The video that I observed was an adult that was given a modified barium swallow (MBS). The adult was given thin liquids to complete the MBS. The MBS observes all stages of swallowing. The oral preparatory stage of swallowing was not clearly observed in the video. However, the oral transport, pharyngeal, and esophageal stages of swallowing were observed. During the oral transport stage, the tongue forms a groove that pushes the bolus posteriorly. However, it was observed that the patient’s tongue did not form a deep groove. This caused the thin liquid barium to travel underneath the tongue.
During the pharyngeal stage of swallowing, it was observed that the patient exhibits reduced hyoid elevation, reduced airway protection, and reduced passive movement of the epiglottis. The patient had a total of three swallows. It was observed during the first swallow that there was a delayed timing of laryngeal elevation. The delayed timing of laryngeal elevation also caused a delay in epiglottic movement. In a typical swallow, the epiglottis folds down to protect the airway. However, the epiglottis did not fold down completely when the patient completed the second swallow.
It was also observed that the thin liquid barium lingered above and below the epiglottis due to the incomplete closure of the epiglottis. Penetration was caused during the second swallow due to the thin liquid barium traveling into the pyriform sinuses and the valleculae. The patient also exhibited aspiration once the epiglottis fully closed, which caused the thin liquid barium to travel down the trachea. The patient exhibited a weak contraction of the pharyngeal wall (pharyngeal stage) and weak peristaltic wave (esophageal stage).
It was observed that the patient had a delayed opening of the upper esophageal sphincter (UES) caused by a weak muscle contraction. The patient exhibited residue underneath the UES and above the UES. The video did not show the complete phase of the third swallow. However, it was observed that the epiglottis was closed during the swallow to allow the thin liquid barium to travel down the esophagus. It was also observed that the aspiration from the second swallow was still occurring during the third swallow.
Based on the characteristics of the patient, it is suggested that the etiology of ysphagia is due to Parkinson’s disease. Parkinson’s disease will cause muscle weakness. Swallowing problems that occur in patients with Parkinson’s disease are evident in the oral, pharyngeal, and esophageal stages. Patients with Parkinson’s disease will exhibit a mild delay that activates the pharyngeal swallow. A delay in the pharyngeal swallow may lead to aspiration. Patients with Parkinson’s disease will exhibit residue in the valleculae and in the pyriform sinuses. The residue in those structures will also increase the risk of aspiration.
Patients with Parkinson’s disease will exhibit reduced laryngeal elevation and pharyngeal wall movement that cause the bolus not travel into the esophagus. I feel that the patient would exhibit the same problems or dysmotility with other consistencies due to reduced laryngeal elevation and muscle weakness. One recommendation for the patient is to drink thickened liquids. Thickened liquids will reduce the chances of the occurrence of aspiration. It is also recommended that the patient use the head flexion-chin tuck technique. The patient exhibits reduced hyoid elevation, reduced airway protection and delayed timing of laryngeal elevation.
Overall, this technique will help improve the airway protection during swallowing. While watching the video, I was able to apply the information learned from class. I was able see view the movement of the various structures while swallowing. I thought it was interesting that I was able to visualize how penetration and aspiration occur during swallowing. I also found it interesting that the patient had no reaction while the aspiration occurred. Overall, I feel that this video was a helpful tool that allowed me to identify the patient’s swallowing impairments.
