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Adult-acquired Neurology - Dysphagia

ness37's version from 2018-04-29 17:52


Question Answer
4 stages to normal swallowing Pre-oral, oral, pharyngeal, oesophageal
Pre-oralGetting food and drink into mouth, producing saliva, attention needs to be given to positioning, feeding method, pre-oral cues (sight, smell, sound), how drowsy the person is, have you got their attention?
OralChewing and preparing food, moving it towards throat, lips close, jaw moves to chew, tongue moves around mouth, food is mixed with saliva to from bolus, tongue pushed bolus back towards throat
PharyngealClosing the airway, opening the throat, swallow triggered when food is approx at level with back of mouth, soft palate is raised, airway is closed to prevent aspiration, larynx raises and tilts, bolus is pushed down pharynx
Oesophageal Stretched open, food is pushed down towards stomach
Associated problems Weak lips (need lip seal to efficiently swallow), poor oral hygiene, weak tongue/jaw, can't chew/move food around mouth, slow to swallow, swallow is weak (airway not protected), residue left in mouth after swallow
RisksAspiration (overt or silent) can lead to chest infections (reoccuring) and can be put off eating and drinking = dehydration + malnutrition, choking if airway is blocked
Warning signsWeight loss, repeated chest infections (not responding to antibiotics), dehydration, not wanting to eat, saliva production is poor
Warning signs during eating/drinkingDifficulty chewing, meals take a long time to finish, not clearing food from mouth, swallowing a few times for each mouthful, choking/coughing, difficulty breathing, wet/gurgling voice, turning red/blue
Warning signs immediately after meal timesChange to voice, high temperature, coughing
Role of SLTAssessment of swallow (e.g. videofluoroscopy/ barium swallow), advice to patient on swallowing safely, advice to nursing staff on consistencies and thickeners, therapy when appropriate (e.g. oromotor exercises), working with MDT, supporting patient with their choice (PEG, NG tube, eating at risk, end of life care) and encourage sips of water to keep hydration up