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Feeding and Swallowing Disorder by: Krystal Speights by Mind Map: Feeding and Swallowing
Disorder by: Krystal Speights
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Feeding and Swallowing Disorder by: Krystal Speights

What are the defining characteristics of adult Dysphagia?

Defining characteristics of adult dysphagia relate to: 1. The phase of swallowing affected 2. The underlying pathology or cause 3. The severity of the disorder

Phase Affected

Gastroenterologists, internists, radiologist, and other professionals study and treat esophageal dysphagia, resulting from impairments of the esophageal phase of swallowing

Oral Preparatory Phase, Breakdowns in the oral oral preparatory phase occur when the structures and functions of the lips, tongue, cheeks, and mandible do not function as they should, Characteristics of oral preparatory phase dysphagia:, Decreased lip closure, Problems controlling the ingested materials, Difficulty biting or chewing, Inefficient oral preparation due to reduced range of motion of the tongue, Impaired sensitivity of the tongue, lips, and other oral structures

Oral Phase, The formed bolus moves posteriorly in the mouth toward the pharynx to trigger the swallow, Characteristics of oral phase dysphagia:, Difficulty moving the bolus to the pharynx, inability to adequately control the bolus flow, Delayed initiation of the bolus movement

Pharyngeal Phase, Breakdowns in the pharyngeal phase occur when the pharyngeal structures do not function as they should to move the bolus through the pharynx to the entrance of the esophagus, Characteristics of pharyngeal stage dysphagia:, Incomplete palatal elevation o seal off the nose from the pharynx, Delayed initiation of the pharyngeal swallow reflex, Diminished tongue and pharyngeal muscle force to move bolus through the pharynx, Reduced laryngeal elevation and closure

Underlying Pathology of Cause

Dysphagia is a secondary disorder, meaning that it results from another primary cause. The most common cause of dysphagia are neurological damage due to a stroke, a brain injury, or a disease, and laryngeal damage due to radiation, surgical removal of the larynx, or trauma.

Brain Injury, Stroke, The percentage of those developing dysphagia following stroke is relatively high 50% or even higher, Traumatic Brain Injury, Dysphagia is a common complication of traumatic brain injury, with one-fourth to three-fourth of individuals with traumatic brain injury exhibiting dysphagia

Progressive Neurological Disease

Progressive neurological diseases are disorders of the nervous system producing discoordination and weakness of motor skills as well as decreased sensory abilities

Parkinson's Disease, Dysphagia in Parkinson's Disease affects the oral, pharyngeal, and esophageal phases of the swallow, with common difficulties including drooling, abnormalities in bolus preparation and transport, delayed triggering of the swallow reflex, residual materials in the pharynx, aspiration, and diminished esophageal motility

Amyotrophic Lateral Sclerosis, Dysphagia is prevalent in ASL because of the disruptions in respiratory, phonatory, and articulatory functions

Dementia, The incidence of dysphagia in Alzheimer's disease ( a form on dementia) is relatively low in the early disease stages, As Alzheimer's disease progresses to moderate and severe levels of impairment, dysphagia is seen in more than one-fourth of individuals

Head and Neck Cancer Treatments

Cancerous growths of the mouth, pharynx, and larynx are currently treated with surgery, radiation, and possibly chemotherapy

Surgical Management, When components of swallowing are either partially or totally removed, changes in swallowing function are probable

Radiation Therapy, Radiation treatment itself reduces saliva production and also results in edema, tooth decay, and pain

Chemotherapy, The side effects can lead to swallowing concerns, particularly adequate intake to achieve good nutritional status, Advances in chemotherapy medications mean they are producing fewer unpleasant side effects


The severity of dysphagia can range from mild to severe

A mild impairment of swallowing includes some difficulties with oral preparation and pharyngeal functioning but overall good mastication and safe, independent feeding and swallowing

A moderate impairment indicates some dangers of aspiration and penetration into the airway

A severe impairment indicates a serious risk of aspiration and penetration, and a profound impairment indicates that a person is unable to safely swallow

How is Adult Dysphagia identified and treated?

Clinical Swallowing Examination

The speech-language pathologist will often conduct a clinical swallowing examination, also referred to as a bedside swallow examination

Speech-language pathologist do the following in this procedure:, Review current and past medical records, Complete a comprehensive client interview to learn medical, social, and family history, Conduct a thorough oral mechanism examination of the mouth and throat, Attempt trial feeding or observe the client during a meal, Make feeding recommendations if appropriate, Refer the client for instrumental assessment of swallowing if indicated, Refer the client to to other professionals for any specialized testing that is needed

These five indicators suggest the need for instrumentation to quantify swallowing problems:, Clinical bedside findings are inconsistent with reported signs and symptoms of dysphagia, Instrumentation is needed to assist in determining the medical diagnosis, Dysphagia diagnosis or the safety and efficiency of the swallow require confirmation, Nutritional or pulmonary compromises are present, Specific swallowing information is required to design and implement a treatment plan

Instrumental Dysphagia Examination

Evaluation of swallowing problems using technology, or instrumentation, typically provides a more objective and quantifiable measure of swallowing functions.

Fiberoptic Endoscopic Examination, Provides direct visualization of the swallowing mechanism, A fiberoptic endoscope, a flexible tube containing a small camera, is passed through the nose and into the pharynx, yielding a real-time picture of swallowing, both before and after the swallow

Ultrasonography, The same technology long used to visualize a fetus in the mother's womb, In dysphagia evaluation, ultrasound uses high frequency sound waves to create a black-and-white picture of the structures targeted

Videofluoroscopy, The most commonly used instrumentation for swallowing evaluation and is the gold standard in most cases, Videofluoroscopy uses radiation, so client exposure must be considered and minimized

Treating Dysphagia

The speech-language pathologist often provides direct treatment to remediate or oropharyngeal dysphagia using two types of rehabilitation strategies: compensatory and restorative approaches

Compensatory Approaches, Compensatory approaches are strategies that compensate for a specific problem in order to make swallowing safe and efficient, Postural techniques are used quite commonly, Speech-language pathologist use diet modifications as a compensatory approach

Restorative Techniques, Are intended to improve or restore swallow function, The therapist might use thermal stimulation to improve the sensitivity of the oral area and the timeliness of the swallow reflex

Nutrition and Dietary Considerations

The importance of nutritional health to an individual with dysphagia cannot be overestimated

Some individuals are unable to meet their nutritional requirements orally so they need alternative nutritional means, such as a feeding tube

It is not unusual for dysphagia clients to receive both oral intake and tube feedings

What are Feeding and Swallowing Disorders?

Pediatric Feeding Disorders

The definition of a child with a feeding disorder is a persistent failure to eat adequately for a period of at least 1 month

Traits of a child with a feeding order:, Unsafe or inefficient swallowing patterns, Growth delay affecting height and/or weight, Lack of tolerance of food textures and tastes, Poor appetite regulation

Mild and transient feeding problems are common in young children; 25 to 35% of parents report that their young children have feeding issues, From the very start of their lives, many of these children exhibit significant impairments of feeding and require the earliest of interventions while in the Neonatal intensive care unit


A swallowing disorder, or dysphagia, occurs when an individual exhibits an unsafe or inefficient swallowing disorder pattern that undermines the eating/drinking process.

Deglutition, The complex neuromuscular act of moving substances from the oral cavity to the esophagus

Unsafe swallowing can be a life-or-death matter, as poor management and coordination of swallowing increases a child's or adult's risk of penetration and aspiration of food or liquid into the laryngeal area, which serves as the gateway to and the protector of the lungs, Penetration, Food or liquid enters the larynx, which can cause choking and respiratory distress, Aspiration, The food or liquid passes through the larynx and into the lungs, which can interfere with the exchange of air in the lungs and cause asphyxiation or a pulmonary infection

The Normal Swallow

Swallowing is so natural that we do it approximately 580 times daily without even thinking about it

There are specific physiological components of a normal swallow that occur in a series of unfolding stages or phases, The Oral Phase, The role of the oral phase is to move the bolus to the rear of the oral cavity and prepare it for propulsion down the throat, The individual still maintains a normal respiratory pattern, breathing through the nose, Oral Preparatory Phase, The role of the oral preparatory phase is to prepare the substance to be swallowed for swallowing, Throughout this phase, respiration continues with inhalation and exhalation through the nose, The Pharyngeal Phase, pharyngeal swallow reflex, The posterior pharyngeal wall and the back of the tongue move toward one another to create a pressure that, in conjunction with the squeezing pharyngeal muscles, move the bolus downward through the pharynx toward the entrance to the esophagus, Reflexive cough, Protective reflex in which exhaled air is forced upward through the vocal folds to expel any foreign matter, Apneic moment, During pharyngeal phase of a normal swallow, respiration experience a brief halt, The Esophageal Phase, The esophageal phase moves the bolus through the esophagus into the stomach

The four phases of swallowing must work seamlessly and efficiently to keep food and drink from talking possibly dangerous routes

The Disordered Swallow: Dysphagia

Dysphagia is a condition is which an individual exhibits difficulty in at least one of the phase of the swallow, causing swallowing to be inefficient or unsafe, When swallowing, is unsafe, individuals are are risk of penetration or aspiration because of poor coordination or management of the bolus as it moves through the swallowing phases, Individuals with dysphagia may be unable to intake certain food consistencies safely and must have their diets changed or need to be fed through an alternative means

Enteral feeding tube, Directs a liquid formula to the stomach and is typically placed through the nose or directly into the stomach

A symptom, Not a Disease, Dysphagia is not a disease but rather is a symptom that results from an underlying etiology, or cause



The impairment in the ability to swallow

Individuals with disruption in their swallowing ability may eating to be a burden

Dysphagia is a type of feeding disorder because the individual with dysphagia can no longer eat safely

Dysphagia occurs during the age spectrum for a variety of reasons due to development, neurological, or structural problems that alter the normal swallowing process

Oral-Motor System

The physical structures and neuromuscular functions involved with both eating and speaking.

Oral-Motor Functions, The strength and coordination of the articulators

Oral-Motor Muscular Tone, The tension and posture of the articulators

Oral-Motor Sensation, The sensitivity to taste, movement, and textures

What are the defining characteristics of pediatric feeding and swallowing disorders?

Pediatric feeding and swallowing disorders may be characterized by such symptoms as a refusal to eat, eating non nutritive substances, and rigidity in eating

Unsafe feeding and swallowing

Feeding and swallowing are unsafe when they pose a risk of penetration or aspiration of the bolus into the airway

Causes and Risks, : Dysphagia frequently accompanies a number of syndromes, particularly those that feature low muscle tone (hypotonia), delayed motor development, and physical deformities affecting the oral-motor areas

Cleft palate, requires help achieving a good seal, as the hole in the palate creates a loss of pressure during sucking and can result in formula, breast milk, or solid foods entering the nasal cavity

Inadequate feeding and swallowing

Defining Characteristics, Inefficiency, Children who are inefficient at feeding and swallowing are unable to meet their caloric and nutritional needs, because the process is not productive, Overselectivity, Children with overselective eating patterns are restrictive in the taste, type, texture, or volume of food they will eat, Refusal, Reflux, Gastic acid is regurgitated into the esophagus and even the pharynx, resulting in a burning of the esophagus and throat, Conditioned dysphagia, Resistance to eating after experiences with severe choking, ingestion of poison, or severe allergic reactions, Feeding Delay, Because of developmental delays, illness, or trauma, some children experience delayed development of feeding skills, Low birth weight: infants born exceptionally small

Causes and Risk Factors, Prematurity, When a child is born at or before 37 weeks of gestation, Prenatal Drug Exposure, Prenatal exposure to alcohol, tobacco, cocaine, heroin, and other toxic substances has been linked to prematurity and low birth weight, as well as to longer-term growth failure and depressed neurological functioning, any one of which can impede a young child's feeding development and swallowing skills, Diet Restrictions, Some children are placed on strict or modified diets in response to diabetes, phenylketonuria (PKU), and other metabolic disorders

Inappropriate feeding and swallowing, Defining Characteristics, Children who exhibit inappropriate feeding behaviors demonstrate undesirable and disruptive behaviors during mealtimes, Inappropriate feeding behaviors include screaming, spitting, throwing, hitting, and other similar actions, Cause and Risk Factors, About one-third of feeding disorders in young children result from nonorganic causes, Many parents behaviors can undermine or impair the feeding relationships:, Being overactive and overstimulating, Being underactive, passive, and unengaged, Being rigid, directive, and demanding, Being chaotic, disorganized, and frenzied, Being overly concerned, anxious, and fearful

How are Pediatric feeding and swallowing disorders identified and treated?

Early Identification and Referral

The timely identification of pediatric feeding and swallowing disorders is critical so that immediate intervention can sustain the child's health and nutrition, Feeding problems emerge much earlier than referral typically occurs, When feeding problems persist, problematic secondary behaviors can emerge

Comprehensive Assessment

The speech-language pathologist will conduct a comprehensive assessment that includes a case history, a physical feeding/swallowing evaluation, and observation of mealtime interactions, Case History, The case history gathers information on the child's and family's eating and feeding experiences to explore possible manifestations of the disorder, Physical Feeding and Swallowing Evaluation, Following the case history, the specialist completes a careful evaluation of the structures and functions of the lips, tongue, jaw, teeth, and hard and soft palate, During the functional examination, the specialist ascertains both the safety and the efficiency of feeding and swallowing, as well as the quality of the intake, Modified barium swallow: video swallow study

Treatment Goals in Pediatric Feeding and Swallowing

The immediate and foremost goals of pediatric feeding and swallowing treatment are to ensure that nutritional needs are met for healthy growth and development and that feeding and swallowing do not endanger a child's life

Both physiological and psychological aspects of feeding and swallowing are targeted, Physiology of Feeding and Swallowing, Physiological targets emphasize the organic and neurodevelopment aspects if eating and drinking, such as muscle tone, articulatory movement and coordination, oral-motor sensitivity and body posture, Treatment focuses on improving the coordination of the swallow to achieve efficiency and safety, Psychology of Feeding and Swallowing, Psychological targets emphasize the behavioral aspects of eating and drinking such as accepting certain food types or textures, decreasing resistance and fussiness when eating, following a consistent meal schedule, and the like, Shaping is when the therapist moves a child incrementally toward a desired goal, Conditioning and reinforcement a child learns to associate a stimulus with a particular outcome, such as receiving a preferred food for eating a nonpreferred food, Systematic desensitization is when the therapist trains a child to accept an aversive sensory experience by breaking down into small steps and showing the child that each step is safe and possible, Alternative and Supplemental Feeding, Children who are candidates for supplement or alternative nutrition are those:, Who cannot meet 80% of their caloric needs orally, Who have not gained weight or who have continuously lost weight for 3 months, Whose weight and height ratio is below the 5th percentile, Whose feeding time is greater than 5 to 6 hours daily, The most common solution is enteral, or tube, feeding, in which liquid nutrition is delivered through a tube, For short term treatment, a nasogastric tube is used, which is passed through the nasal cavity and into the esophagus