Detailed Study Notes on Swallowing Impairments from Cadaver Lab Lecture

Cadaver Lab Overview

  • Computer Issues: The speaker faced technical difficulties due to an update on their computer, which led to frustration during the class.

Importance of Health Communication

  • Health Person Contact: The speaker encourages students to contact health personnel for inquiries as they are knowledgeable and have good examples.

Overview of Swallowing Impairments

  • Focus: Today’s lecture will mainly focus on oral impairments related to swallowing.

  • Common Causes of Dysphagia:

    • Neurological Problems:

    • Stroke

    • Parkinson’s disease

    • Amyotrophic lateral sclerosis (ALS)

    • Myasthenia gravis

    • Multiple sclerosis (MS)

    • Surgical Complications (e.g., Trauma, TBI)

Risk Factors for Dysphagia

  • Age: Increases risk of swallowing disorders.

  • Neurological Conditions: Autoimmune disorders affecting swallowing.

  • Pulmonary Issues: Particularly with Chronic Obstructive Pulmonary Disease (COPD).

  • Oncology Specialization in Head and Neck Cancer: Extensive related treatments observed in practice.

  • Gastroesophageal Reflux Disease (GERD): Related complications discussed later.

  • Medication Side Effects: Certain drugs can exacerbate swallowing issues.

  • Oral Health: Poor oral health is a risk factor; a future lecture will cover this.

  • Structural Abnormalities:

    • Tumors or growths in the oral cavity leading to strictures or diverticula.

    • Strictures: Narrowing of the esophagus complicating bolus transport.

    • Diverticula: Pouches that can trap bolus, affecting swallowing.

Radiation Therapy Risks

  • Acute Toxicities: Side effects occurring during treatment (e.g., edema).

  • Late Effect Toxicities: Occur years post-treatment, including fibrosis leading to long-term swallowing difficulties.

    • Impact on Structures: Movement of the hyoid and larynx is compromised due to thickened tissues caused by radiation.

  • Patient Education: Importance of informing patients about the potential for dysphagia years after cancer treatment.

  • Exercises: Recommended to maintain swallowing function, termed prophyactic exercises, preemptively suggested for patients.

Pulmonary Issues Related to Swallowing

  • Lung Transplant Cases: Many experience dysphagia pre- and post-surgery; evidence gathered from a research study in a hospital setting leading to standard care protocols.

  • Aspiration Pneumonia: Linked to dysphagia due to aspiration of food into the lungs, causing pneumonia.

Globus Sensation

  • Concept: A sensation of something being lodged in the throat, often without any physical obstruction.

    • Causes: Can be psychological or a result of a prior choking experience leading to fear of swallowing.

    • Assessment Techniques: Instrumental assessments may show normal swallowing function despite complaints.

Psychogenic & Rare Dysphagia Cases

  • Psychogenic Dysphagia: Rare conditions with no identifiable cause despite complaints of swallowing disorders.

Temptation of a Treasure Hunt

  • Upcoming Activity: A hands-on approach to understanding swallowing physiology will involve assessments and interactive learning.

Reduced Lip Closure

  • Observations:

    • Anterior food loss when lips cannot close.

    • Excess oral residue and drooling as symptoms.

  • Possible Causes: Neurological deficits impacting muscle control or sensory deficits due to reduced sensation in the oral area.

Premature Spillage and Bolus Control

  • Premature Spillage: Occurs when the liquid or food starts to descend before the swallow is initiated, risking aspiration.

  • Neurological Conditions: Often connected to issues in coordinated tongue movement, especially in stroke patients.

Glossectomy

  • Definition: Surgical removal of the tongue (partial or complete).

  • Impact on Swallowing: Affects range of motion and functional swallowing capabilities.

Disorganized Tongue Movements & Timing Issues

  • Repetitive Tongue Rocking: Common in patients with Parkinson’s due to impaired fine motor movements.

  • Incomplete Oral Sensation: Can delay the initiation of swallowing if patients cannot feel the bolus, leading to risks for aspiration.

Conclusion of Key Points

  • Patient Cases: Important to consider individual physiological conditions, patient motivation, and support systems in treatment plans.

  • Standard Care Changes: Facilities may differ in protocols, always keeping abreast of the latest research is essential for effective treatment.

  • Instrumental Assessment: The importance of using MBSImp to evaluate swallowing capabilities accurately.

Further Discussion

  • Next Lecture: Solidifying understanding of swallowing impairments using patient examples during future sessions.

  • Questions from Participants: Acknowledge interactions and encourage student engagement for clarity and deeper learning.