Dysphagia

Treatment Options

Assessments for Swallowing Disorders

Categories of Dysphagia

Several treatment options are available depending on the specific swallowing disorder and the severity of it.

The three assessments primarily used for Dysphagia include:

Swallowing difficulties fall into one of three categories:

• esophageal: the feeling that something is stuck in your throat
• oropharyngeal: this is caused by disorders of the nerves and muscles in throat
• unknown: is just that, unknown

• History
• Non-instrumental Examination
• Instrumental Examination

Neurogenic Conditions

Dysphagia

Motility Disorders are treated by:

• Stretching the narrowed esophagus by dilation
• Stent implantation
• Injecting onabotulinumtoxinA (botox) into the lower portion of the esophagus

Involving damage to the nervous system. This includes damage to the brain, spinal cord and nerves.

• Stroke
• Dementia
• Neurogenerative Disorders ( Parkinsons, Multiple Sclerosis and Motor Neurone Disease)
• Brain tumors
• Spinal cord injuries
• TBI
• Myasthenia Gravis

By: Chloe Wylin & Julia D'Angelo

References

The Causes

History

Difficulty Swallowing (Dysphagia) Causes and Treatments. (2011, June 27). WebMD. Retrieved July 16, 2014, from http://www.webmd.com/digestive-disorders/tc/difficulty-swallowing-dysphagia-overview

Dysphagia. (n.d.). Dysphagia. Retrieved July 16, 2014, from http://www.nidcd.nih.gov/health/voice/pages/dysph.aspx

Dysphagia. (2011, October 21). Definition. Retrieved July 16, 2014, from http://www.mayoclinic.org/diseases-conditions/dysphagia/basics/definition/con-20033444

Dysphagia. (2011, October 21). Treatment at Mayo Clinic. Retrieved July 16, 2014, from http://www.mayoclinic.org/diseases-conditions/dysphagia/care-at-mayo-clinic/treatment/con-20033444

Dysphagia (swallowing problems) . (2014, November 14). Dysphagia (swallowing problems). Retrieved July 17, 2014, from http://www.nhs.uk/conditions/Dysphagia/pages/definition.aspx

Dysphagia (swallowing problems) - Causes . (2012, November 14).. Retrieved July 17, 2014, from http://www.nhs.uk/Conditions/Dysphagia/Pages/Causes.aspx

Graduate Curriculum on Swallowing and Swallowing Disorders (Adult and Pediatric Dysphagia). (n.d.).. Retrieved July 16, 2014, from search.asha.org

Kahn, A. (2012, July 8). What causes difficulty in swallowing? 6 possible conditions.Swallowing Difficulty: Causes, Types & Symptoms. Retrieved July 16, 2014, from http://www.healthline.com/symptom/difficulty-in-swallowing

Swallowing (Deglutition) Reflex, Stages, Physiology, Process. (2010, October 17).— Healthhype.com. Retrieved July 17, 2014, from http://www.healthhype.com/swallowing-deglutition-stages-physiology-process.html

Cause for Dysphagia is usually related to preexisting health conditions, such as:

• Neurogenic Conditions
• Congenital and Developmental Conditions
• Obstruction
• Muscular Conditions

Obstruction

DYSPHAGIA

Clinical Management

The history assessment is used to gather information on the patient regarding:

• Age/gender/sex
• Past medical history
• Primary diagnosis/Current medical status
• Psychosocial history
• Current diet/Nutritional status

Treatment Options (Ctd.)

These health conditions cause an obstruction in the throat, resulting in a narrowing of the esophagus:

• Mouth cancer
• Radiotherapy treatment
• Post-surgical conditions
• Tracheostomy and/or ventilation issues
• Gastro-esophageal reflux disease (GERD)
• Infections (e.g. Tuberculosis and Thrush)

SPA 4870C

Julia D'Angelo

Chloe Wylin

Case Study

Swallowing must be taken into consideration to ensure that bolus properly goes down the esophagus. This is achieved through compensatory strategies and modifications.

• Proper postures and positioning
• Bolus modification
• Adaptive equipment
• Physio-therapeutic exercises
• Sensory Augmentation
• Biofeedback
• Nutrition/hydration
• Non-oral feeding
• Counseling families and patients regarding diagnosis and treatment planning

Normal Swallowing Process

Signs/Symptoms of Dysphagia

To alleviate swallowing disorders caused by a narrowing of the esophagus, vocal nodules/growths, paralysis, cancer and GERD, surgery may be recommended.

A few surgical procedures include:

• Laryngeal suspension surgery
• Laparoscopic Nissen fundoplication
• Laparoscopic Heller myotomy

Case Study: 36 (Hannah)

The client in this case is a 5 year 6 month old girl who has a developmental delay.

Her diagnosed impairments include dysphagia secondary to Cerebral Palsy .

She also suffers from cortical blindness and severe global developmental delays in motor, cognitive, self-help, language and oral-motor skills.

She was born prematurely at 26 weeks' gestation weighing 3lbs. 2oz.

Upon her birth she remained in the hospital for 3 months. At five months of age she contracted respiratory syncytial.

Her case involved Dysphagia management in schools to ensure adequate attendance, nutrition and hydration.

• Coughing and choking when eating or drinking
• Bringing food back up through the oral cavity or through the nose
• Having a sensation that food is stuck in the throat or chest
• Drooling
• Hoarse voice
• Unexpected weight loss or dehydration
• Pain when swallowing

There are three stages involved in the swallowing process:

• Oral (voluntary) - Chewing and bolus formation
• Pharyngeal (involuntary) - Soft palate raises, vocal folds close, blocking airway and allowing peristalsis to force bolus downwards towards the esophagus
• Esophageal (involuntary) - Passage of food through lower esophageal sphincter (LES) into stomach

Modified Barium Swallow Study

Non-Instrumental Examination

Instrumental Examinations

This form of examination is based off of observation of the functioning body systems. These include:

• Cognition/State
• Position/Posture
• Pulmonary/Respiratory status
• Multi-system sensorimotor examination (Oral Mechanism Examination)
• Clinical "hands on" swallowing examination
• Patient is given a puree, liquid, mechanical soft and regular solid to ingest and the swallowing pattern is observed for each substance.

What is Dysphagia?

Muscular Conditions

Congenital and Developmental Conditions

• Dysphagia is the medical term for a difficulty swallowing
• Usually signals a problem with the throat and/or esophagus
• It is most common in adults, although it still can occur in children

These conditions affect the muscles used to push the food down the esophagus into the stomach:

• Scleroderma
• Achalasia
• Paralysis

Use of equipment to monitor the swallowing process and identify where the breakdown occurs.

• Videofluoroscopy
• Modified Barium Swallow Study (MBSS)
• Fiber optic Endoscopic Examination (FEES)
• Electromyography
• Bronchoscopy
• Flexible
• Rigid
• Manometry

Involving conditions which exist at time of birth:

• Learning disabilities
• Cerebral Palsy (affects child's movements)
• Cleft Lip and Palate (resulting in a gap or split in the upper lip or roof of the mouth. )