Without treatment, dysphagia is known to be associated with respiratory complications including aspiration pneumonia, malnutrition, hospital admission and increased mortality. Oropharyngeal dysphagia is a common condition, particularly amongst older people and those with underlying neurodegenerative conditions and non-neurological (head and neck cancer) diseases. Impairment in any component may lead to a disorder or symptom characterised by difficulty in swallowing, termed dysphagia.
NECTAR THICK LIQUIDS SERIES
Swallowing is a complex series of neuromuscular events. He reported tolerating a normal diet including thin fluids. The patient was followed up via telehealth by the speech pathology and medical teams. While he was advised to remain on thickened fluids, his intense dislike of this therapy resulted in him self-upgrading to thin fluids and accepting the potential aspiration risk.
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4 days later the patient discharged against medical advice and subsequently did not undergo a planned instrumental swallow assessment, which was scheduled for the following day. On day three of his hospitalisation, the medical team identified signs and symptoms of dehydration and the patient was commenced on small quantities of thin fluids (water only) in between meals. Subsequently, he was prescribed moderately thickened fluids and a purée diet. There were also documented clinically overt signs of aspiration with thin fluids.
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On hospital admission he was assessed by the multidisciplinary allied health team and found to have moderate oropharyngeal dysphagia, characterised by reduced oropharyngeal coordination, reduced bolus control and variable timing of pharyngeal swallow. Previously he had been assessed by a speech pathologist in the community, and prior to hospitalisation his diet consisted of a regular diet and fluids. He had a past medical history significant for Guillain–Barré syndrome and gastro-oesophageal reflux disease. We introduce the concept of pressure slope as a meaningful way to examine tongue-palate pressure application in swallowing.An 86-year-old male was admitted to hospital with an infective exacerbation of his idiopathic pulmonary fibrosis and delirium. Modulation does, however, occur with respect to the tonguepalate contact surface area and pressure durations. Tongue-palate pressure amplitude modulation does not occur for nectar-thick swallowsĬompared to thin liquid swallows.
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Pressure modulation was not noted with respect to pressure amplitudes (in mm Hg), but was identified both in the pressure patterns observed (the sites and number of bulbs activated) and temporal aspects of pressure duration. Tongue-palate pressures were measured at three sites (anterior, medial and posterior palate)using an adhered 3-bulb pressure strip in 20 healthy, young adults during discrete swallows of water and nectar-thick apple juice. In theĬurrent investigation, we sought to confirm whether tongue-palate pressures are modulatedīetween discrete swallows of water and nectar-thick juice. This mirrors a lack of clear evidence in the literature of tongue and hyoid movement modulation between nectar-thick and thin liquid swallows. Evidence of tongue-palate pressure modulation during swallowing between thin and nectar-thick liquids stimuli has been equivocal.