications can reduce enjoyment of eating and affect quality of life


35

Emotional and Social Effects

• Anxiety

• Depression

• Grief

• Embarrassment

• Sense of loss

copyright © 2008 delmar. all rights reserved. unit ten dysphagia

Documents

aspiration slide

mouth slide

airway slide

open slide

stomach slide

pharynx slide

diagnosis of dysphagia

esophageal phase bolus