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DYSPHAGIA DIET Dysphagia is defined as the inability to swallow or difficulty in swallowing. Dysphagia is not a disease, but is a symptom of an undariying condition that alfects the swallowing process. If untreated, dysphagia can lead to malnutrition, weight loss, dehydration, and/or aspiration preumonia, Normal Swallowing Process A normal swallow involves four distinct stages, and dysphagia can occur at any one of these stages: 41. Oral Preparatory Phase + Manipulation of solids and liquids in the mauth and forming food into a bolus Moving the bolus to the back of the mouth with the tongue Voluntary Completed when the swallowing reflex is trlagered by liquid or a bolus of faod stimulating the receptors in the posterior region af the mouth 2. Oral Phase » . Pharyngeal Phase * Allowing the bolus to pass from the pharynx into the esophagus by closure of the nasal cavity, peristalsis of the pharynx which carties the bolus to the top af the esophagus (called the cricopharyngeal sphincter), closure of the larynx at three levels to protect the ainway, and finally relaxation of the cricopharyngeal sphincter lavoluntary Phase iasts one second or less 4. Esophageal Phase * Transports the bolus to the stomach by gravity and peristaltic waves * Cricopharyngeal sphincter contracts to prevent reflux of the swallowed material » Respiration is resumed during this phase + Lasts eight to twenty seconds Section 13.1 CLINICAL PROBLEMS ASSOCIATED WITH DYSPHAGIA + Alzheimer's disease + Huntington's chorea + Amyotrophic lateral sclerosis (ALS) « Muttiple sclerosis + Brain tumor + Myasthenia gravis + Cerebral vascular accident + Muscular dystraphy + Cerebral palsy + Parkinson's disease = Closed haad injury (CHI) + Poliomyelitis = Dementia + Tumor or obstruction of throat + Dermatomyasitis ‘or esophagus + Guillain Barre Syndrome + Surgery of head and/or neck (head and neck cancer) Signs of Dysphagia + Solids or liquids falling from the mouth Excessive secretions and drooling Pocketing of food on the weak side of the mouth, under the tongua or on the hard palate © Tongue thrusting and poor tongue control * Coughing before, during, or after 2 swallow © Choking + Voice changes (gurgly or hoarse) after 2 swallow * Food sticking in the throat + Repeatedly trying to swallow 2 single bite or sip. Complaining of pain in the esophagus. Excessive amount of time necessary to eat Slurrad speech Regurgitation of material through nose and mouth Slow oral transit Unexpiained weight loss Silent Aspiration + Undetected dysphagia as a result of liquids or solids entering the larynx aspirated into the lungs with no obvious indications such as coughing or complaint of foud licking. * Signs of silent aspiration occur several hours after @ meal and include an elevated temperature, coughing, wheezing, and frothy sputum. Nutrition Management The dysphagia diet is a consistencymadified diet that is highly individualized based on each person's neads. Ideally, a “dysphagia team” determines the diet. Members of the dysphagia team include a dietitian, nurse, occupational therapist, physician, radiologist Section 13.2 
