Feeding Disorders

deglutination

swallowing

dysphagia

swallowing disorder

oral-motor sensation

awareness and sensitivity to taste, temperature, texture of liquids, and semi-solids/solids

oral-motor movements/function

strength and coordination of muscle movements

goal

move the bolus, in stages, to the esophagus

bolus

whatever it is that you are swallowing (move from front to back of mouth)

phases of a normal swallow

oral preparatory phase, oral phase, pharyngeal phase, and esophageal phase

oral preparatory phase

acquire and organize the liquid, semi-solid, or solid

soft palate lowers to contain the bolus until ready

saliva breaks down substance and lubricates

mastication/chewing if needed

mouth open, insert food, contain it with lips and velum, use tongue and teeth to break down bolus

oral phase

tongue strips material and compresses via buccal muscles

tongue moves the bolus to the rear of the oral cavity

pharyngeal phase

pressure squeezes the bolus toward entrance to esophagus…cricopharyngeus opens passage to esophagus

largely reflexive…posterior pharyngeal wall and back of tongue press the material

safety mechanisms: soft palate prevents entrance into nasopharynx, larynx moves forward and up to protect airway, epiglottis hinges over glottis, apneic movement, and fail safe

forward and up

how does the larynx move during the pharyngeal phase to protect the airway?

apneic movement

respiration suspended; NO BREATHING

fail safe

cough

when something enters the larynx that doesn’t belong there (like something you want to eat), in timing or movement

survival (protection of the airway)

what is the primary function of the larynx?

esophageal phase

automatic - pharyngeal constrictors…superior, middle, and inferior

squeeze involuntarily when you swallow to move the bolus down the esophagus

goal

safely transfer food or liquid from the front of the mouth into the esophagus

etiology of acquired dysphagia

stroke (sudden), TBI, and degenerative disorders like parkinsons, ALS, and MS

long history of food preferences, family traditions, and cultural factors

what do you consider in adults with acquired dysphagia?

assessment

includes case history, oromotor exam of structure and function, and various instruments

clinical red flags

coughing and gagging, spitting out food, resisting touch around oral structures, crying during eating, and gurgly “wet” voice quality (like liquid is getting in the way)

instruments

FEES, videofluoroscopy, and ultrasound

FEES - fiberoptic endoscopic examination of swallowing

camera at the end of a flexible tube that is passed through the nose, down the throat, to view the larynx

no radiation involved

looking down at the larynx

videofluoroscopy/MBSS - modified barium swallow study

radio-opaque material (barium) mixed with foods (to watch what happens when you swallow)

patient fed while video x-ray is taken

penetration of liquids, soft solids, and solids

what does videofluoroscopy/MBSS assess for?

aspiration pneumonia

what does penetration lead to?

when bolus penetrates laryngeal space

how can aspiration pneumonia occur?

ultrasound

sound waves creates picture, best, of oral structures

treatment

to compensate and restore

compensate

modify diet texture and temperature changes (NPO to unrestricted), positioning (chin tuck) to reduce chance of aspiration, intake modified via placement in oral cavity (bite size, swallow between every bit, etc), and meal set-up (minimize distractions, adaptive equipment, monitor, etc)

restore

biofeedback, thermal stimulation, mendelsohn maneuver, and oral motor exercise

biofeedback

increase awareness of sensations and movement

thermal stimulation

cold is easier to swallow than room temperature or warm

mendelsohn maneuver

pause during elevation of larynx

oral motor exercise

never for speech (same structure, different function)

work different structures

conclusion

places, people, and events associated with eating, need to nurture, holidays, need to be nurtured, safe child care, and sense of loss in adults