Escolar Documentos
Profissional Documentos
Cultura Documentos
o Buccal pocketing
Buccinators; pocketing in the cheeks
Not integrating that they have something there
Sometimes it is sensory
Weakness in cheek or lack of tone in cheek
Neglecting own physicality
o Intra-oral stasis
Things being left over in the patients mouth
Contained to tongue or diffused through mouth
Reduced ability to create oral pressure
Trigeminal, facial, and hypoglossal
o Labored mastication; reduced rotary chew
Chewing pattern is rotary for normal adults
Working hard to chew or jaw is sliding
Can be caused by lack of dentition; weakness in
muscles of mastication
Trigeminal primary contributor; jaw stability
Hypoglossal - tongue
o Anterior-posterior transit
Refers to formulation and transition of bolus from
transition to posterior portion of tongue
Intra-oral pressure generation can be a cause
Glossectomy will contribute
hypoglossal
o Premature spillage
Something is dumping down before it is ready to
go down pharynx or swallow
Caused lingual weakness
Glossectomy can be a cause
Hypoglossal or cognitive deficits
Pharyngeal dysphagia
o Delayed swallow initiation
Big one
1.2 seconds
whether mild or sever or absent, associated with
sensory dysfunction either in oral phase or start
of pharyngeal phase
o Nasal regurgitation
Not seen a lot
Dont have full velopharyngeal elevation or
closure to seal nasopharynx
Innervation is glossopharyngeal; also velo rise is
controlled by vagus (CNX)
o Decreased hyolaryngeal elevation/excursion
Caused by suprahyoid muscle weakness or
resistance
Spinal fusion may be a cause
Controlled by vagus nerve
Ng tube can anchor movement
o Multiple swallows
Levels of impairment
o Normal
Within normal or function limits
No safety risks
o Minimal
Requires utilization of strategies but is
independent
o Mild
Regular diet but require cues
o Mild-moderate
On a prescribed diet; supervision with meals
o Moderate
Alternate means of nutrition but may be tapering
away
50% of time need cuing
o Moderate-severe
Requires alternate source of nutrition
Cues with modified diet
o Severe
Full alternative source of nutrition; NPO
NPO nothing by mouth
Supplemental
o NG tube
o PEG (G tube)- tube going straight into stomach
o J tube enters through intestine; done for patient who
have disease in higher portion of GI tract
o TPN IV based
Evaluation
o Clinical evaluation
Bedside swallow evaluation
o Instrumental evaluation
Modified Barium Swallow Evaluation
Fiberoptic Endoscopic Evaluation of Swallowing