Chapter 18: Swallowing Disorders/Dysphagia

• Dysphagia (swallowing disorder): difficulty swallowing that occurs when impairments affect any of the 4 phases of swallowing, puts a person at risk for aspiration of food and/or liquid, potential aspiration pneumonia
• Aspiration: food or liquid entering the lungs
• Aspiration Pneumonia: acute inflammation of the lungs caused by foreign material entering lung tissue & resulting in infection
• Incidence of dysphagia post-stroke = 60-75%
• People swallow 600 times per day
• Four Stages of Swallowing: Oral Preparatory Phase, Oral Phase, Pharyngeal Phase, Esophageal Phase.
• Oral Preparatory Phase: masticating food. Soft palate moves down to protect airway
• Oral Phase: Begins when chewing stops. Tongue tip elevates to touch alveolar ridge, pull food to back of the mouth toward pharynx. Soft palate moves up to prevent nasal regurgitation. Takes 1 sec
• Pharyngeal Phase: All occur in 1 second. 1) Pharyngeal peristalsis, contraction of muscles to move bolus downwards. 2) Larynx moves up, causing epiglottis to drop down over larynx to prevent bolus from entering airways (aspiration). 3) Upper esophageal valve relaxes & opens, allowing food to enter esophagus. 4) larynx lowers, epiglottis back in natural position, soft palate opens for breathing
• Esophageal phase: esophagus muscles contract, move food down to lower esophageal valve which opens allowing food to enter stomach
• Silent Aspiration: penetration of food or liquid into the larynx and passing below vocal folds without protective cough or choking
• Esophageal peristalsis: coordinated contraction wave that travels length of esophagus
• Modified Barium Swallow Study (MBSS): moving xray procedure used to examine swallowing process, watching from bolus entering mouth to stomach
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES): endoscope enters thru nasal passageway into nasopharynx to view laryngopharynx and patient is asked to swallow food that has been dyed green
• Best practices: procedures based on the best available evidence
• Treatment effectiveness: extent to which services are shown to be beneficial under typical conditions
• Treatment efficacy: extent to which intervention can be shown to be beneficial under optimal conditions
• Compensatory Treatment Techniques: help optimize patient's ability to use their current swallowing abilities. Includes postural techniques and food placement.
• Facilitation Treatment Techniques: improve function of swallowing mechanism. Oral-motor exercises, holding breath, etc.
• Diet Modification Techniques: Foods (regular, advanced, mechanically altered, pureed). Liquids (thin, nectar-like, honey-like, spoon-thick)
• Nothing By Mouth (NPO): patient prohibited from orally ingesting food, beverage, or medicine orally.
• Enteral Feeding: feeding/hydration thru tube feedings from nose or stomach
• Bioethics: attempt to understand and resolve ethical issues and problems in a healthcare setting
• autonomy: respect for patient's right to determine their own healthcare decisions