Given the following, list the potential sign of dysphagia and/or patient complai

Question

Given the following, list the potential sign of dysphagia and/or patient complaint, possible diet modification, therapeutic exercises and/or maneuvers if applicable for each:

a.     Reduced labial seal

b.     Reduced lingual elevation

c.     Delayed or absent triggering of the pharyngeal swallow

d.     Bilateral reduction in pharyngeal contraction

e.     Unilateral pharyngeal paralysis

f.      Cervical osteophyte

g.     Cricopharyngeal dysfunction

h.     Reduced laryngeal elevation

i.      Reduced laryngeal closure at the vocal folds

j.      Reduced laryngeal closure at the airway entrance

Explanation / Answer

Diet modifications for dysphagia patients can be listed as;

S.No

Cause

Treatment

Effect/ rationale

Meneuver

1

Reduced labial seal

Giving thickened liquid, puree food

To decrease spilling of food from mouth

2

Reduced lingual elevation

Increase tongue movement

3

Delayed or absent triggering of the pharyngeal swallow

To trigger swallowing

Thermal stimulation to increase sensitivity

4

Bilateral reduction in pharyngeal contraction

Head turn to weak side

Prevents bolus from travelling to weak side by decreasing the size of weak side pharyngeal cavities.

Masako meneuver

Helps stabilizing tongue anteriorly for greater recruitment on pharyngeal constriction

5

Unilateral pharyngeal paralysis

Supraglottic swallowing

Helps to close airway at the vocal fold before and after swallow

Supraglottic swallowing

6

Cervical osteophyte

7

Cricopharyngeal dysfunction

Shaker exercise (head lifting )

Decreases resistance of cricopharyngeus.

Mendelsohn meneuver involves keeping the larynx elevated longer prolonging the opeing of upper oesophageal spincter.

This improves pharyngeal swallow timings and coordination of the swallow

8

Reduced laryngeal elevation

Multiple effortful swallows, turning head to weak side and allowing super-supraglottic swallow

Prevents bolus from travelling to weak side by decreasing the size of weak side pharyngeal cavities.

Mendelsohn meneuver involves keeping the larynx elevated longer prolonging the opeing of upper oesophageal spincter.

This improves pharyngeal swallow timings and coordination of the swallow

9

Reduced laryngeal closure at the vocal folds

Super-Supraglottic swallowing, Supraglottic swallowing

Helps to close airway at the vocal fold before and after swallow

Supraglottic swallowing

10

Reduced laryngeal closure at the airway entrance

Supraglottic swallowing

Helps to close airway at the vocal fold before and after swallow

Supraglottic swallowing

S.No

Cause

Treatment

Effect/ rationale

Meneuver

1

Reduced labial seal

Giving thickened liquid, puree food

To decrease spilling of food from mouth

2

Reduced lingual elevation

Increase tongue movement

3

Delayed or absent triggering of the pharyngeal swallow

To trigger swallowing

Thermal stimulation to increase sensitivity

4

Bilateral reduction in pharyngeal contraction

Head turn to weak side

Prevents bolus from travelling to weak side by decreasing the size of weak side pharyngeal cavities.

Masako meneuver

Helps stabilizing tongue anteriorly for greater recruitment on pharyngeal constriction

5

Unilateral pharyngeal paralysis

Supraglottic swallowing

Helps to close airway at the vocal fold before and after swallow

Supraglottic swallowing

6

Cervical osteophyte

7

Cricopharyngeal dysfunction

Shaker exercise (head lifting )

Decreases resistance of cricopharyngeus.

Mendelsohn meneuver involves keeping the larynx elevated longer prolonging the opeing of upper oesophageal spincter.

This improves pharyngeal swallow timings and coordination of the swallow

8

Reduced laryngeal elevation

Multiple effortful swallows, turning head to weak side and allowing super-supraglottic swallow

Prevents bolus from travelling to weak side by decreasing the size of weak side pharyngeal cavities.

Mendelsohn meneuver involves keeping the larynx elevated longer prolonging the opeing of upper oesophageal spincter.

This improves pharyngeal swallow timings and coordination of the swallow

9

Reduced laryngeal closure at the vocal folds

Super-Supraglottic swallowing, Supraglottic swallowing

Helps to close airway at the vocal fold before and after swallow

Supraglottic swallowing

10

Reduced laryngeal closure at the airway entrance

Supraglottic swallowing

Helps to close airway at the vocal fold before and after swallow

Supraglottic swallowing

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