Disorders of Swallowing

Dysphagia

refers to the variety disorders that occur when person attempts to ingest/ swallow food or liquids\

→ Ingest:bring food, liquids, medications, saliva to the mouth/bolus

→ Swallow: attempt to move food , liquid from mouth to pharynx in preparation to enter the esophagus

Stages of Swallow ( 4)

Anticipatory Stage: sensory stimulation factors (aesthetic appeal), motivational l factors (hunger, integrity of upper extremity motor skills)

→ Oral preparatory stage: bolus formation , breakdown the ingested material (chewing)

→ Oral stage: bolus transit from the front to the back of the mouth before it enters the pharynx

→Pharyngeal Stage: material enters the pharynx and travels to top of esophagus, involuntary actions occur ( action of larynx, epiglotis) protective funtion ( penetration: material passes through the VFs; aspiration: continued movement of food into lungs; aspiration pneumonia: potentially life threatening condition, due to entry of foreign material and bacteria

→ Esophageal stage: material enters esophagus and then travels to stomach for digestion, involuntary not managed by SLP but rather medically managed through meds

Pediatric Dysphagia

Infants and children with dysphagia can result in inadequate growth, I'll health, fatigue, diffuclty learning, impaired parent child relationship which can negatively affect their development and overall quality of life.

Main Causes of PD

CP, Spina Bifida, MR and Cevelopmental Delay, PDD and Autism, HIV/AIDS

Spina Bifida

Congenital malformation of the spinal column that is commonly associated with brain damage /results in sensory and motor problems which can affect one or more stages of swallowing

MR and Developmental Delay

Delayed motor skills (affects more than 1 stage of Swallow) , delayed communication skills (difficult to inform people of their food preferences, hunger; can result in nutrition and hydration problems)

PDD and Autism

Characyerized by social withdrawal, communication impairment, and repetitive behaviors, difficulties in posture and tone , hypersesitivities to sound, light, pain, smell, touch, all of this contributes to many possible complex causes for dysphagia

HIV/AIDS

exposed to in uterus, results in surpressed immune system, mouth soreness from oral herpes ( very painful = reduced food intake); may also result in other problems (MR, language and motor impairments)

Structral and physiological anomalies

cleft lip or palate, pierre Robin syndrome ( congenital abnormalities of the jaw); treacherous Collins syndrome (congenital abnormalities of the face); esophageal atresia (esophagus doesn't have open connection to the stomach) pyloric stenosis ( the pyloric sphincter ( outlet of stomach) narrow so that food cannot pass into small intestine)

10 main causes of adult dysphagia

Stroke, Cancer of the mouth/larynx, HIV/ AIDS, MS/ ALS, PD, Silent aspiration, Spinal cord injury, medications and non-food substances, dementia, depression and isolation

Stroke

10 - 20% of stroke victims have dysphagia during the first 8 months pst; after that 5 -10% continue having dysphagia problems

Cancer of mouth/throat/larynx

swallowing impairments may be caused by surgical treatments which indicate severe dysphagia, radiology (reduced saliva) swelling of mouth/ mouth sores, and chemotherapy 9 vomiting, appetite loss)

HIV/AIDS

immunity is suppressed do more vulnerable to infection , oral herpes

MS/ALS

ms = reduced muscles strength & coordination; ALS = progressive motor disorder that greatly impacts muscles for speech and swallowing , likely develop dysphagia severe enough for feeding tube

PD

progessive motor disorder , ocuurs during midlife, results in slowness of movements, muscle rigidity, tremor ( can result in severe dusphagia)

Silent aspiration

aspiration with no overt signs (coughing, clearing throat)

Spinal Cord Injury

higher incidence of esophageal dysphagia resulting in heartburn, chest pain and slow abnormal peristaltic movement of the esophagus ( Treatment: surgery of the front portion of the upper anterior cervical spine)

Medications & non-food substances

side effects of meds may negatively impact swallow ( insufficient saliva, drowsiness /nonalert); causing permanent involuntary movements ( tardive dyskinesia : caused by medication for neuropsychotic difficulties)

Dementia

Cognitive (attention to environment ) ; memory, motor disorders ( develop with progression of disease)

Depression and Isolation

serious problem in geriatric population ; may result in lack of interest in food and fatigue; not organic, yet negatively impacts caloric intake