The most common type of dysphagia is delayed or absent initiation of the pharyngeal stage of the act of swallowing, and 80 to 90 percent of CVA (stroke) patients who exhibit dysphagia have this type of problem (McCaffrey, 2001). Most of these patients have more than one type of swallowing problem. Patients with pharyngeal stage problems keep trying to push the bolus of food into the pharynx with the tongue, and eventually succeed. The path the food takes after this happens depends on three things: the posture of the patient, the consistency of the food, and size of the bolus. Small amounts of a thicker bolus will usually lodge in the pharyngeal recess rather than going directly down the airway.
When the patient moves the tongue to try and push the bolus into the pharynx, the movements of the tongue and hyoid bone look as if the patient is swallowing, and it may be difficult to tell whether or not the patient is aspirating (McCaffrey, 2001). Patients may aspirate without coughing, and food may also be lodging in the pharyngeal recess which can hold several teaspoons of material before it is aspirated. Silent aspiration occurs in from 40 percent to 70 percent of patients (Dysphagia, 2005). Aspiration can lead to pneumonia and other complications for the dysphagic patient.
Reduced tongue driving force or poor pharyngeal stripping action are common problems of patients who have suffered CVAs (McCaffrey, 2001). These cause food residue to accumulate in the valleculae and can lead to aspiration after the swallow. The pharyngeal stripping action is the last part of the swallow in the normal swallowing process to recover. No site-specific problems are associated with these problems in CVA dysphagia.
Fifty percent of CVA dysphagia patients who have pharyngeal stage problems also have oral stage problems (McCaffrey, 2001). Fifty percent of patients with problems that affect the oral stage of the swallow have reduced ...