NEURO EXAM 3 - DYSPHAGIA

what constitutes an efficient swallow?

food transferred to stomach without residue

normal swallows are ____ and _____

safe and efficient

Dysphagia is a difficulty/inability during swallowing.

What aspects of swallowing does this include? (9)

• biting

• chewing

• oral containment

• swallowing

• airway protection

• timing

• strength

• endurance

• coordination

What are the consequences of dysphagia?

• aspiration

• nutrition/hydration issues

• decreased enjoyment

• social consequences

symptoms of dysphagia

• perception of an issue

• choking, coughing, gagging

• refusing to eat

• weight loss

• drooling

• gurgly sounding breathing

• food build-up in mouth

• respiration issues

silent aspirator

a patient with dysphagia with no visible symptoms

causes of dysphagia (categories)

• normal aging

• structural

• neural

• cognitive

• medications

• other causes

laryngeal vestibule

space directly above vocal folds

Why are SLPs involved in dysphagia?

Speech and swallowing share structures and often co-occur.

What is the role of the cheeks in swallowing?

Prevent food from entering buccal cavity and assist with sucking by compressing inward.

What does the tongue do during swallowing?

Lateralizes food, forms bolus, maintains posterior seal with soft palate, and propels bolus against hard palate.

What is the hyoid bone’s role in swallowing?

Moves up and forward, pulling the larynx up/forward to aid airway protection.

What are the valleculae?

Space between base of tongue and epiglottis.

What are the pyriform sinuses?

Spaces between pharyngeal walls and thyroid cartilage.

What is the laryngeal vestibule?

space above the vocal folds

What happens during the oral preparatory phase?

Labial seal, chewing, bolus formation, open nasal airway.

What happens during the oral phase?

Tongue propels bolus posteriorly toward pharynx.

What are the key events in the pharyngeal phase?

velum elevates, larynx elevates/anteriorly moves, VFs close, epiglottis inverts, pharyngeal contraction, UES relaxes.

What happens in the esophageal phase?

Bolus moves to stomach; larynx returns to rest; breathing resumes.

What are the main components of a dysphagia assessment?

chart review, patient interview, oral mech exam, clinical swallow evaluation, and possibly instrumental exam

What are three signs of dysphagia on a bedside exam?

Delayed swallow, coughing, no laryngeal movement, wet voice, poor coordination, muscle weakness/droop.

Why can dysphagia not be diagnosed based on a bedside exam alone?

A bedside exam cannot visualize the pharyngeal or esophageal phases.

What is an MBS/VFSS?

• A real-time fluoroscopic exam of all swallow phases using barium

• gold standard

When should an MBS be done?

When bedside exam is inconclusive, pharyngeal/esophageal dysphagia is suspected, or signs of aspiration persist.

What is penetration?

Bolus enters the laryngeal vestibule to the level of the vocal folds

What are residue, vallecular residue, and pyriform residue?

Material remaining in valleculae or pyriform sinuses after the swallow.

Name a contraindication for MBS.

Medically unstable, cannot be positioned, excessive size for equipment, allergy to barium.

What is FEES?

A fiberoptic exam through the nose allowing direct view of pharynx/larynx during swallowing.

When is FEES preferable?

When transport is difficult, radiation is a concern, or positioning in fluoroscopy is not feasible.

Difference between compensatory and rehabilitative strategies?

Compensatory improves safety/efficiency without changing physiology; rehabilitative changes physiology through exercises.

Give two compensatory strategies.

Chin tuck, head turn, thickened liquids, small bites, slow rate, bolus hold.

Give two rehabilitative strategies.

Effortful swallow, Mendelsohn maneuver, Masako, Shaker/head lift.

what is the goal of the Mendelsohn maneuver?

Prolong laryngeal elevation and increase UES opening.

What is the purpose of thickened liquids?

Slow bolus flow to reduce risk of aspiration.

What is IDDSI?

A global standardized framework for describing food/liquid consistencies.

What are the IDDSI levels?

0–7

0 is thin liquids

1–4 are increasing thickness

3–7 include food textures from

liquidized → pureed → soft → regular.