Radiation Associated Dysphagia Essay

Radiation Associated Dysphagia Essay
Many people are living longer because of radiation therapy to treat cancer, but what happens after
treatment is over? Most people go back to their normal life. However, some people will have their
quality of life affected by late effects of radiation therapy. Late effects of radiation therapy can
happen months or years after treatment and may be temporary or permanent. Some can be minor
such as skin changes to the treated area, and some can be as serious as cardiovascular problems. As
radiation therapy has become more advanced and more common in treating cancer, professionals in
medicine have studied the treatments and late effects to decide what can be done to prevent late–
effects from occurring. Radiation–associated dysphagia (RAD) is a late effect of radiation therapy to
the head and neck. Dysphagia is difficulty swallowing. Eighty–six percent of people with late
radiation–associated dysphagia are survivors of oropharyngeal cancer, which is commonly caused
by human papillomavirus.1 Ninety percent of people with late RAD have evidence of at least partial
denervation, leading to atrophying lingual and pharyngeal structures.1 The severity of radiation–
associated dysphagia can be minimized by medicine and swallowing therapy. Radiation to the head
and neck includes oral problems including mucositis, taste loss, loss of ... Show more content on
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A dose of more than four Gray can permanently damage germ cells, and a dose of more than twenty
Gray can produce hypogonadism.10 A dose of sixteen to eighteen Gray for testicular irradiation is
associated with a high rate of permanent sterility.10 If possible the gonads should be shielded, and
the lowest effective dose should be used. Cryopreservation of semen before treatment is currently
the only successful method of future fertility, and in vitro fertilization or intracytoplasmic sperm
injection is usually used after treatment to become a
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Dysphagia Case Study Essay
To the best of our knowledge, this is the first case of a HCC extending into gastroesophageal
junction presenting as dysphagia reported in English literature. Hepatocellular carcinoma is the most
common hepatic malignancy. Extrahepatic metastasis of liver cancers occurs through three routes
including hematogenous, lymphogenous, and direct invasion1–3. Direct serosal invasion by
contiguous neoplasm was the major mode of GI tract involvement with unusual clinical
presentations. The presumed mode of direct involvement of the GI tract is initiated by the adhesion
of the serosal side of the adjacent organ with a bulky, exophytic tumor. Direct invasion or extrinsic
compression of the GI tract by HCC is uncommon 4,5,6,. The most common site of invasion ...
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The mode of metastasis was presumed to be haematogenous spread in 2 patients and direct invasion
in 5 patients (invasion to stomach in one and of the duodenum in four), but was undetermined in the
remaining one patient, in whom the stomach was involved 4..
Upper GI tract obstruction Tanaka et al. [8]reported that in 19 of the 29 patients, in whom HCC
involved directly the upper GI tract; initial endoscopic assessment revealed an ulcerative
hemorrhagic tumor protruding into the lumen of the stomach or duodenum [9], in most of these
cases were very advanced HCCs like in our case. There is no effective therapy for patients with
HCC diagnosed in the late stages of the disease. Surgically treated late stage patients usually die of
metastatic disease, while most medically treated patients died of GI or tumor bleed .10 The median
survival after the diagnosis of gastrointestinal involvement was 1 month (2 weeks–4 months). An
active surveillance program of the high risk or relative hepatitis B viral infection groups may aid in
earlier detection at a time when patients are better candidates for

Neuromuscular Dysphagia Treatment
Neuromuscular electrical stimulation (NMES) is a type of therapy used as a form of treatment for
swallowing disorders (dysphagia). This method involves placing electrodes on one or several
external sites on the anterior neck to which an electrical current is applied to peripheral tissue targets
(Clark, Lazarus, Arvedson, Schooling, & Frymark, 2009, p 362). "it is hypothesized that such
stimulation aims to improve function by strengthening the swallowing musculature or by
stimulating the sensory pathways relevant to swallowing or both. To facilitate strengthening, muscle
contractions elicited via NMES generally recruit larger and more motor units than voluntary
contractions, causing metabolic responses within the muscle tissue that ultimately ... Show more
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The primary diagnosis associated with these participants dysphagia is stroke in three out of the six
participants , and all participants were under the age of 90 (Carnaby–Mann and Crary, 2008). The
investigation was about whether NMES was effective treatment for swallowing disorders. The
participants had to obtain a score of 23 or greater on the mini mental state examination (MMSE) and
a score of 5 or less on the Functional Oral Intake Scale (FOIS), and lastly the participants could not
have received swallowing therapy within the last three months (Carnaby–Mann and Crary 2008).
Before therapy began baseline scores were collected including clinical and instrumental swallowing
evaluation, documentation of weight and the participants of self perception of swallowing ability.
The Mann Assessment of swallowing ability (MASA) was used to assess swallowing ability. A
videofluoroscopic swallowing evaluation was conducted to confirm the presence of pharyngeal
dysphagia (Carnaby–Mann and Crary 2008). Materials used in this examination were thin liquid,
nectar thick liquid, and pudding in both 5ml–10ml amounts, and modified per participant. Effort
was made to present each material to each participant, but if participant aspirated in large quantities
the

Oropharyngeal Dysphagia Case Study
Client Assessment
The patient has been addressed as Ms. W for confidentiality purposes. Psychosocial: Ms. W is a 67
year old female patient who was admitted into the palliative homecare program after a recent stroke.
She lives with her daughter who is the primary care giver and is often daily visited by her son, who
acts as her secondary care giver. Her daughter's family also lives with her, whom consists of her son
in law, two young grandchildren and a toddler. Ms. W requires full assistance with ADLs which her
daughter attends to. However she was previously fully independent with ADLs prior to stroke.
Neuro: Ms. W was awake and appeared partially orientated on the visit. Her level of consciousness
was monitored using Glasgow coma scale (Appendix 1) which had a score of E3 for eye opening, ...
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W tends to have difficulty swallowing her food and tends to cough or choke while being fed. It has
also been noticed that she tends to drool saliva. These are few of the signs of dysphagia as well as,
fear of choking, difficulty chewing and avoiding certain food with particular consistencies (Miller &
Patterson, 2014). Oropharyngeal dysphagia is common in up to 55% of the patients who has
suffered from strokes. Oropharyngeal dysphagia is when the patient has difficulty preparing the
food bolus and transporting it from mouth to the stomach (Kumar, Selim, & Caplan, 2010). The
patient's abdomen was assessed by listening to bowel sounds using flat disc diaphragm as intestinal
sounds are high pitched and is well accentuated by the use of diaphragm (Berman & Snyder, 2012).
By gathering patient history on her usual bowel patterns any new changes in bowel movement can
be identified. According to patient's daughter patient has had bowel movements daily and by using
the Bristol stool chart (Appendix 3) it was identified that her stool was normal (Lewis & Heaton,
1997). The patient required assistance with toileting as she was bedbound and uses a bed

Reflection in Nursing
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This assignment is a ... Show more content on Helpwriting.net ...
Severtseen (1990) cited by Duxbury (2000) applies the term 'therapeutic communication' as the
dialogue between nurse and patient to achieve goals tailored exclusively to the patients needs. In
this case dialogue is used by Mr. Comer in the form of body language and noise to communicate his
needs because of speech loss.
Nelson–Jones (1990) states that facial expressions are an intrinsic way to express emotions and eye
contact is one way to show interest. The avoidance in eye contact displayed by Mr. Comer showed
his distinct lack of interest. Compounding these factors was his facial paralysis, which made it
especially difficult for me to ascertain the exact nature of his feelings.
The nurse must be the sender and more importantly the receiver of clear information. Patients with
speech impairment or loss have a more difficult task sending the messages they want and are
sometimes unsuccessful in making themselves understood. (Arnold & Boggs 1995).
It appeared to me that Mr. Comer's cough was not only a physiological disorder caused by his
condition, but a way for him to communicate, in this case, his displeasure. Critical analysis of this

experience has pointed to the fact that I have inadequacies in my skills, to identify covert and overt
clues provided by Mr. Comer to his needs. I had focussed too much on the presenting task to feed
him,

Clinical Article Summary
This article researched patients with swallowing functions over the first six months after acute
stroke. They identify the important clinical factors that associated with an increased risk of
swallowing dysfunctions and complications. The studies relied on bedside clinical examinations to
diagnose dysphagia and assessed swallowing function for two weeks after the patient's stroke. After
a patient has an acute stroke, swallowing abnormalities are a common function depending on the
timing of assessment, diagnostic methods, and criteria. If patients aren't taken care of right away
with a diet, nutrition, and hydration have the potential to cause them serious complications.
Aspiration is a common problem for patients after a stroke, and it occurs when a patient swallowing
food or liquids enters their airway and lungs. After a stroke, a patient could have silent aspiration,
which food and liquids enter the airways and lungs without the patients knowing. Reasons, why
some stroke patients have difficulty with swallowing are due to weakness or loss of feeling in the
tongue, lips, palate and throat. The voluntary of swallowing takes place in the cerebral cortex of the
brain, and the "region of the cerebral cortex that command swallowing functioning ... Show more
Were patients given any treatment during the time of their study? What types of diet were the
patients given? How many of the patients recovered after their stroke and swallowing function?
Overall I thought this article had some good points on swallowing functions after a stroke but still
unclarity throughout the article. Although the data collected was organized and matched up with
what they said throughout the article. Results and conclusion made it clear to what was studied, and
the results made it easier to read. Research conducted was put together well, and I learned a lot
about how a stroke can affect the function of

Neuromuscular Electrical Stimulation
The subject of Neuromuscular Electrical Stimulation (NMES) in the treatment of dysphagia triggers
much controversy within the field of speech–language pathology. The argument created between
professionals with opposing views is mainly due to a lack of sufficient empirical evidence that
NMES either improves or decreases swallow function. Currently, studies examining the outcome of
NMES application are not of high quality and often yield inconclusive results. Despite limited
evidence–based support, many clinicians incorporate NMES into dysphagia treatment plans in a
variety of clinical cases. This is problematic as the American Speech–Language Hearing Association
(ASHA) has promoted evidence–based practice as an integral component of clinical decision–
making in recent years (ASHA 2005). To better understand the debate surrounding NMES and its
implementation, several aspects of this treatment modality must be considered. While NMES in the
treatment of dysphagia is a relatively new clinical practice, NMES itself is not. In physical and
occupational therapy, electrical stimulation of the trunk and limbs has been a successful and well–
documented component of rehabilitation (Clark, Lazarus, Arvedson, Schooling, & Frymark 2009).
However, generalizing the possible benefits of NMES across disciplines to the swallowing
mechanism is difficult because the oral, pharyngeal, and laryngeal systems are unique in structure
and function. Regardless of these apparent differences, Defabrizio

Stroke is the fourth leading cause of death in American...
Stroke is the fourth leading cause of death in American and a leading cause of adult disability.
Stroke or other known as a "transient ischemic attack" occurs when a blood clot blocks an artery or
a blood vessel breaks, interrupting the blood flown to an area of the brain. These characteristics
cause a loss of cerebral function. (NSA, 2014) When brain cells die during a stroke, abilities
controlled by that area of the brain are lost. These abilities include speech, movement and memory.
How a stroke patient is affected depends on where the stroke occurs in the brain and how much the
brain is damaged. (NSA, 2014) Stroke rehabilitation starts on admission to hospital and continues
after discharge; the aim is to restore a level of ... Show more content on Helpwriting.net ...
(Hughes, 2011) When a stroke occurs each of these stages could be affected as a result of
neurological and muscular changes. Swallowing problems can increase risk or morbidity and
mortality, as well as risk of aspiration pneumonia where food or fluids pass into the airway. Some
ways to treat dysphagia would be swallowing therapy and changing of diet. Most post–operative
patients will be placed on a strict puree diet to assess feeding. Gradually they will rise back up to a
regular diet. Most circumstances require approval from the therapy department but it's up to the
nurses or the nursing assistants to inform therapy about changes in swallowing. After assessing a
patient and you can tell that there is some difficulty in swallowing then they should be placed on
thickened fluids to ease the swallowing process. Thickened liquids are common practice in the
management of dysphagia as they are easy to implement by nursing staff awaiting formal
assessment by therapy. (Hughes, 2011) Other factors that can help treat dysphagia in a stroke patient
would be positioning. You need to make sure that the patient is always sitting in an upright position.
Positioning the patient correctly is crucial because of physical and neurological changes that occur
after stroke, such as reduced muscle tone or paralysis which can obstruct the airway and result in
aspiration. Proper management of dysphagia in stroke patients can

Dysphagia Case Studies
2.1 Dysphagia
Dysphagia is the medical term for the symptom of difficulty in eating and swallowing solid and/or
liquid foods (Germain et al., 2006). It occurs when there is a problem with the neural control or the
structures involved in any part of the swallowing process (National Institutes of Health, 2012).
These problems make it hard for dysphagia people to moves food and liquids from mouth toward
the stomach.
It is estimated that dysphagia affects 18 million adults and millions of children in the United States
and 45% – 87% of residents in long term care (Agency for Health Care Policy and Research, 1999;
Langmore, 1994; Steele et al., 1997). Dysphagia is common in people who are elderly or who have
had a neurological event such as a stroke ... Show more content on Helpwriting.net ...
Videofluoroscopic evaluation is the most common method diagnosis of dysphagia. It is used to
record an X–ray video of individual swallowing liquid boluses with various concentrations and
volumes of barium sulfate particles (Logenmann, 1997). The patient is given a radiopaque barium
sulphate suspension and his or her ability to swallow is monitored using videofluorscopy. The
radiographic video could determine bolus transit time and direction, bolus clearance, various
structural movement of the hyoid, upper esophageal sphincter, tongue, mandible and larynx. These
measurements would provide an indication of a patient swallowing ability at mealtime (Logenmann,
1997; Schulze–Delrieu et al., 1997). If the patient exhibits aspiration or excessive residue,
intervention strategies like altering the volume or apparent viscosity of liquids are introduced to
improve swallowing (Logenmann,

Dysphagia Essay
You may be surprised how many times you swallow throughout the day –– every time you eat or
drink something, you have to swallow multiple times. You also swallow salvia throughout the day.
The condition where one has difficulty swallowing is referred to as dysphagia or the swallowing
disorder. Use this guide to better understand what your loved one is going through, and how a
qualified speech pathologist can assist them. Symptoms Of Dysphagia Dysphagia affects each
person a little differently. Some of the common symptoms of dysphagia include: Difficulty
swallowing liquids Difficulty swallowing solid foods Difficulty swallowing foods that have a
specific texture Food comes back up after you attempt to swallow it Eating causes you to gag or
choke Eating causes you pain ... Show more content on Helpwriting.net ...
It is important to focus on treating the cause of your loved ones dysphagia as well the dysphagia
itself. Challenges Of Dysphagia Having dysphagia can present one with many challenges. The most
common challenges are: Dry mouth An inability to maintain weight An inability to get the proper
amount of nutrients These challenges can be life–threatening if they are not treated. Treating
Dysphagia Luckily, a speech–language pathologist can help treat your loved one's dysphagia. They
will work with your loved ones and help them deal with their dysphagia. A speech–language
pathologist can: Help your loved one with exercises to strength the weak muscles that are behind
their dysphagia. Help your loved one with exercises that will increate the coordination of the
affected muscles. Teach your loved one new ways to swallow and use their muscles to get around
their dysphagia. Help your loved one identify which foods and drinks they should avoid. They can
help identify which foods triggering the dysphagia, and which type of foods your loved one doesn't
have the muscular strength to handle at the

VFSS Vs Dysphagia Essay
For class requirements for her master's degree in speech language pathology, Jennifer Allison, from
Southern Illinois University, researched the advantages and disadvantages of using FEES (fiberoptic
endoscopic evaluation of swallowing) versus videofluroscopy (such as VFSS, or Modified Barium
Swallow (MBS)). There has been a lack of research to determine the gold–standard for assessing
dysphagia especially for the pediatric population. VFSS and FEES can be compared based on each
procedure's ability to enable feedback during intervention, assess sensory threshold, evaluate and
diagnose GER, provide patient comfort, and assess a wide range of appropriate candidates. Research
states that a MBS is more commonly ordered, although there is concern with the radiation ... Show
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The exact amount of radiation a child is exposed to during an MBS is unknown. To reduce radiation
exposure, the client should be covered with protective shields and exposure time should be kept
under a minute and a half. Radiation exposure for children at such a young age is a concern because
these children are often exposed to multiple forms of radiation in their first few years of life, such as
x–rays as well. Family preference may determine the use of FEES vs. MBS due to radiation
concerns. Since a FEES does not have time restraints, it allows the clinician to teach, educate, and
monitor the client's behavior during intervention. Although this is also an option while doing a
MBS, the more compensatory strategies tried out, the more radiation the child is undergoing.
Another advantage FEES holds over MBS or VFSS is the use of the sensory evaluation (FEESST).
A puff of air can be administered to test the laryngeal adductor (swallow) reflex. FEESST is the
only swallowing evaluation that directly tests airway protection by determining if the larynx can
fulfill its airway protection function, while at the same time assessing bolus transfer. This

The Effects Of Radiation On Patients With Pgc Undergoing Xrt
Radiation is known to damage the parotid glands and surrounding tissues, resulting in various
toxicities which can lead to a functional decline in swallowing. The current study examined the
incidence, nature and severity of treatment–related toxicities in patients with PGC undergoing XRT
and found a trend of acute toxicities and swallowing difficulties that deteriorated throughout the
course of XRT and peaking at the end of the treatment. Whilst this pattern of toxicity presentation
and recovery is similar to other HNC groups, the severity of toxicities presenting in this clinical
group was much lower, with few patients having any persistent difficulties at 3 months post
treatment. The current information can be used to develop models of ... Show more content on
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Although the types of toxicities are comparable to prior research, there has been minimal data
reported regarding the specific nature and severity of these toxicities experienced during XRT. In the
current study, maximal incidence of Grade 2 severity across the toxicities monitored in this study
ranged from 12–68%. This data supports that XRT induced toxicities in this clinical group were
mostly mild and the majority of the patients did not require SLP intervention to manage symptoms,
including dysphagia, while undergoing treatment. The low level of severe toxicities experienced by
patients in our current study was similar to that found in the few studies to date which examined
early toxicities following PGC management. Oliver et al. (2004) found that only 23% of their study
population of 25 patients who underwent XRT experienced Grade 2 mucositis, which is directly
comparable to the incidence of oral mucositis (24%) and pharyngeal mucositis (28%) in the current
cohort. In comparison, Chung et al. (2011) and Patel et al. (2014) reported only 3–5% of their study
population experienced Grade 2 mucositis. Chung et al. also reported low incidence of Grade 2
xerostomia (5%), while Patel et al. reported only Grade 1 xerostomia and dysgeusia in 5%. These
maximal incidence rates for early toxicities are much lower than the current study data. However
different rating scales (Radiation Therapy Oncology Group

The Body Position Of The Resident
enjoyed ice cream, and I tried to combine the meals with bites of ice cream in between. He seemed
to like the sensations created by the differences in taste and temperature. In addition, I sat and talked
with Henry as well as offered encouragement. It also helped when I added sweetening or lightly
salted the food whenever possible. This strategy worked well in maintaining his weight and health.
Feeding elderly's who had dysphagia or difficulty swallowing also proved challenging. When one
had difficulty swallowing, they might cough when they eat or drink. They can choke on foods and
fluids, so they were unable to drink liquids like water, juice, tea or coffee or food safely. The option
for liquids was water and fluids that were as thick as honey. These thick fluids were good for
elderly's who were at risk for choking on thin fluids, like water. The body position of the resident
was also very important when they had difficulty swallowing. For instance, a resident by the name
of Ms. Good had dysphagia or difficulty swallowing and was bed ridden. Strategies I used with
feeding her for safety purposes were as followed: I positioned her in a 60–90 degree upright position
with the head flexed forward and midline. Her pillows were positioned behind the lower back to
help stabilize or to prevent reflux (food flows back). This technique was also important in order to
reduce aspiration, which is when the food or drinks enters into the lung, which can cause serious
complication,

Dsyphaging And Presbyphagia
Dysphagia is a disorder that is characterized by difficulty swallowing, causing aspiration which, in
result, causes many other life threatening sicknesses. Nearly 15 million adults in the United States
are affected by dysphagia. Dysphagia and aspiration may cause complications such as malnutrition,
pneumonia, dehydration, pulmonary fibrosis, and even death (Blumenfeld, Hahn, Lepage, Leonard,
& Belafsky, 2006). Another common illness related to swallowing disorders is presbyphagia.
Presbyphagia is when the function of swallowing changes as one ages (Pede, Mantovani, Felice, &
Masiero, 2015). This disorder affects both the oropharyngeal and esophageal phases of swallowing;
oropharyngeal and esophageal are terms that can be operationalized ... Show more content on
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Humbert, Michou, MacRae, and Crujido explain electrical stimulation as a technique used to
improve or restore the use of the muscles. In regards to a person with dysphagia or presbyphagia,
this means improving or restoring the use of the muscles used in swallowing. Electrical stimulation
may be used on the surface of the skin (transcutaneously) or within the muscle (percutaneously).
The main purpose of electrical stimulation is to create an electrical current within the muscles that
increases the current intensity of the muscle, thus, causing it to move (2012). When electrical
stimulation is used in combination with traditional therapy methods, it has been known to improve
swallowing ability even more (Crary, et al., 2007).
Previous literature has supported the need for electrical stimulation therapy in treating dysphagia
and presbyphagia. In Suntrup et al.'s study, they state that oropharyngeal dysphagia affects
approximately 50% of individuals affected by stroke (2015). Effective treatment for swallowing
disorders is important because recurring swallowing problems may cause pneumonia, dehydration,
and other illnesses–even death. A more improved treatment method than traditional therapy is
needed to help bridge the gap between healthy individuals and those suffering from swallowing
problems. Treating dysphagia with

Transient Ischemic Attacks: A Case Study
Mrs. September is a 55 year old woman who suffered a stroke 2 years ago. She received
management for her swallowing difficulties after the stroke, and was discharged from the hospital
on an oral diet with normal intake. She is currently complaining about fluctuating swallowing
problems. She has also recently suffered multiple Transient Ischemic Attacks (TMIs) and has
chronic multiple infarcts. She reported that she has suffered a few chest infections recently but there
was no diagnosis of aspiration pneumonia. Information was gathered through a case history,
followed by a Clinical Swallow Examination and from these results, a trial therapy was preformed.
All this information was compiled to form a management plan for Mrs. September.
It is evident that Mrs. September has oropharyngeal dysphagia, resulting from a delay in initiating
the oral swallow and reduced base of tongue retraction on liquids, with this causing a delayed oral
onset time. It was also evident that Mrs. September has a delayed triggering of the pharyngeal
swallow with reduced laryngeal elevation and anterior movement on liquids and semi–solids,
resulting in aspiration on liquids. It is also evident that Mrs. ... Show more content on
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September's cultural views of swallowing as well as any religious beliefs that may influence
management. These beliefs must be upheld regardless of whether it is what the clinician believes in,
as Mrs. September's autonomy needs to be respected (Sharp & Genesen, 1996). By not doing this a
barrier will be created between the clinician and Mrs. September (Kaizer, Spiridigliozzi & Hunt,
2012). If Mrs. September is staying within a hospital setting it is important to educate the nurses
around her on the techniques needed to help Mrs. September and what to do if she is coughing or
chocking (Shanley, 2000). The clinician will also need to find out what Mrs. September's favourite
foods are so she is able to incorporate this into

Dysphagi A Case Study
Allison Kwan
Research Article Worksheet
Title of Article: Parker, Claire, Power, Maxine, Hamdy, Shaheen, Bowen, Audrey, Tyrrell, Pippa, &
Thompson, David G. Awareness of dysphagia by patients following stroke predicts swallowing
performance. Dyshagia, 19, 28–34.
APA format: last name, first name author (year). Title of article in lower case (if journal article).
Title of journal italicized, Volume Number (Issue Number), page numbers.
The purpose of this study was to detect dysphagia awareness in 70 stroke patients, and how this
awareness or lack of awareness can predict the severity of swallowing behavior.
Rationale: Why was this important exploration? Knowing the complications of swallowing after a
stroke can potentially lead to ... Show more content on Helpwriting.net ...
Based off the findings, many individuals do not know they are dysphagic, meaning they are not only
taking proper steps to ensure better and safer swallowing patterns, but the many individuals that
have worked with these patients have not discussed or made proper swallowing a strong focus. With
this idea, I think it is important to assess the types of environment these patients are living in and the
type of care they receive (medically and personally, from family and friends). It may lead to a better
understanding of why some patients are more aware than others. After my own learning about
dysphagia, proper care for dysphagia is not an independent task, but relies on a multitude of
individuals including those closest to the patient. Researching those that have a strong support
system may lead to a better outcome of those with more awareness of dysphagia, hopefully leading
to improved swallowing and a longer

Dysphagia Case Study
Dysphagia is a term used in health care to define the symptom of difficulty swallowing. It is defined
as any impairment in drinking, eating or swallowing ( Lewis, 2014). It occurs when there is any
change in the neural functioning or any weakness of muscles that help us to swallow the food, most
commonly the esophagus and the facial muscles. However, sometimes it is the tongue that is unable
to push the food posteriorly towards the pharynx for further digestion. Studies have shown that
approximately 53%–74% of long–term care facility residents have dysphagia (CAN training
advisor, 2014). It is more common in older clients and the ones who have experienced stroke at
some point in their lifetime. In Canada, approximately half of all new stroke ... Show more content
on Helpwriting.net ...
Nurses play a vital role in the management of dysphagia before the speech therapists arrive. Nurses
are considered accountable for maintaining proper nutrition and hydration of the client. The main
core assessment that go along with dysphagia management is to assess the swallowing status of the
client within 24 hours of admission to the hospital. The nurse performs this assessment to ensure
that the client is well hydrated and nourished. Moreover, pain is often the main complaint by the
clients who have difficulty swallowing. Due to pain, they are at high risk for malnutrition and
dehydration. The role of the nurse is to obtain a client's current nutrition status, blood exam results
and past medical history provided by the family doctor. For this, The National Collaborating centre
for acute care (2006) recommends the nurses to perform weekly nutrition assessment while the
patient is in the hospital. This helps the nurses to mark a baseline and make changes to the clients
dietary needs according to situation as evidenced by the nutrition screening test. The speech
therapists then come and check the swallow reflex. Also, according to Mills (2008), people with
dysphagia should be given thickened fluids on a regular basis to manage the complications of
dysphagia. However, health care providers should also keep in mind not to just rely on texture diets
but also, talking to the doctor to prescribe fortified supplements alongside meals for proper
maintenance of dysphagia. Therefore, the main goal here is to minimize weight loss that can result
in other problems as well. A nurse is trained and educated well to handle the situation and act
accordingly before the help of the therapists come into play. Consequently, a nurse use his or her
clinical discretion and begins with performing a nutrition

The Effects Of Unlimited Oral Intake On Patients With...
Debate & concerns
Teamwork is critical to implementing this type of water protocol.
Ensuring pristine oral hygiene is critical for this type of protocol to work efficiently and effectively.
Implementations across whole facilities and not just on a case–by–case basis can be problematic.
Compliance of patients and families to remain on a modified diet of thickened liquids only can be
difficult, especially after leaving facilities.
Patients who are on a thickened liquids diet only may face dehydration which can cause more
problems than aspiration of water alone.
Allowing patients to consume water as they wish may increase in their quality of life.
Individuals on a modified thickened liquid diet or feeding tube may aspirate ... Show more content
on Helpwriting.net ...
Critique: This was a very small study done and did not provide a representative sample of the
dysphagia population, only studying patients whom had suffered a CVA. The sample size of this
study was limited due to the numerous subjects who declined participation after education of the
protocol or because they did not meet the inclusion criteria. Even though there were no instances of
aspiration pneumonia in the group who was allowed the free water protocol, this study is limited in
it's clinical significance. It is important to note however, that patients who were involved in the FWP
study group had a much higher patient satisfaction compared to their modified diet of thickened
liquids counterparts.
Pooyania, S. , Vandurme, L. , Daun, R. and Buchel, C. (2015) Effects of a Free Water Protocol on
Inpatients in a

Pharyngeal Phase
Pharyngeal Phase Despite the fact that the pharyngeal phase of swallowing is the most complex,
from start to finish the entire phase takes less than one second. Sensory receptors at the back of the
tongue and anterior faucial pillars are stimulated by the sensation of the bolus, and trigger the
pharyngeal phase of swallowing. Additionally, the oropharynx detects and relays sensation
information related to the viscosity and consistency of the bolus, which then influences the
physiology of the pharyngeal swallow. Nevertheless, the swallow is also under volitional control, as
one can be triggered without stimulation to the posterior oral structures (Logemann 1997; Corbin–
Lewis, Liss, & Sciortino, 2005). Once the pharyngeal phase is triggered, ... Show more content on
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During quiet breathing, the diaphragm contracts upon inhalation, causing the abdomen to depress
and the ribcage to expand. Due to the pleural connection between the ribcage and the lungs, the
expansion of the ribcage forces the lungs to expand as well. As the volume of the lungs increases,
air rushes in through diffusion. Upon exhalation, the diaphragm relaxes, causing the ribcage and
lungs to recoil without muscular assistance. Air rushes back out of the lungs, exiting through the
mouth and nose.
Forced breathing (such as during exercise) and speech breathing require greater muscle involvement
for both the inhalation and exhalation portions of the respiratory cycle. Speech breathing involves
rapid, forceful inspirations, and proportionally less time is spent inhaling than spent exhaling
(Owens, Metz, & Farinella, 2011). The muscles of forced inhalation (see Appendix B) assist by
increasing the size of the thoracic cavity, allowing more air to enter the lungs. In addition, the
muscles of forced inhalation contribute to the "checking" action that maintains support of the
ribcage, preventing collapse (Taylor, 1960). The muscles of forced exhalation (see Appendix B)
force the diaphragm upward, compressing the ribs, and thereby allowing the speaker to control the
flow of air necessary for

Dysphagia In The Elderly Population
Introduction Research has highlighted that stroke is one of the primary causes of dysphagia in the
elderly population (Christmas 2002). Physiological implications such as aspiration are some of the
difficulties that stroke–induced dysphagia can cause. Thickening–liquids, a form of intervention
involving modification of the bolus, is frequently mentioned in the literature for reduction of the risk
of aspiration in dysphagic post–stroke patients. Despite being a popular compensatory method of
intervention, research has shed light on some of the potential disadvantages of thickeners usage such
as increased dehydration (which is likely due to decreased fluid intake) and the impact on the
patient's quality of life. This leads health professionals

Essay On Dysphagia
DYSPHAGIA. Definition? Difficulty or discomfort in swallowing. Signs & Symptoms Signs and
symptoms associated with dysphagia may include: Pain while swallowing Inability to swallow
Having the sensation of food getting stuck in your throat or chest or behind your breastbone
(sternum) Drooling Regurgitation Having frequent heartburn Having food or stomach acid back up
into your throat Unexpectedly losing weight Coughing or gagging when swallowing Having to cut
food into smaller pieces or avoiding certain foods because of trouble swallowing Complications?
Difficulty in swallowing can lead to: Malnutrition. Since it is difficult for the patient to swallow,
they might lose their appetite leading to malnutrition and they cannot meet the nutritional needs for
... Show more content on Helpwriting.net ...
As the patient have difficulty in swallowing, chances are high that the food or the liquids can enter
their airway when swallowing that can lead respiratory problems, such as pneumonia or upper
respiratory infections. Causes? The muscles and nerves that help move food through the throat and
esophagus are not working right. This can happen if you have: Had a stroke or a brain or spinal cord
injury. immune system problem that causes swelling (or inflammation) and weakness, such as
polymyositis(a condition marked by inflammation and degeneration of skeletal muscle throughout
the body) or dermatomyositis(inflammation of the skin and underlying muscle tissue, involving
degeneration of collagen, discoloration, and swelling, typically occurring as an autoimmune
condition or associated with internal cancer). Esophageal spasm. When the muscles of esophagus
suddenly squeeze causing the food to reach stomach sometimes. Scleroderma. When the tissues of
the esophagus become hard and narrow. Scleroderma can make the lower esophageal muscle weak,
which cause the food and stomach acid to come back up into the throat and mouth. Treatments
Cervical auscultation Blood

Dysphagia Research Papers
The speech–language pathologists (SLPs) at Martin Health System (MHS) evaluate, diagnose, and
treat a diverse patient population who present with a myriad of medical issues, the most common of
which is a condition known as dysphagia. More than 80% of patients referred to an SLP at our
facility present with this diagnosis. Broadly characterized by trouble swallowing, dysphagia
includes everything from painful swallows, to coughing or choking while eating and drinking, or
even a sensation of a lump in throat, . Complications of dysphagia can lead to dehydration,
malnutrition, and respiratory problems such as aspiration pneumonia, fatigue, cognitive confusion,
decreased quality of life, or even death. The most common age group treated by SLPs ... Show more
The study showed a $20,000 reduction in radiology costs over 6 months, increased radiology access
for other patients, decreased patient wait times for instrumental evaluations, and earlier discharge
from the hospital. Increasing patient access to diagnostic swallow testing while reducing patient
wait time and healthcare costs will improve individual patient outcomes and effectively allocate
valuable resources to other aspects of patient care. The MBSS requires three hospital personnel to
administer, two hours total time for the SLP to complete, and five minutes of pure diagnostic
examination with the patient. This is in direct contrast to FEES, which requires one individual to
administer, one hour total time for the SLP to complete, and 15 minutes of diagnostic assessment
with the patient. This reveals several critical details. First, FEES requires the presence of fewer
hospital staff, saving both time and resources. Second, FEES takes less setup and follow up time for
the SLP, making it a more efficient evaluation process. Third, although requiring less overall time,
FEES allows the SLP to spend more time in direct patient contact to provide the highest level of
care while still streamlining the assessment

The Implementation Of Adult Nursing Care For A Patient /...
An implementation of Adult Nursing care for a patient/client will be the focus of this essay. An
evidence based discussion will look into a common health condition, how nursing care will be
implemented for a chosen priority as well as principles of person centred care, safe nursing practice
and the role of the multi–disciplinary team. For this essay, patient profile 3 will be used. Eileen
Smith, is an 73 year old lady, who has had a Thrombotic Cerebrovascular Event. Cerebrovascular
event or stroke is a clinical syndrome caused by disruption of blood supply to the brain (Stroke
Association, 2015). A nurse has assessed Eileen, and recognised four priorities of care. The chosen
priority being discussed will be Eileen's difficulty with eating and drinking. This priority has been
chosen as it is an topic of interest and because cerebrovascular events involve a wide multi–
disciplinary team with aftercare being individualised and person centred.
As briefly defined above, a cerebrovascular event or stroke is a disruption of blood supply to the
brain. It is characterised by sudden and rapid developing signs of the affected artery or the
disturbance of cerebral functions (Wiley–Blackwell, 2011). There are two types of stroke: Ischaemic
and Haemorrhagic. Ischaemic stroke is caused by an obstruction of a blood vessel that supplies the
brain, either by an in–situ thrombus or embolus from a site elsewhere, most common in the carotid
artery (Wiley–Blackwell, 2011). Haemorrhagic stroke is

Dysphagia Research Paper
The Causes of Dysphagia in the Aging Adult Population Dysphagia, a swallowing disorder that can
be seen in anyone at any age, is a prevalent problem among aging adults. Dysphagia can be defined
as an abnormal swallowing process. In other words, one is swallowing unconventionally (Sura,
Madhaven, Carnaby, & Crary, 2012); but when one looks at the physiology behind dysphagia, they
can note that this impairment is caused by an abnormality of function in one of the various
swallowing structures, such as the lips, throat, or the lower jaw (Li, Wang, Han, Lu, & Fang, 2015).
In fact, this swallowing disorder can be seen in a large number of adults annually for a variety of
reasons, but most of the adults who develop dysphagia are elderly, which means that they are at a
higher risk for problems that can eventually lead to this swallowing impairment (Sura, Madhaven,
Carnaby, & Crary, 2012). Not only that, but dysphagia can commonly be found in adults who have
head and neck cancers as well (Clarke, Radford, Coffey, & Stewart, 2016). Since dysphagia effects
one's ability to swallow, it can also impact areas that have to do with ... Show more content on
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In fact, dementia, like stokes, are one of the more prevalent factors that can cause one to acquire the
complication of dysphagia. The risk for developing dementia increases as one ages. For example, a
little under half of patients who have dementia have been diagnosed with dysphagia. (Sura,
Madhaven, Carnaby, & Crary, 2012). Speech language pathologists (SLPs) have observed that those
who present dysphagia alongside dementia seem to have a slowing in their swallowing. Thus, it has
been concluded by SLPs that patients who are presenting their dementia in various ways may have
different degrees of dysphagia, including patients having various abilities to complete the tasks of
swallowing and feeding. (Sura, Madhaven, Carnaby, & Crary,

Dysphagia Case Studies
Theory State There are multiple therapeutic techniques used today to alleviate the effects of
dysphagia; one commonly used technique is the chin–down posture (Young, Macrae, Anderson,
Taylor–Kamara, & Humbert, 2015). The article, the Sequence of Swallowing Events During the
Chin–Down Posture, investigated the clinical effectiveness of the chin–down posture (Young et al.,
2015). According to the authors, prior studies have expressed the chin–down posture to be widely
prescribed to minimize aspiration in patients with dysphagia and neurological deficits (Young et al.,
2015). The clinical usefulness of the chin–down posture has been shown to be far–reaching;
however, there is less research explaining why or how the posture prevents aspiration. ... Show more
The authors provided information on the participants age and gender. However, there was a lack of
information of race, ethnicity, and residential location. In addition, the authors specified the
participants to be healthy based on the participant report. In order for the study to be reproduced
similarly, there should be an understanding of what is considered "healthy" and how it was
determined. For the procedure, there was explicit information on how it performed. The results of
the study were clearly written and related to the research questions. The findings were expected
based on previous evidence supporting that LVC was longer in duration during chin–down postures.
Moreover, it was previously supported that the physiological movements required for swallowing
were different between normal (neutral) head position and chin–down posture. The current study
agreed with other previous findings in that LVC tended to have a longer duration during chin–down

Myasthenia Gravis : An Autoimmune Neuromuscular Disorder
Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder meaning grave muscular
weakness. Symptoms associated with myasthenia gravis include painless, fluctuating, and fatigable
weakness involving specific muscle groups. Weakness is usually least in the morning and progresses
as the day continues especially with prolonged muscle use. Double vision and drooping eyelids is
usually the first symptom complaint from patients with MG. The patient may complain of difficulty
with speech, chewing, swallowing, or breathing. Initial symptoms of difficulty chewing,
swallowing, or speaking is reported in 16% of patients. Weakness can also be present in the arms or
legs. Prevalence of MG is currently 20/100,000 in the United States. The ... Show more content on
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Patients with MG are at a high risk for silent aspiration. Literature has demonstrated that silent
aspiration occurs in approximately 50% of those with MG who aspirate (Higo, Nito, Tayama, 2005).
Colton–Hudson reported silent aspiration in 4 out of 7 patients (2005). Kluin et al studied 8 elderly
men with MG and found silent aspiration in 5 out of 8 patients (1996).Due to the high incidence of
silent aspiration instrumental evaluation of the swallow is suggested for patients with MG. In most
instances cholinesterase inhibitor medication provides improvement in the patient's swallow. Colton
et al reports that active exercise to maximize the strength of the oropharyngeal muscles are
generally limited by fatigability and not recommended for dysphagia associated with MG (2002).
Chewing and swallowing functions may be improved by the administration of cholinesterase
inhibitor medication one hour prior to the meal. Speech–language pathologist can educate patients
on taking medication in conjunction with meal times. Other compensatory strategies can be
implemented following instrumental swallowing evaluation. The swallowing quality of life scale
(SWAL–QOL) could be used for patient reported measure of functioning for dysphagia. The
SWAL–QOL has demonstrated strong internal consistency and strong test re–test reliability
(McHorney et al, 2002). This test would be beneficial for intervention planning because it

Dysphagia Summary
A Summary of Dysphagia: Warning Signs and Management Dysphagia is a condition of weakened
or damaged muscles and nerves that are utilized during the swallowing process, leaving a patient
unable to properly swallow food, drinks, and medications. This disorder, which can be caused by
many different disease processes, can cause a serious problem known as aspiration. The prevalence
of this disorder varies due to the etiology of a disease process but it is projected to affect fifty to
seventy–five percent of nursing home inhabitants and roughly eight percent worldwide. Dysphagia
can be categorized mostly into three categories of neurological, obstructive, and muscular.
Neurological dysphagia can have multiple causes, including cerebral palsy, Parkinson's disease,
multiple sclerosis, and stroke, which is the most common cause of this type of dysphagia.
Obstructive causes of dysphagia include cancers of the mouth and esophagus, cleft lip and palate,
and the effects of radiotherapy which can result in accumulating scar tissue that can eventually
occlude the mouth or esophagus. The last broad category is muscular, which include myasthenia
gravis, achalasia, scleroderma, and more. Dysphagia in these conditions are caused by
neuromuscular defects of the swallowing muscles. ... Show more content on Helpwriting.net ...
Nurses should be aware of the interventions that should be employed to identify and decrease the
risk for aspiration, including examination of the patients swallowing capability, referral to other
health care providers, including speech and language therapists, proper positioning and support
during mealtimes, and altered texture diets that will safeguard the patient from further

Dysphagia Case Study Essay
From what I have understood, I would say the contributing factors for dysphagia would have been
because she has suffered from a stroke that has possibly contributed in the difficulty to chew or
swallow foods and liquids, that may have been the lead cause of her malnutrition. Ignatavicius, &
Workman (2016) found "studies indicate that as many as 50% of patients are malnourished at 2 to 3
weeks after a severe stroke" (p.942). complication from tube feeding may include fluid and
electrolyte imbalance or even fluid overload from too much tube feeding. In order to limit
complication from tube feeding the nurse must assess signs and symptoms of circulatory overload
for example peripheral edema. Keeping the tube site free from infections, auscultating lung sounds
and also observing for signs of dehydration. The Albumin levels from Mrs. Smith is low normal
rage is between 3.5–5.0 so she may have fluid excess. Also, her pre–albumin is low and could be a
result of protein and calorie malnutrition. The priority nursing diagnosis I would choose for Mrs.
Smith would be Imbalance nutrition less that body requirement ... Show more content on
Helpwriting.net ...
My initial assessment would start with her medical history, asking about changes in eating habits,
such as changes in appetite, recent weight changes then followed by a full set of vital signs, a head
to toe assessment. Also, a psychosocial assessment such as her living, arrangements and mental
status. List the nursing assessments the nurse will complete in order to plan for her discharge. I
would assess Mrs. Smith vital signs, make sure her tube feeding sight has not signs of infections, no
skin breakdown, and providing resources that she may need. Also, that her weight and nutritional
status is within a normal range. How are they different from the initial assessments? The initial
assessment is what the nurse may need to know before determination what is wrong with the
patient.

Dysphagia Essay
Copstead and Banasik (2013) explain the pathophysiologic basis for dysphagia can fall under three
categories:
(1) "problems in delivery of the bolus of food or fluid into the esophagus as a result of
neuromuscular incoordination"; (2) "problems in transport of the bolus down the body of the
esophagus as a result of altered esophageal peristaltic activity"; (3) "problems in bolus entry into the
stomach as a result of lower esophageal sphincter (LES) dysfunction or obstructing lesions" (p.
721).
In the first category of dysphagia, "individual have a decreased ability to accomplish the initial steps
of swallowing in an orderly sequence" (Copstead & Banasik, 2013, p. 721). The normal process of
swallowing starts with the contraction of pharynx, which then leads to the closure of the epiglottis
and results in the relaxation of the upper esophageal sphincter (Copstead and Banasik, 2013). After
the relaxation of the upper esophageal sphincter, there is an "initiation of peristalsis by contraction
of the striated muscle in the upper portion of the esophagus is altered, or the certain steps in the
sequence may be absent" (Copstead & Banasik, 2013, p. 721). ... Show more content on
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721). Three causes of this are due to diverticula, achalasia, and structural disorders. Esophageal
diverticula cause outpouching which results in one or more layers in the esophageal wall (Copstead
& Banasik, 2013). Achalasia is a "disorder of esophageal smooth muscle function" (Copstead &
Banasik, 2013, p. 721). Structural disorders "may interfere with proper peristaltic activity in the
esophagus", thus results in "peristalsis may be simply weak peristaltic activity, aperistalsis, or
disorganized and therefore ineffective peristalsis" (Copstead & Banasik, 2013, p.

Aspiration Pneumonia Essay
Introduction
Background and Significance Dysphagia is a swallowing disorder that is described as an
abnormality in transferring a solid or liquid bolus from the oral cavity to the stomach (Bernard,
Loeslie, & Rabatin, 2015). With a diagnosis of dysphagia, a patient will likely aspirate foods and/or
liquids of different consistencies. Aspiration is "the entry of food or liquid into the airway below the
true vocal folds" (Logemann, 1998, p. 5). Specifically, thin liquid dysphagia occurs when a patient
aspirates while consuming any liquids that are not thickened, such as water. Patients with thin–
liquid dysphagia are often prescribed a modified thickened liquid–only diet, meaning they consume
liquids that are thickened to a greater consistency of nectar, honey, or pudding (Carlaw et al., 2007).
An increased viscosity reduces the flow rate of a bolus, makes it more cohesive, and is easier for
many people to control intraorally, thus preventing spillage into the airway (Murray, Miller,
Doeltgen, & Scholten, 2013). Dysphagia can also contribute to the occurrence of aspiration
pneumonia. Aspiration pneumonia occurs "when organisms infiltrate the lower respiratory tract
during an episode of aspiration and the ... Show more content on Helpwriting.net ...
One of the most commonly used free water protocols is The Frazier Free Water Protocol (FWP)
developed by the Frazier Rehabilitation Institute (Langdon, 2009). This protocol allows patients
with dysphagia to have oral intake of water between meals, even while prescribed with a thickened
liquids diet. Initially, the purpose of the FWP was to increase compliance of patients on modified
diets; however, more recently, researchers are claiming the positive outcomes of increased hydration
levels (Bernard et al, 2015). Patients on thickened liquids–only diets often complain often show
disapproval of thickened liquids and modified solid consistencies (Karagiannis, M. et al.,

Dysphagia Essay
Introduction Swallowing problems (dysphagia) occur when solids and liquids seem to stick in a
person's throat on the way down to the stomach, or when food takes longer to get to the stomach.
What are the causes? This condition is caused by: Problems in the muscles. These may make it
difficult for you to move food along the tube (esophagus) into your stomach. You may have ulcers,
scar tissue, or inflammation which blocks the normal passage of food. Causes of these problems
include: Acid reflux from your stomach into your esophagus. Infection. Radiation treatment for
cancer. Medicines taken without enough fluids to wash them down into your stomach. Nerve
problems. These prevent signals from being sent to the muscles of your esophagus to contract and
move ... Show more content on Helpwriting.net ...
This condition is diagnosed by: Barium X–ray. In this test, you swallow a white substance (contrast
medium) that sticks to the inside of your esophagus. X–ray images are then taken, with the pictures
made clearer by the contrast medium. Endoscopy. In this test, a flexible telescope is inserted down
your throat to look at your esophagus and your stomach. How is this treated? Treatment for
dysphagia depends on the cause the condition: If the dysphagia is caused by acid reflux or infection,
medicines may be used. If the dysphagia is caused by problems with your muscles, swallowing
therapy may be used to help you strengthen your swallowing muscles. If the dysphagia is caused by
a blockage or mass, procedures to remove the blockage may be done. Follow these instructions at
home: Try to eat soft food that is easier to swallow. Check your weight on a daily basis to be sure
that it is not decreasing. Drink liquids when sitting upright (not lying down). Take over–the–counter
and prescription medicines only as told by your health care provider. If you were prescribed an
antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic
even if you start to feel

Helping Adult Hypertenstive Patients with Difficulty...
Aim: The aim of this work was preparing once daily fast disintegrating tablets to handle easily for
adult hypertensive patients who have difficulty in swallowing.
Methods: Solid dispersions bisoprolol hemifumarate (SD–BH) was prepared by using EC and
HPMC in different ratios. A 3* 22 full factorial design was used to investigate the main formulation
parameters (different fillers, binder differ in the molecular weight and different coat type).
SD–BH were prepared and characterized by DSC. Disintegration time, wetting properties, friability,
and hardness of FDTs were evaluated. Percent drug dissolved was determined. Furthermore, the
bioavailability was compared with commercial market product.
The results: The mean production yield of BH–SDs was 93.50 ± 0.39 %. The tablets demonstrated a
hardness of 2–5 N, friability 0.04–0.56% and disintegration time of 67 ± 1.54 sec. The formulations
were subjected to accelerated stability study as per ICH guidelines and were found to be stable after
three weeks at 60 °C and 75 % R.H.
Conclusion: Based on The present study; the suggested FDTs (Ta1) which delivers a solid
dispersions' 10 mg BH using HPMC and EC in 1:1 ratio showed an extended effect in lowering the
blood pressure and decrease the disintegrating time lesser than commercial oral tablets.
Key words: bisoprolol hemifumarate, fast disintegrating tablets, bioavailability study, extended
release, solid dispersion.
1. Introduction
Hypertension is still one of the most

How Dysphagia Is A Common Complication Of Dysphagia Essay
Introduction
Dysphagia is defined as a difficulty moving food from the mouth to the stomach. Dysphagia can
come and go or slowly worsen over time depending on the other disorders present. When a person
has a cerebrovascular accident (CVA), dysphasia can appear and later go away. If a progressive
neurological impairment is the cause of the dysphagia, the swallowing problems can worsen over
time and never go away (Logemann, 1998). Dysphagia is a commonly diagnosed for at least a short
time after a CVA has occurred and individuals are more likely to aspirate liquids with a lower
viscosity (Murray et al. 2016). Increasing the viscosity, or thickening liquids, is a common strategy
that individuals diagnosed with dysphagia use as a compensatory strategy. Changing the viscosity of
liquids by adding thickeners helps keep the bolus together and slows down the rate of dispersion in
the oral and pharyngeal cavities. This helps the individual reduce their risk of aspirating when
swallowing the liquid (Murray et al., 2016). However, dehydration is a common complication of
dysphagia. Hydration is a process of maintaining a balance of water in the body. Half of our water
intake is through drinking beverages including water (Sharpe et al., 2007). The standard daily fluid
intake for individuals is 1500 mL per day. However, many individuals who are in acute care do not
meet this daily standard (McGrail et al., 2012). The lack of fluid intake in individuals can impact
their

Essay On Orophagia
Oropharyngeal dysphagia is the difficulty of transferring food from the mouth to the pharynx, which
initiates the swallowing process. This type of dysphagia occurs in the pharynx and upper part of the
esophagus. The phase of swallowing that is affected is initiating a swallow, and then propelling the
bolus through the pharynx and into the esophagus. Treatment for dysphagia is extremely important
to prevent malnutrition, dehydration, obstructing the airway, and pneumonia. Occupational therapy
identifies swallowing and the eating processes an essential activity of daily living. Therapists can
use a wide range of interventions to enhance our patient's ability to participate in eating activities of
daily life. To describe oropharyngeal and occupational therapy, there will be a progression
beginning with the etiology into the ... Show more content on Helpwriting.net ...
The modified barium swallow test can be used to identify the food consistencies that the patient may
swallow easier. This test can also identify the best position of the head and neck to initiate the
swallowing process. If the patient has a narrow esophagus, they may benefit from dilating the
esophagus. There are several techniques to achieve this including: a balloon or dilators; such as
rubber or plastic cylinders are passed through the endoscope to stretch the narrowing. Acid lowering
agents or steroids can be used; they are sprayed into the back of the throat and then swallowed.
Botox can also be used to relax the muscle at the bottom of the esophagus. These treatments are
used if the dysphagia is caused by motility disorders (Gyawali, 2010). Medications can be used to
treat the dysphagia if it is caused by GERD. If it is caused by neurological disorders, exercises and
new swallowing techniques taught by an OT or SLP to help compensate. Lastly, surgery can be
performed. A myotomy can be preformed to cut the lower esophageal sphincter (Mayo,

Dysphagia Cup Research Papers
If you are searching for a well–made dysphagia cup, you might take a look at this mug offered by
AliMed. Users love the shape of the cup, but some do note that it's overpriced. This dysphagia cup
has a weighted base that slows tremors to promote self–drinking, a wide handle, and an oval shape
that directs the flow of the liquids. The dysphagia mug also has a nose clearance that would allow
you to drink without tilting your head. The capacity of the mug is 8 ounces, and you can clean it in
the dishwasher. It's available in two colors – almond and green. Overall, users have a favorable
opinion of the AliMed dysphagia mug, and they praise its functionality and design. A happy buyer
mentions that the cup is perfect for unsteady hands due to its

Research Paper on Huntington's Disease
Huntington's disease is a hereditary brain disorder that is progressive in neurodegeneration; which
means, there is a loss of function and structures of one's neurons. In the long run it results in the loss
of both mental and physical control. The disease affects muscle coordination, cognition and
behavior. It used to be known as Huntington's chorea because it is the most common genetic disease
that is the cause of abnormal twitching. Huntington 's has an intense effect on patients, as
individuals gradually lose the ability to reason, speak and swallow. Also, motor symptoms, which
affects in problems with walking, (Mayo Clinic Staff, 2011). Children born to parents who suffer
from the disease have a 50% chance of inheriting and ... Show more content on Helpwriting.net ...
Other problems that are associated with the effects of swallowing are; difficulty controlling rate of
food or liquid ingestion, impulsivity while eating, difficulty chewing and initiating a swallow,
holding food or liquid in the mouth, drooling and spillage, incomplete swallows – whereas the food
or liquid is left in the mouth or

Summary of the Research: Treatment of Post-stroke...
In their study titled Treatment of post–stroke dysphagia with repetitive transcranial magnetic
stimulation, Khedr, Abo–Elfetoh and Rothwell (2009) aimed to investigate the therapeutic potential
of rTMS over the esophageal motor cortex for treating post–stroke dysphagia. The authors rationale
for the purpose of this study is that dysphagia often follows a stroke. Due to the numerous and
potential grave effects of dysphagia, developing best practices which ameliorate the condition has
been long considered a priority.
Twenty–six patients with dysphagia resulting from stroke participated in this study. All patients
suffered monohemispheric stroke and were assigned randomly to treatment and sham treatment
groups. Fourteen patients were assigned to the treatment group and twelve patients were assigned to
the sham treatment group. Patients received repetitive transcranial magnetic stimulation (rTMS)
treatment over the esophageal motor cortex to the affected motor cortex for five consecutive days
with pulses at intensity levels of 120% over their hand motor threshold for 300 pulses. Motor
disability and dysphasia were assessed "before and immediately after the last session and then again
after 1 and 2 months" (p. 155).
The group that received real rTMS treatment demonstrated significantly greater improvement over
the sham treatment group in motor disability and dysphagia symptoms. Improvements were seen in
dysphagia score, and Barthel index scores. These improvements were

Severe Anorexia Nervosa
Oftentimes, Anorexia Nervosa is classified as a psychological disorder and is not viewed as an
instigator of communication disorders. Besides the obvious negative consequences of eating
disorders, anorexia can cause an onset of dysphagia. Anorexia is a terrible disease and the annual
death rate is approximately 12 times higher than the death rate of all causes of death among females
ages 15 to 24 (Holmes, Gudridge, Gaudiani, & Mehler, 2012). Severe anorexia Nervosa
encompasses a plethora of medical complications that affects each body system and causes severe
weakness (Holmes, Gudridge, Gaudiani, & Mehler, 2012). At this time, Speech Language Pathology
(SLP) is not well versed in treatment and management of anorexia conditions. Veldee ... Show more
The women were institutionalized in an acute medical center and experienced complications of
malnutrition and dysphagia (Holmes, Gudridge, Gaudiani, & Mehler, 2012). To begin the study, the
women were subjected to a bedside swallow evaluation and video fluoroscopic studies (VFSS)
(Holmes, Gudridge, Gaudiani, & Mehler, 2012). Two of the patients showed signs of mild to
moderate dysphagia and one demonstrated severe dysphagia (Holmes, Gudridge, Gaudiani, &
Mehler, 2012). Two of the three also showed aspiration and the third showed penetration (Holmes,
Gudridge, Gaudiani, & Mehler, 2012). Upon reviewing the findings, a SLP team was brought in to
perform therapy via NMES, along with swallowing therapy (Holmes, Gudridge, Gaudiani, &
Mehler, 2012). Swallowing therapy tasks included compensatory strategies and strengthening
exercises (Holmes, Gudridge, Gaudiani, & Mehler, 2012). The NMES device of choice in the study
was the Vitals Stim Therapy Unit (Holmes, Gudridge, Gaudiani, & Mehler, 2012). The patients were
tested orally using the following consistencies: puree, thin, nectar– thick, honey– thick, mechanical–
soft and regular textures. Their results were measured by using the Penetration– Aspiration Scale
that scores the passage and ejection of material into the airway and vocal folds. The scale provides a
score ranging from one to

Dysphagia
The fluoroscopy and the upper gastrointestinal endoscopy are different, but remarkable diagnostic
methods used for the people suffering from dysphagia. Dysphagia is a medical term that means
difficulty swallowing due to abnormal contractions of the esophageal muscles. It is important to find
a quick evaluation that will lead to a better diagnosis and recovery with lesser complications. This
research paper will discuss the appropriate diagnostic method by comparing between the
fluoroscopic unit, and the UGI endoscopy. Data will be collected from King Abdul Aziz University
hospital, the sample will be a large diverse patients with dysphagia as the main complaint.
Dysphagia is a common indication that needs functional and anatomical assessment. ... Show more
Images were obtained for the oropharynx, the whole length of the esophagus including the proximal
and distal ends, and the gastroesophageal junction ( GEJ ) for any present pathology, with single and
double contrast studies for mucosal relief. The images were taken while the patients were in the
supine position. For upper GI endoscopy, a complete preparation was done for the patients including
nothing per oral ( NPO ) for at least four hours before the start of the examination, under local
anesthesia. The complications and risks of the procedure were also explained to the patients prior
the exam. The patients were positioned on their left side, and to prevent them from biting on the
endoscope, a mouth guard was placed between the teeth. The endoscope was moved over the tongue
into the oropharynx under vision, the endoscope was guided into the esophagus with fast and gentle
manipulation, noting any pathology while the endoscope was gradually advanced down the
esophagus. If necessary, a biopsy was taken immediately. The result of the study was ten of the
patients ( 83.34% ) were diagnosed with videofluoroscopy, and five patients ( 41% ) were diagnosed
with upper GI endoscopy, however; eight of the examined patients, no problems were found on both
videofluoroscopy, or upper GI endoscopy. The results showed That in comparison with the upper GI
endoscopy, videofluoroscopy can accurately diagnose a large number of positive causes of
dysphagia. Also, videofluoroscopy was readily done, and it did not require a previous work up of
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