Neuro Dysphagia Pt 1

Neurogenic dysphagia occurs when there is damage to the…

CNS (brainstem/spinal cord) and/or PNS (efferents, cranial nerves, neuromuscular junction)

How many individuals are affected by neurogenic dysphagia each year

between 300,000 and 600,000

Neurogenic dysphagia results in…

• sensory-motor changes; changes to both sensory and motor

• sensory and motor generally occur together, but can be separate

i.e. aspiration (sensory in trachea not responsive, inadequate muscular function)

Central Etiologies (brainstem/spinal cord)

Non-degenerative

• CVA (Stroke)

• brain injury

• medication

• neoplasm

• Congential CP syringobulbia, arnold chiari malformation)

• Psychogenic

Degenerative

• dementia/AD

• PD and PD+

• MS

• HD

• ALS

Peripheral Etiologies (cranial nerves/ efferent muscular junction)

Myopathy

• polymyositis, dermatomyositis

• Muscular dystrophies

  • OPMD, MD, DMD

Neuropathy

• Guillain-Barre

Latrogenic

• Post-surgery or RT of H&N

Neuromuscular

• MG

• Polio, Post-polio syndrome

Neurogenic dysphagia: Evaluations

• best completed in a multidisciplinary environment (multidisciplinary team; neurologists, nurses, slps etc)

• Sensitivity of BCES ranges from 40-80%; specificity ranges from 59-91%

• Instrumental assessment is invaluable; most often VFS or FEES

Compensatory Treatment

• diet modifications

• postural changes

• prothetics

• sensory input

Rehabilitative/ Restorative Treatment

• range of motion

• strength

• coordination

• endurance

Combined Modality Treatment

compensation + rehab strategies

Normal Oral Prep stage

• food to mouth (sensory and motor)

• lips seal- Orbicularis Oris

• keep bolus from spilling into pharynx- palatalglossus

• bolus formation (mix with saliva)

• Chewing- masseter, temporalis, pterygoids, submentals

Oral prep stage: Disordered

• lack of interest in food following sensory impairments, depression, reduced alertness/consciousness

  • hyperphagia (overeating/over fill the oral cavity)

  • feeding aversion

  • reduced appetite

• motor problems may lead to reduced ability to maintain appropriate position for feeding or difficulty bringing food to the mouth

  • i.e. tremor, drooling, impaired chewing

  • infants may have difficulties in breast feeding