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Swallowing

Dysphagia is difficulty in swallowing.

  • caused by weakness and paralysis of the lips, facial muscles, tongue, larynx and pharynx resulting from affected trigeminal, facial, glossopharyngeal, vagus, accessory and hypoglossal nerves. 
  • eventually affects about two thirds of people with motor neurone disease

Swallowing difficulties should be assessed and regularly reviewed by a speech pathologist. The goal of managing swallowing difficulties is to maintain optimal levels of nutrition and hydration and to reduce choking episodes (MND Australia 2014).

MND Australia 2014

Effects of dysphagia include:
  • impaired ability to form a lip seal, chew, form a bolus and propel food/fluid with the tongue
  • impaired swallow reflex
  • impaired airway protection during the swallow
Results of dysphagia include:
  • drooling
  • dehydration and malnutrition
  • aspiration and resultant chest infections which contribute to impaired respiratory function
  • severe coughing - choking risk
A person's needs include:
  • assessment and monitoring of swallow, advice concerning food and fluid consistency, modification of diet, modified eating and drinking utensils, percutaneous endoscopic gastrostomy (PEG) - consult speech pathologist
  • advice concerning modified plates, cups, cup holders, cutlery, and non-slip matting - consult occupational therapist
  • assessment and advice concerning nutritional intake and PEG - consult dietitian
  • head and neck support and positioning - consult physiotherapist
  • training carers to perform assisted cough - consult physiotherapist
  • information concerning managing swallowing difficulties, nutrition and PEG - consult MND Association Family Support Service
  • see Referral Pathways

Nutritional management algorithm (Miller and others 2009a)

Reproduced with the kind permission of AAN Enterprises, Inc., 2009, LIPPINCOTT WILLIAMS & WILKINS 

MillerandOthers2009aNutritionalAlgorithm_20100606115455_Resized_20100606115527.jpg
 
KEY
 
* = e.g., Bulbar questions in the Amyotrophic Lateral Sclerosis Functional Rating Scale, or other instrument.
‡ = Prolonged meal time; ending meal prematurely because of fatigue; accelerated weight loss due to poor caloric intake; family concern about feeding difficulties.
† = Percutaneous endoscopic gastrostomy: rule out contraindications.

 

Referral Pathways

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