1. Swallowing Difficulties
HLTEN504A - INCP
Swallowing Difficulties

2. Dysphagia
Is a problem or difficulty with swallowing

3. Swallowing
During the oral phase, the lips, teeth, tongue, and jaw muscles mix the food with saliva to create the proper consistency for ingestion.
Once the bolus is formed in the oral cavity it is propelled into the oropharynx by the tongue; this completes the oral phase of swallowing.

4. Swallowing
During the oral phase, the lips, teeth, tongue, and jaw muscles mix the food with saliva to create the proper consistency for ingestion.
Once the bolus is formed in the oral cavity it is propelled into the oropharynx by the tongue; this completes the oral phase of swallowing.

5. Swallowing
Once the bolus reaches the tonsils, it triggers the pharyngeal phase of the swallowing reflex.
This phase of the swallow mechanism is completely automatic.
The palate closes against the back wall of the throat separating the oral cavity from the nasal cavity.
The epiglottis tilts posteriorly, covering and protecting the vocal cords.
The upper esophageal sphincter relaxes.

6. Swallowing The final phase of the swallow is the oesophageal phase.
Once the food bolus enters the esophagus, it is actively transported down to the stomach.
Swallowing is complete when the bolus passes the lower esophageal sphincter and into the stomach

7. Causes of dysphagia
These may develop suddenly or develop slowly over an extended period of time
Severe pain
Trauma/accident
Surgery
Radiation
Obstruction
Structural defects

8. Causes of dysphagia (cont)
Abnormal peristalsis
Neuromuscular
Degenerative diseases
Metabolic/toxic
Impaired gag reflex
Neurological
Unconscious states
Excessive, scant, or thick oral secretions

9. Some conditions that cause dysphagia
Stroke
Closed head injury
Parkinson’s disease
Motor neuron disease
Huntington’s disease

10. Clinical manifestations of impaired swallowing
Patient reports difficulty
Coughing with food or liquid intake
Longer time taken with meals than other people
Drooling, constantly open mouth, constantly mopping mouth
"Gurgly" voice
Food remaining in mouth after meals
Choking or asphyxiation with oral intake

11. Clinical manifestations of impaired swallowing
Diminished or absent cough
Diminished or absent gag reflex
Weight loss
Pneumonia
X-Ray evidence of aspiration
Fluctuating levels of consciousness
Tracheostomy
Naso-gastric feeding tube

12. To prevent aspiration/choking
Sit person upright to assist gravity. Sometimes the person needs to sit out of bed for all meals.
Maintain slight neck flexion
Ensure that patient is awake and alert
Modifications to the consistency of the food and fluid may be required:
Soft/pureed diet, thickened fluids (nectar or honey consistency)
Initiation of the swallowing reflex may be required – press on the tongue

13. To prevent aspiration /choking
Offer food and fluid at a rate that the person can cope with – prevents aspiration
One mouthful at a time
Effective swallow before next mouthful
Examine mouth at end of meal
Unhurried mealtime
If facial paralysis is present offer the food to the non-affected side.
Check that they have swallowed each mouthful offered.
Ensure that there is no food left in the mouth before you leave the person unattended.
Maintain upright position 1/2 hour post meal