Dysphagia 145bodies are found. The neurologist believes that there may be a small lesion in the cranial nerve
X– XI complex. Alternatively, the lesion may be higher in the motor control network involving
motor speech programming: apraxic dysphagia. The neurologist suggests a pos si ble psychological
role in the dysphagia. Some neurological event may have precipitated it, but classically conditioned
anxiety and associated negative emotions may be perpetuating it. You and the neurologist agree
that the precise etiology of the dysphagia may never be discovered. You also agree that knowing
the etiology, although helpful, is not necessary for treating it.
After another day of observation, Mr. Manterolla is discharged home. Over the next several
weeks, you work with him on his swallowing disorder. You use a tongue blade to gently probe
the back of his throat to elicit a gag ref lex, massage the laryngeal muscles, and use be hav ior
modification to increase laryngeal elevation during attempts to swallow. Gradually, spontaneous
recovery occurs, the therapies produce results, and the necessary sensation and motor movements
return to the posterior oral cavity. You use ice chips as swallowing stimuli, and one day, the patient
voluntarily swallows them. Soon thereafter, Mr. Manterolla’s swallowing ref lex returns and he is
able to eat normally. You discharge him, never knowing the true cause of his isolated dysphagia.
Swallowing, defined broadly, includes the emotional, cognitive, sensory, and/or motor acts
involved in transferring a substance from the mouth to the stomach. Dysphagia results in failure
to maintain hydration and nutrition, and poses the risks of choking and aspiration. Only limited
information can be obtained during a clinical/bedside screening; a video swallow study is often
required. There are several common sense changes in diet and modification of chewing and
swallowing be hav iors that can help patients regain the ability to meet their hydration and nutrition
needs orally.
- Why have speech- language pathologists assumed a primary role in evaluation and treatment of
dysphagia? - Define dysphagia.
- Describe a normal swallow and explain how speech production is related to swallowing.
- Describe the goals, procedures, and limitations of a clinical/bedside dysphagia evaluation.
- What factors predict the severity of dysphagia?
- Describe a video swallow study.
- Describe nasogastric, gastric, and tracheal tubes and their use in patients with dysphagia.
- What factors are involved in the diagnosis and treatment of dysphagia in geriatric and pediatric
patients? - List and describe five dysphagia therapies.
- Discuss false- positive and false- negative dysphagia test results.
Culbertson, W., & Tanner, D. (2011). The anatomy and physiology of speech and swallowing (rev. ed.). Dubuque, IA:
Kendall Hunt Publishers.
Chapter 7 discusses the anatomy and physiology of the normal swallow.