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Swallowing disorders (1) (Defns (Aspiration (Entry of food/liquid into…
Swallowing disorders (1)
Role of SLT
Assessment, diagnosis of oral, pharyngeal stage swallowing disorders eg. texture and how safe it is swallowing it
Identify symptoms of swallowing disorder, degree of aspiration risk, anatomy/physio cause of symptoms
Treatment of oral, pharyngeal stage swallowing disorders eg. devise mgm plan that allows person to be nourished, optimise swallow safety
Work in multidisciplinary team
Person w dysphagia
Family
SLT
OT (look at ADL)
PT (postural control, chest health, aspiration pneumonia)
Dietitian
Medical staff (still can rule over our recommendations)
Nurses
Dentist (dentures)
Social work, psych (help w adjustment, near EOL, decision making)
Benefits
Reduced risk of aspiration
Reduced feeding difficulties
Reduction in mortality
Impv nutrition
What SLT does not do
Insert NG tube
Evaluate nutritional intake/plan non-oral feeding
Suction via trachea
Independently insert endoscope for FEES assessments
Diagnose, mgm oesophageal disorders. Just refer on
Neurological process of swallowing
Cortical recognition of food- temp, amt that you took in, visual and tactile recognition (limbic system, frontal lobe)
Food processed, activates sensory receptors-sensory info (tactile, taste, proprioception) from mouth, oropharynx, pharynx, larynx (V, VII, IX, X, XI, XII)
Complex neural network to generate swallow response
Cranial nerves
Trigeminal (V)
Sensory: from nasal mucosa, every part of face + proprioception of muscles of mastication
Motor: muscles of mastication
Facial (VII)
Sensory: tastebuds on anterior 2/3 tongue, nasal, palatal sensation + proprioception of muscles of facial expression
Motor: muscles of facial expression, secretion of saliva (submandibular, sublingual)
Glossopharyngeal (IX)
Sensory: tastebuds posterior 1/3 tongue, sensation from pharynx, proprioception of muscles of pharynx
Motor: motor impulses to muscles of pharynx used in swallowing, secretion of saliva (parotid gland)
Vagus (X)
Sensory: tastebuds on posterior 1/3 tongue, proprioception of pharynx, larynx
Motor: contraction of muscles pharynx, larynx
Accessory (XI)
Motor: laryngeal mvm, muscles for mvm of H&N
Hypoglossal (XII)
Motor: motor control of intrinsic, extrinsic muscles of tongue, infrahyoid muscle
Phases of swallowing
Oral prep phase
Food prepared-manipulation of food, liquid to form a cohesive bolus
Mastication, combination of food, saliva (from salivary glands), tasting food, forming bolus of appropriate size, consistency
Duration depends on bolus consistency, volitional control
Airway open, breathing mainly via nasal airway
Oral phase (1-1.5s)
Begins when bolus prepared w posterior propulsion of bolus by tongue into oropharynx--> hypopharynx. Ends w trigger of swallow. Location can change across people, changes over lifespan
Bolus held at mid-central grove/depression, lateral edges of tongue against hard palate, lateral sides of teeth
Lips, buccal muscles contract, velum raised to close off nasopharynx
Posterior of tongue depresses, anterior tongue presses against hard palate, propel bolus backward--> stripping action
Pharyngeal phase (<1s)
Largely under involuntary control, but we can initiate a swallow
Velum raises to close off nasophayrnx to prevent food from going into nasal cavity
Larynx elevates, closes to prevent material entering airway
Breathing momentarily stopped bcos vocal folds close off
Progressive contraction of pharyngeal constrictor muscles --> pharyngeal stripping wave
Relaxation upper oesophageal sphincter allow food to pass into oesophagus--> might get reflux if dont do this properly
Oesophageal phase (8-20s)
Involuntary control
Begins w bolus moving thru UOS--> oesophagus. Ends when bolus reaches lower oesophageal sphincter @ opening stomach
Bolus transported by peristaltic waves--> push bolus down to, through lower OS into stomach
Breathing & swallowing
Closely related, need to coordinate
Foods, fluids, air both travel same pathway until just above larynx (food goes into oesophagus, air goes into larynx, down to trachea)
Adults
Prevent food, fluids entering lungs, airway closes during swallow
Basic stages of process
Inhale
Hold breathing, larynx closes, protects airway (apnoea period) while you swallow
Exhale post swallow
*Disruption to this cycle can mess up swallow
Peds
Velum close to epiglottis
Babies cannot breathe and swallow at same time
Adults vs. peds
Infants need maximal postural support (45 degrees)
Infants usually have dev > acquired dysphagia
Children might not be able to use compensatory strategies
Need to treat whole family in both
Defns
Dysphagia
Delay/ wrong direction of fluid/solid bolus as it moves from mouth to stomach
Disorder @ any one of 3 stages stages of swallowing
Feeding disorder
Impairment in process of food transport outside alimentary system, difficulty bringing food to mouth, need to work with OTs
Picky eating
Part of typical dev.
up to 50% children
Limit diet, generally still meet nutritional requirements
Feeding difficulties
eg, eat only 3 foods, white foods
Limit diet, X meet nutritional requirements
Difficult behaviours at mealtimes
Aspiration
Entry of food/liquid into airway below true vocal folds
can have build up of bacteria, aspirate on your vomit
can lead to choking, death
can lead to chest infection, pneumonia if X fight
X eat, drink normal fluids bcos no teeth, decrease jaw opening, cant seal lips--> if they aspirate on assessment, need modified diet, textures
May X be able to manage foods/fluids safely--> NIL by mouth
Penetration
Entry of food, liquid into larynx, above true vocal folds
Silent aspiration
Swallowed material that goes below vocal folds, X produce cough reflex
What makes things go wrong?
Congenital conditions
Cerebral palsy, spina bifida, autism, cleft lip/palate
Neurological changes
Post stroke, brain injury, degenerative disease (Parkinson's disease, multiple sclerosis)
Structural changes
Trauma, surgical changes to structures inv, in swallowing
Car accidents, cancer and treatments, laryngectomy
General ill health/ fatigue
Cognitive changes
Dementia: usually need 2 assessments bcos might have diff habits at diff times, could get disoriented, so need to design backup intervention: 1) when normal 2) when not looking normal