Dysphagia 101

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					Dysphagia 101

      For Therapists New to
      the Clinical Setting.
Question:
Anatomy of the swallow


Oral Cavity
Pharynx
Larynx
Esophagus
Physiology of the swallow

5 phases of the swallow.

Anticipatory Phase: CN Trigeminal (V)
Oral Prepatory Phase: CN Facial Facial Nerve (VII),
  Trigeminal (V) and Spinal Accessory (XI).
Oral Phase: CN Glossopharyngeal Nerve (IX), Vagus
  (X), and Spinal Accessory (XI)
Pharyngeal Phase: CN Glossopharyngeal (IX), Vagus
  (X), Spinal Accessory (XI) and Hypoglossal (XII).
Esophageal Phase: Vagus (X).
Oral Structures and Function

Lips              Posterior Pharyngeal Wall
Jaw               Valleculae
Cheeks            Pyriform Sinus
Teeth             Epiglottis
Tongue            Larynx and Hyoid Bone
Salivary Glands   Vocal Folds
Soft Palate       Cricopharyngeus Muscle
Diagram of the swallow
Dysphagia:                        is the medical term for the symptom of difficulty in
swallowing. It derives from the Greek root dys meaning difficulty or disordered, and

phagia meaning "to eat".




                             Dysphagia Team
“Golden Ticket” – Certified Nursing Assistants.
  Nurse
  Doctor
  Dietician
  Physical Therapy
  Occupational Therapy
  Speech Therapist
  Family
  Patient
Referral Process
Documentation for difficulty
Concerns communicated
ST Screen
Physicians Order
Bedside Swallow Evaluation
Oral Phase
* drooling
*oral spillage
*residuals in lateral sulci
*scattered lingual residuals
*nasal regurgitation
*increased oral prep and oral transit.
*decreased or absent gag reflex
*mashing chewing pattern
*pumping tongue movement
Pharyngeal Phase
*Delayed initiation of the swallow
*Wet voice
*Cough before, during or after the
swallow
*Absent swallow reflex
*Reduced laryngeal elevation
Esophageal Phase
*Regurgitation
*Patient complains of food
sticking high in throat.
* Pain in the chest when they
swallow, other reflux signs.
Bedside Swallow Evaluation


 History and Chart Review
 Oral Motor Exam
 Deglutition: PO Trials
Interpreting Results
Referrals: GI, ENT, VFSS, FEES
MDT Discussion
ST Clarification: Diet level,
supervision, feeding, medicine
administration, precautions.
Treatment Strategies

 Oral Phase
 Pharyngeal Phase
Diagnoses Affecting Swallowing

 Stroke
 Head Trauma
 Cerebral Palsy
 ALS
 MS
 Parkinson’s Disease
 Cerebellar Degeneration
 Myotonic Dystrophy
 Oculopharyngeal Dystrophy
 Lateral MedullarySyndrome (Wallengberg’s)
Case Studies
   CVA

   Dementia
Pediatric Swallowing Diagram: The tongue fills the oral cavity,
the fat pads in the cheeks narrow the oral cavity laterally, and
the hyoid bone and larynx are much higher than in adults.
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posted:11/24/2011
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