Please enable JavaScript.

Coggle requires JavaScript to display documents.

Normal swallowing, alterations to normal swallow (2) - Coggle Diagram

- - - - Approx 40% of population will present w dysphagia
      - Impact determined by size, location of cortical, brainstem damage
      - Brainstem
        
        Worst scenario
        
        Impacts to processing sensory, motor aspects of swallow
        
        Impacts pharyngeal stage
        
        Often present w absent swallow initially, may take weeks for some to recover
      - Cortical
        
        Left CVA
        
        Oral, pharyngeal stage deficits
        
        Unilateral weakness
        
        Impact of associated aphasia on rehab
        
        Right CVA
        
        Oral, pharyngeal stage deficits
        
        Unilateral weakness
        
        Behavioural issues impacting, motor deficits also complicates things eg. verbose, decreased attention, poor new learning, very impulsive, left neglect
        
        Multiple strokes
    - - Diverse damage bcos of diverse injury
      - Direct head injury, contra-coup damage, brainstem twist, puncture wound (neck); laryngeal fracture, crush injury, penetration wounds (chest)
      - Impact: r/s b/w time extent of injury (GCS, ventilation, intubation), swallowing severity
      - Impact of mgm: medications, intubation, surgery
      - Swallow patterns
        
        Oral disorders: lip closure, tongue fn, oral reflexes
        
        Pharyngeal: triggering swallow, decreased laryngeal elevation, CP opening, decreased airway closure
        
        Cognitive overlay: impulsiveness, too much food intake, decreased new learning (possible problems w compliance w diet recomm-fam + pt)
        
        Pulmonary complications may be present-long term ventilation
        
        Recovery varies
  - - - Syndrome characterised by rigidity, tremor in limbs, bradykinesias (slow mvm)- basal ganglia disorder
      - Dysphagia is X an early feature
      - X all exhibit severe swallowing disorders, variability in disorder, progression of disease
      - Effects of medication (used to modulate symptoms)- timing of oral intake, tablets used to suppress symptoms, need to know when you should give them meals
    - - Chronic disease: progressive degeneration of motor neurons in spinal cord, brain stem, cerebral cortex, aetiology unknown (suggest metabolic), relatively rare
      - X medical treatment, palliative, steady progression until death
    - - Reduced interest, has desire to re-eat
      - Easily distracted
      - Food agnosia
        
        Confusing what is/is not food- difficult to accept food into mouth
        
        Problems remembering what to do w the utensils. May take inappropriate boli, affects independence
        
        When eating: move food around in oral cavity, not sure what to do with it, X recognise it as food. Forget there is food there, adds more
  - - - Neurological damage
      - Structural damage
      - Mgm: brace, collars (spinal), positioning (burns); iatrogenic damage eg. surgery, intubation
      - Medical fragility and instability-long periods of ventilation, intubation
      - During burns-damage to tissues, labial fn, labial seal reduced. Inhaled a lot of heat (damage to pharynx, larynx)
  - - - Failure of LES to keep food in stomach, causes backflow of acid that can extend to pharynx, may cause aspiration as airway is unprotected.
      - Complain of burning sensation in pharynx, oesophagus, freq coughing, gagging (after swallow)
      - Redness of arytenoid-gastric contents are highly acidic (they burn). If gastric contents is aspirated, it is more irritating to the lungs cf. non-digested food/fluid.
      - Muscles in oesophagus dont work well: can cause backflow of material into pharynx
  - - - sedatives, antipsychotics
      - Reduce saliva production
      - Reduce awareness, alertness
      - Can delay swallow (both oral, pharyngeal stages)