Adult EDS and Dysphagia

These flashcards cover key vocabulary and concepts from the Adult EDS and Dysphagia overview lecture, focusing on the normal swallow and its phases, assessments, and difficulties associated with swallowing.

Normal Swallow

The safe transit of food from the oral cavity to the oesophagus.

3 phases of the normal swallow

1. oral phase 

2. pharyngeal phase 

3. oesophageal phase 

Oral Phase

The first phase of swallowing where voluntary actions like mastication and bolus formation occur. Can be subdivided into: preparatory and propulsion stages

Oral Preparatory Stage

The initial part of the oral phase of swallowing where food is anticipated, saliva is produced and food is chewed/mixed with that saliva to form a cohesive bolus.

Oral Propulsion Stage

The second part of the oral phase of swallowing where the tongue pushes the bolus towards the pharynx, initiating the swallowing reflex.

Pharyngeal Phase

The reflex phase of swallowing, triggered when the bolus reaches the pharynx. Innervated by Glossopharyngeal nerve CN IX and Vagus nerve CN X.

• Soft palate rises to close off nasal cavity

• Epiglottis folds down

• Vocal folds tightly adduct 

• Upper Oesophageal Sphincter relaxesto allow the passage of the bolus into the oesophagus.

Oesophageal Phase

The final phase of swallowing where the bolus is transported down the oesophagus to the stomach via peristaltic contractions and gravity.

Mastication

The process of grinding and crushing food to prepare it for swallowing (chewing)

• tongue keeps food in oral cavity and assists in grinding it

• buccal wall (cheeks) contracts to prevent food from entering space between gum and cheek

• sensory receptors monitor consistency and know when ready to swallow

Bolus

A rounded mass of food that is formed in the oral cavity and transferred to the pharynx.

IDDSI

International Dysphagia Diet Standardisation Initiative, which describes food and fluid consistencies.

Glossopharyngeal Nerve (IX)

The cranial nerve involved in taste and triggering the pharyngeal phase of swallowing.

Vagus Nerve (X)

The cranial nerve that sends signals back to muscles during the pharyngeal swallow.

Facial Nerve (VII) and Glossopharyngeal Nerve (IX)

Involved in sensation of taste:

Facial - anterior 2/3 tongue

Glossopharyngeal - posterior 1/3 of tongue

Suprahyoid muscles

Group of muscles involved in elevating the tongue and hyoid bone during swallowing. Hypoglossal nerve CN XII

Lip Seal

The closure of the lips to keep food contained in the oral cavity during swallowing.

Silent Aspiration

The condition where food enters the larynx without a triggering cough due to reduced sensation.

Postural Adjustments

Adjustments in position that can help compensate for swallowing difficulties.

E.g. chin tuck can manually protect the airway, reducing risk of aspiration if swallow is delayed 

Bedside Swallow Assessment - 3 stages

1. History

2. Oro-motor exam

3. Oral trials

Bedside Swallow Assessment - History

The initial stage of the Bedside Swallow Assessment that involves gathering detailed information about the patient's medical history, previous swallowing difficulties, and any current symptoms related to dysphagia.

Bedside Swallow Assessment - Oral-Motor Examination

An assessment focusing on the status of cranial nerves related to swallowing.

Bedside Swallow Assessment - Oral Trials

The final stage of the Bedside Swallow Assessment where the patient is given various textures and liquids to evaluate their swallowing ability and identify any potential risks of aspiration.

Usually will start with easiest to swallow (e.g. thickened fluid) and move to more difficult textures (e.g. dry biscuit)

Will observe swallow, feel swallow and watch for symtpoms of aspiration (coughing, voice quality, etc)

Oral Propulsion

The act of moving the bolus to the back of the oral cavity to trigger the swallow reflex.

Oral Phase Difficulties - Sensory

Reduced ability to feel food in the mouth, affecting bolus formation.

Compromised ability to hold food in mouth

Oral Phase Difficulties - Motor

Difficulty coordinating muscle movements for swallowing, impacting bolus manipulation and transit.

Oral Phase Difficulties - Saliva Glands

Issues with saliva production, leading to dry mouth and affecting bolus formation.

Pharyngeal Phase Difficulties - Sensory

Delayed swallow trigger. Could be due to CN damage. Risk of aspiration as protections of airway are not in place

Pharyngeal Stage Difficulties - Motor

Reduced laryngeal movement may lead to bolus not being fully clear from pharynx in one swallow so when airway reopens, food still in larynx

Videofluroscopy

A radiographic procedure used to evaluate swallowing function by visualizing the movement of food and liquid through the oral and pharyngeal phases.

Laryngeal Palpation

Technique used during a bedside swallow evaluation to assess laryngeal movement.

IDDSI Level 3

Liquidized foods that are smooth and lump-free, requiring no chewing.

IDDSI Level 4

Pureed foods that are smooth, without lumps, with a texture similar to extremely thick drinks.

IDDSI Level 5

Minced and moist - Foods that are minced into small, moist pieces that can be mashed with the tongue. 

IDDSI Level 6

Small and bitesized - Foods that are soft and can be easily squashed but still have a defined shape. 

IDDSI Level 7

Level 7 - Easy to chew - Foods that are easy to chew and swallow, with no hard, tough, or sticky parts. 

Level 7 - Regular

IDDSI Levels 0-3 

For drinks: 

Level 0 - Normal

Level 1 - Slightly thick
Level 2 - Mildly thick

Level 3 - Moderately thick