Signs/symptoms of aspiration

o Coughing, choking, throat clearing, wet vocal quality,

fever, runny nose, watery eyes
*However can also be silent.*
Aspiration -> Cause
o Before, during or after swallow
o Before -> lack of bolus control due to lingual
musculature or delayed initiation of swallow
Not able to control food or drink in mouth so goes
down or goes down before swallow
o During -> failed laryngeal closure/protection
As patient is swallowing, squeeze happens but
airway is not protected
If fully protected, nothing should have gotten in
there
o After -> reduced pharyngeal constriction/bolus
propulsion or UES opening
They dont clear everything
UES closed too quickly or opened early so can tip
over into airway
Insufficient propulsion of bolus
Oral dysphagia
o Dysfunction -> impairment ->possible
etiology/pathology
o Anterior loss refers to spillage out of the lips or
inferior labial seal
Caused by reduced sensation of lips (numb) or
labial weakness
Trigeminal for sensory or facial for orbicularis oris

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

Sign of reduced pharyngeal constriction or base of

tongue retraction
Inefficiency in how they are squeezing that down
o Cough/throat clear after swallow(immediate)
Maybe aspirating during swallow
Indicative of reduced airway protection
Vagus nerve
o Delayed cough/throat clear
Indicative of something being left over; residuals
in pharynx
Reduced UES opening
o Change in vocal quality
Due to fact that patient is not clearing
o Silent aspiration
Caused by reduced laryngeal sensation or reduced
level of cognition
Esophageal dysphagia
o Globus
Feeling that there is something stuck
o Significantly delayed aspiration
Delayed regurgitation
o Belching
Esophageal dysmotility
o Hiccups

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