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Dysphagia CSD
Test 2
| Question | Answer |
|---|---|
| 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
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