Topic 3: Dysphagia

Nancy, a 75-year-old lady who had a stroke (a lacunar infarcts of the brain stem) last year has been referred to you. In addition to her inability to walk, Nancy’s attending physician also noticed that she is having problems with swallowing. It takes a significantly longer time for her to swallow the food, and very often she shows spillage and leakage from her lips when chewing food. Over the last 6 months, Nancy has been admitted to hospital due sudden onset of fever and has been on antibiotic medication all the time. According to the nurse who has been taking care of her, Nancy does not seem to have a problem with swallowing as she never chokes or shows any irritative feeling during feeding. However, the patient’s daughter complained that her mom can never swallow safely and something else should be done to allow her to swallow more safely.

Nancy was later referred to a radiologist for a Barium swallow examination. The below image was sent by the radiologist. It shows what happens when Nancy attempted to swallow liquid. You are assigned to be her speech therapist.

In your presentation, make sure you include the following components:

  • Do you think the patient has dysphagia? what are the different stages of swallowing? What are the anatomy and physiology behind these stages?
  • Why do you think the nurse and the daughter do not agree with each other?
  • What else needs to be done to confirm your suggestion?
  • Describe what you see from the VFSS provided by the radiologist.
  • Why has the patient been on antiobiotic medication for the past 6 months?
  • As her speech therapist, what would you suggest to be done to Nancy?
  • What is IDDSI? How is it related to Nancy’s condition?