Swallowing difficulty in neuromuscular disorders by sammyc2007

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									Swallowing difficulty
in neuromuscular
disorders
             Aziz Shaibani, MD, FACP
             Nerve & Muscle Center of Texas




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             Objectives

                To familiarize you with the
                 symptoms .
                To provide you with hints to
                 improve them.
                When to seek medical
                 advice

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             Physiological facts

                We swallow 600 times a
                 day
                We produce 1-1.5 liters of
                 saliva a day




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             Normal Swallowing

                Chewing
                 (to prepare the bolus)
                Swallowing
                Digestion



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             Normal swallowing
                Oral phase: tongue thrust against
                 the palate: 2 seconds, nasal cavity
                 closes
                Pharyngeal phase: one second:
                 larynx closes
                Esophageal phase: 10 seconds:
                 the airway reopens



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             Causes of dysphagia
                Oral weakness:
                    nasal regurgitation, drooling
                Pharyngeal weakness:
                    aspiration, chocking, death
                Esophageal weakness:
                    regurgitation



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             Neuromuscular
             causes
                Polymyositis, DM, IBM
                Myasthenia gravis
                Muscular dystrophy
                Spinal muscular atrophy
                ALS



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             Dysphagia
             consequences
                Malnutrition & dehydration
                Aspiration and pneumonia
                Social isolation




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             Symptoms deserve
             formal dysphagia
             evaluation
                Coughing / chocking
                Recurrent pneumonia
                Involuntary weight loss:
                    may be the first sign
                Prolonged eating time
                Voice change after eating



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             Evaluation

                Mouth examination
                Tongue and palate
                Gag reflex
                Modified barium swallow



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             Treatment

                Lip, tongue exercises, chewing
                Hold breathing during
                 swallowing
                Change food consistency
                Six small meals a day



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             Treatment

                Change head position
                PEG: the sooner the better
                Medications
                Cricopharyngeotomy




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