Dysphagia 101

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Dysphagia 101

• For Therapists New to the Clinical Setting.

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Question
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Anatomy of the swallow

• Oral Cavity
• Pharynx
• Larynx
• Esophagus

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Physiology of the swallow

• 5 phases of the swallow.
• Anticipatory Phase CN Trigeminal (V)
• Oral Prepatory Phase CN Facial Facial Nerve
  (VII), Trigeminal (V) and Spinal Accessory (XI).
• Oral Phase CN Glossopharyngeal Nerve (IX),
  Vagus (X), and Spinal Accessory (XI)
• Pharyngeal Phase CN Glossopharyngeal (IX), Vagus
  (X), Spinal Accessory (XI) and Hypoglossal (XII).
  
• Esophageal Phase Vagus (X).

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Oral Structures and Function

• Lips Posterior Pharyngeal Wall
• Jaw Valleculae
• Cheeks Pyriform Sinus
• Teeth Epiglottis
• Tongue Larynx and Hyoid Bone
• Salivary Glands Vocal Folds
• Soft Palate Cricopharyngeus Muscle

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Diagram of the swallow
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Dysphagia is the medical term for the symptom
of difficulty in swallowing. It derives from the
Greek root dys meaning difficulty or disordered,
and phagia meaning "to eat".

• Dysphagia Team
• Golden Ticket Certified Nursing
  Assistants.NurseDoctorDieticianPhysical
  TherapyOccupational TherapySpeech
  TherapistFamilyPatient

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Referral Process

• Documentation for difficultyConcerns
  communicatedST ScreenPhysicians OrderBedside
  Swallow Evaluation

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Oral Phase

• droolingoral spillageresiduals in
  lateral sulciscattered lingual residualsnasal
  regurgitationincreased oral prep and oral
  transit. decreased or absent gag
  reflexmashing chewing patternpumping tongue
  movement

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Pharyngeal Phase

• Delayed initiation of the swallowWet
  voiceCough before, during or after the
  swallowAbsent swallow reflex
• Reduced laryngeal elevation

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Esophageal Phase

• RegurgitationPatient complains of food
  sticking high in throat.
• Pain in the chest when they swallow, other
  reflux signs.

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Bedside Swallow Evaluation

• History and Chart Review
• Oral Motor ExamDeglutition PO Trials

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Interpreting Results

• Referrals GI, ENT, VFSS, FEESMDT DiscussionST
  Clarification Diet level, supervision, feeding,
  medicine administration, precautions.

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Treatment Strategies

• Oral PhasePharyngeal Phase

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Diagnoses Affecting Swallowing

• StrokeHead TraumaCerebral PalsyALSMSParkinso
  ns DiseaseCerebellar DegenerationMyotonic
  DystrophyOculopharyngeal DystrophyLateral
  MedullarySyndrome (Wallengbergs)

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Case Studies

• CVA
• Dementia

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Pediatric Swallowing Diagram The tongue fills
the oral cavity, the fat pads in the cheeks
narrow the oral cavity laterally, and the hyoid
bone and larynx are much higher than in adults.
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