[Dysphagia] Cricopharyngeal Diet

[sjloper at comcast.net (Shawn & Jennifer Loper)]

I agree that a larger bolus is better for certain patients.  In patients 
with a delayed pharyngeal swallow, the larger bolus can help to trigger the 
swallow.  However the smaller boluses can be recommended for patients with a 
weak pharyngeal swallow who evidence multiple swallows per bolus.  According 
to Logemann, this is to prevent the accumulation of a large amount of food 
in the pharynx, and aspiration.  Other researchers have shown that smaller 
bites were often better due to a significantly increased pattern of 
inspiration following a large liquid or solid bolus vs. the typical pattern 
of expiration post swallow for a small, single bolus, thus increasing their 
risk of aspirating residue.   Therefore at times recommending a small bolus 
would be appropriate.

----- Original Message ----- 
From: "Irene Campbell-Taylor" <eripley@yahoo.com>
To: <dysphagia@b9.com>
Sent: Wednesday, September 14, 2005 3:58 PM
Subject: [Dysphagia] Cricopharyngeal Diet


>
>
> We've come to learn that it stems from vitalstim education and the 
> identification of and significance of cricopharyngeal dysfunction in 
> dysphagia.
>
> *** Well. well. Another example of the almost complete misunderstanding of 
> swallowing physiology evidenced by the promoters of VitalStim. Many.many 
> communications with them have led me to accept that I am banging my head 
> against that proverbial brick wall. It is NOT a cricopharyngeal 
> dysfunction (unless so demonstrated by manometry and in very specific 
> cases) but failure of opening of the UES due to failure of anterior 
> movement of the hyoid - the most common aspect of oropharyngeal dysphagia. 
> The "diet" part refers to the multiple studies that have shown that the 
> larger and heavier the bolus, the easier the passage through the UES - 
> See, Kahrilas, Logemann, Dent, Cook, Ravich, Shaker etc. etc. (Which, as a 
> by the way - has always called into question the inexplicable tendency to 
> recommend tiny boluses for dysphagic patients. I'l never  understand that 
> one.)
>
> Tiny crackers may be of a better consistency when mixed with saliva but 
> not by much.
>
> The "diet" part is very simple - larger, heavier boluses are easier to 
> swallow than tiny, light ones as passage through the UES depends on the 
> traction of the hyoid combined with the weight and velocity of the bolus - 
> on which there is a plethora of research.
>
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia