slh - dysphagia and motor speech

dysphagia

difficulty swallowing

dysarthria

weakness, difficulties with coordination, mushy sounding speech, drooling

apraxia

neurological, difficulties with motor planning

epiglottis

structure that closes over larynx for protection during swallowing

vallecula and pyriform sinus

structures in throat that catches things when swallowing

issues in oral preparatory stage

• chewing - weakness and incoordination

• bolus formation - pocketing (getting stuck in cheeks or under tongue) or piecemeal deglutition (swallowing before ready)

issues in oral stage

• moving food toward pharynx

• piecemeal deglutition (swallowing before ready)

• premature spillover (coming down before ready)

• nasopharyngeal leakage (goes up nose)

issues with pharyngeal stage

• moving food from tongue base toward esophagus

• most dangerous

• spillover to pyriform sinus and valleculae

• laryngeal penetration

• aspiration and silent aspiration

issues in esophageal stage

• reflux

• addressed by ENTs

assessment for dysphagia

• case history

• oral mechanism/positioning review

• cognitive and communication screening

• laryngeal function

• modified barium swallow test

• fiberoptic endoscopic evaluation of swallowing

modifies barium swallow test (MBS)

shows where someone may have difficulties swallowing

fiberoptic endoscopic evaluation of swallowing (FEES)

used to assess swallowing when MBS is not possible

treatments for dysphagia

• food texture modification

• body and head positioning

• environmental modifications

• placement in mouth

• bolus size

• oral motor exercises

• swallowing strategies

compensatory swallow strategies

• supraglottic swallow, mendelsohn maneuver, effortful/double swallows, masako maneuver