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A Sensory Approach to Dysphagia Treatment: After the Cranial Nerve Exam

A Sensory Approach to Dysphagia Treatment: After the Cranial Nerve Exam
Tiffani Wallace, MA, CCC-SLP, BCS-S
February 4, 2015
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>> Tiffani Wallace:  Thank you for spending time discussing sensory treatment ideas for swallowing.  I have worked as an SLP for 15 years in a variety of settings and my passion has always been working with patients with swallowing disorders.  I was always intimidated by cranial nerves until I started studying for my board certification disorders test.  The cranial nerves finally started making sense to me.  When I learned how to treat dysphagia, I learned how to do oral motor exercises, having my patients do 10 repetitions of sticking out their tongue or trying to touch their nose with their tongue.  I was buying all of these tools and gadgets, and I was not seeing progress in my patients.  Then, I started using food as my therapy tools with exercises involving swallowing.  I started changing consistencies, adding flavors, having the patient swallow a bolus, and that is when I started seeing significant changes in shorter periods of time. 

This course is a spin-off from the cranial nerve assessment course that is on SpeechPathology.com, Cranial Nerves and Dysphagia: Making the Connection.  Participants requested ideas on how to add sensory stimulation to their dysphagia treatments. 

Cranial Nerve Review

Do you feel that you have a good grasp on sensory?  Sensory is an area that has been researched a lot lately.  There is a lot of research out about how to add sensory to your treatments for dysphagia.  There is a lot about cranial nerves.  This has been a big focus in dysphagia.  Today we will do a quick cranial nerve review, including the nerves involved in the swallowing process and what they do.  Then we will talk about sensory and all of the sensory experiences that we can provide for our patients daily. 

Terminology

An important part in our cranial nerve review is the terminology.  Some of the terminology related to cranial nerves includes the central nervous system (CNS) and the peripheral nervous system (PNS).  The CNS is the brain and the spinal cord while the PNS is made up of cranial nerves, spinal nerves and autonomic functions including salivation.  Basically, the CNS receives and interrupts all of the sensory information, processes it, and sends it out as motor information.  The PNS is the wires that send and transmit the information. 

Another term is afferent, which is sensory, and it is impulses from the peripheral tissue, such as the tissues in the oral cavity or in the pharynx towards, toward the central nervous system.  Efferent is the motor output.  It is going from the brain to the muscles to the glands. 

The nucleus tractus solitarius (NTS) is a cluster of nerve cell bodies in the medulla oblongata where sensory input is recognized.  This then programs the swallow into the nucleus ambiguus.  The NTS houses input for taste from cranial nerve VII (facial nerve), IX (glossopharyngeal nerve) and X (vagus nerve). These transmit chemical and mechanically sensitive nerves from the lungs, the GI system and the pharynx.  It mediates the gag reflex, the cough reflex, and much of that GI motility. 


tiffani wallace

Tiffani Wallace, MA, CCC-SLP, BCS-S

Tiffani L. Wallace has been an SLP for over 13 years.  She holds her Board Certified Specialty in Swallowing and Swallowing Disorders.  Tiffani enjoys working with patients of all ages, however has a special interest in adults with head and neck cancer.   Tiffani is the co-author of the app Dysphagia2Go by SmartyEars.  Tiffani is the administrator and creator of several Facebook dysphagia groups and the author of Dysphagia Ramblings.



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