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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