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Dysphagia CSD

Test 2

Increase in number of chewing strokes, especially with dentures Changes in adult swallow: chewing
Calcification of the thyroid and cricoid cartilages and hyoid bone Changes in adult swallow: calcification
Decreased pharyngeal constriction causing need for second swallow Changes in adult swallow: pharyngeal constriction
Increased use of dipper swallow Changes in adult swallow: swallow
Longer oral phase and delay in pharyngeal swallow Changes in adult swallow: oral phase
Increase in penetration of laryngeal vestibule but no aspiration Changes in adult swallow:laryngeal vestibule
Esophageal transit time is slower Changes in adult swallow: esophageal transit time
Cricopharyngeal opening less flexible Changes in adult swallow: cricopharyngeal
Reduction in reserve of neuromuscular control increasing risk of problems from becoming ill Changes in adult swallow: neuromuscular
Chemical sense in the oropharyngeal region activated during eating and drinking Taste
Reduced with age, affected in trach patients, affected in head and neck cancer patients Taste
airway closure during the swallow when there is no respiration during the pharyngeal swallow. Duration increases as bolus volume increases Apenic period
Interruption of the apenic phase occurs during exhalation and the patient returns to exhalation after swallow Predominant pattern of swallow respiration
Allows airflow through larynx after the swallow to clear residue, dysphagic patients often inhale during swallow Coordination of respiration and swallowing
Changes in bolus volume Creates greatest change in swallow
Normal oral phase, pharyngeal phase, esophageal phase Small bolus 1-3ml
simultaneous oral and pharyngeal activity, tongue base retraction occurs later in the swallow Large bolus 10-20ml
Tongue base and pharyngeal wall make contact when the bolus reaches the tongue base to generate pressure All volumes of bolus
Early airway closure and pre elevation of the larynx as the cup is approaching the lips; closure extends across the swallow, can last 5-10 seconds Sequential cup drinking
Velopharngeal area is closed, lips maintain a seal around the cup, oral tongue repeatedly propels liquid, tongue base and pharyngeal wall make contact, UES opens repeatedly, difficult for patients with dysphagia Sequential cup drinking
Bolus is brought into the mouth via suction created in the oral cavity Straw drinking
Soft palate is lowered against the back of the tongue, muscles of the cheek and face contract, suction is discontinued when material reaches the mouth. Palate elevates and the oral stage begins Creating suction
Pull the larynx forward to upper UES volitionally, hold their breath to close off the airway at the larynx, dump material through oral cavity and pharynx into the esophagus Chug-a-lug
Secretions build up in the valleculae and pyriform sinuses,no oral swallow, volitional control over pharyngeal swallow No oral swallow
Oral propulsion of the bolus into the pharynx, airway closure, UES opening, tongue base propulsion to carry the bolus through the pharynx into the esophagus Component of the all swallows
Pattern ellicited response Swallow
Triggered by a noxious substance touching the back of the tongue, pharynx, or soft palate. Controlled by the brain stem Gag reflex
Provide a picture of the swallow Imaging studies
Do not provide a picture Non imaging studies
Can be used to measure tongue function, oral transit time, motion of the hyoid bone. Cannot visualize the pharynx, used for the oral stage only Ultrasound
Used to study the anatomy of the oral cavity and the pharynx from above, pharynx and larynx before and after, uses a flexible scope placed through the nose to the soft palate, does not visual the oral cavity. Videoendoscopy
Can assess velopharngeal closure, inward movement of the later/posterior pharyngeal walls, elevation and retraction of the soft pallate, location of residual food, epiglottis, airway entrace, valleculae, aryepiglottic folds, pyriform sinuses Videoendoscopy (FEES-Flexible fiberoptic examination)
Pharynx closes around the endoscope during the pharyngeal swallow blocking the view Videoendoscopy
Provides info on bolus transit time, motility problems, amount and etiology of aspiration. Enables visualization of oral activity, triggering of the pharyngeal swallow, motor aspects of swallow. Videoendoscopy
Nuclear medicine test when the patient swallows radioactive material, bolus is recorded by gamma camera, allows aspiration to be measured, does not give info about the physiology of the mouth and pharynx Scintigraphy
Provides info on timing and amplitude of muscle contractions, used as a biofeedback tool for Mendelsohn maneuver Electromyography
Try to control muscles that are normally involuntary Mendelsohn Maneuver
Designed to track vocal fold movement by recording impedance changes as the vocal folds move toward and away from each other during phonation Electroglottography
Records sounds of the swallow-click with the opening of the eustachian tube and a clunk for the opening of the UES using a stethoscope Cervical Auscultation
Sensors are placed at the tongue base, UES, and cervical esophagus to measure intrabolus pressure, timing of the contractile wave, relaxation of the cricopharyngeal muscle. Used with videofluoroscopy Pharyngeal Manometry
Gives evidence of swallowing disorder but not physiology, identifies signs and symptoms Screenings
May be performed by nursing, at the bedside, may be limited to a chart review. Should be quick, low cost, and low risk. Should have minimal false positives Screenings
Time swallow test, 3oz water test Types of screenings
Eating is seen as dangerous and not a means for survival in adults with delay and children Rejection of food
Limit intake to certain foods, tastes, temperatures,or consistencies Food selectivity
May indicate hypersensitivity or abnormal oral sensation Gagging as food is placed in the mouth
Inability to recognize food Tactile agnosia
Mouth is open during eating, assess upper airway to make sure nasal breathing is possible Open mouth posture
Recommend no eval or a formal swallow eval At the end of the screening
history,medical status, structure of the oral cavity, respiratory function, labial control, lingual control, palatal function, pharyngeal wall contraction, laryngeal control, cognitive status, reaction to changes, alertness, and ability to participate Bedside Swallow eval purpose
Current and past medical history, medications, swallowing history, airway device, oral nutrition Chart review
Check with nursing, check for previous MBS, check diet, check for order in the chart, check for living will Chart review
See if the patient is alert, patient's reaction to therapist, trach tube, secretions, interest in food, types of food Entering the room
Timing of swallow, inhalation after swallow, swallow coordination, coughing, how long they can hold their breath, breathing pattern at rest, ventilator Respiratory Status
Observation of lips, soft palate, uvula, faucial arches, tongue, sulci, asymmetry. Does the patient have dentures, is their mouth dry, Oral exam
Includes lips, tongue, soft palate, pharyngeal wall during speech, reflexive activity, swallowing Oral-Motor control exam
Rotary massage of the cheeks with downward pressure Help to open their mouth
Use gauze and touch the teeth and alveolar ridge. If present do not use utensils or touch their teeth bite reflex
Patient is unable to initiate a swallow or prepare the bolus with instructions, can do spontaneously Swallowing Apraxia
Hyperactive gag, tongue thrusting, tonic bite Abnormal oral reflexes
Have them say /e/ and /ou/ ten times for lip retraction and protrusion. Assess diadochokinetic rates, have them read sentence with labials (please put the paper by the back door) for closure Labial functioning
extend/retract tongue, touch tongue to corners of mouth rapidly, clear lateral sulcus with tongue, touch alveolar ridge and behind teeth with tongue tip rapidly, say /ta/ repeatedly, repeat Take Time to Talk to Tom, slide tongue across palate. Anterior tongue lingual function
Pull tongue to /k/ position and hold, assess diadochokinetic rates for /k/, repeat Can you Keep the Kitchen Clean Posterior tongue lingual function
Have patient try to chew a gauze roll Chewing function
Have patient say ahhh and look for movement Soft palate function
Cold instrument against the hard and soft palate juncture Palatal reflex
Tongue blade against the base of the tongue Gag reflex
touch lightly across various parts of the tongue, buccal cavity, and faucial arches, Oral sensitivity exam
Often associated with aspiration, will sound like water on the vocal folds Gurgly voice
Can be due to reduced laryngeal closure during swallow, need to refer to otolaryngologist Hoarse voice
Have patient repeatedly say ha, have them cough and clear throat, have them sing up and down the scale Laryngeal function
Reduced sensitive in and around the larynx Inability to change pitch on the scales
Ordered by the physician to see if patient can take aspiration and continued oral intake Pulmonary Function Testing
Observe reaction to food, oral movements in mastication, coughing, changes in secretion level, total intake, coordination of breathing and swallowing Observe during feeding
Laryngeal mirror, tongue blade, cup, spoon, straw, syringe Swallow evaluation utensils
Clinician places hand under chin . Index finger under mandible, middle finger at hyoid, third finger at top of thyroid, fourth finger at bottom of thyroid Digital manipulation during swallow
Have patient say ahhh and listen for gurgly voice, have them second swallow if needed, have them turn their head and swallow Assessing voice
Check orders in chart, speak with nursing, talk with patient about swallowing, oral motor ROM, 1/2 tsp applesauce, digital manipulation, say ah, 1tsp liquid, ditto, straw liquid, ditto, cracker, ditto. Cough Mrs. Shelors Bedside swallow eval
Define abnormalities in anatomy or physiology, identify strategies for diet and eating. Looks at oral transit times, velopharynx, larynx, and cricopharyngeal region MBS
Patient is lying down, looks at esophagus, must drink more barium, does not look at oral cavity or pharynx Barium swallow
thin liquid, barium paste, solid; 1cc, 3cc, 5cc, 10cc; Logemann MBS protocol
3cc, 5cc, uncontrolled amounts; uncontrolled amounts of honey, 1tsp pudding, cracker with pudding, cheerios for solid and liquid mix Mrs. Shelors MBS protocol
Time for the bolus to move through the oral cavity until it passes the tongue base; 1sec Oral transit time
Time between initiation of pharyngeal swallow and the bolus passing through the cricopharyngeal junction, 1 second Pharyngeal transit time
Allows assessment of location of bolus, lingual movements, vallecular residue, aspiration, Lateral View
Looks at the asymmetry of the swallow and vocal fold movement Anterior-Posterior View
Created by: rawlinan on 2011-03-05

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