CD 663 Swallowing Flashcards
(171 cards)
1
Q
Three aspects of the eating act that we, would constitute dysphagia.
A
- problems in the mouth; getting the food ready to be swallowed.
- problems in the act of actually swallowing -difficulty after the food is swallowed but is still in transit to lower locations in the digestive tract.
2
Q
What controls the oral stage of swallowing?
A
Medial temporal lobe control
3
Q
Oral Phase is a ___________ activity but it is overly _____________ therefore; not neccessarily a ____________ activity.
A
voluntary routinized consious
4
Q
How do we use our sense when eating?
A
Visual
Olfactory
Auditory (food prep, pouring of liquids)
Kinesthetic (Sensation of lip and food item touching, the feel of the bolus)
5
Q
Describe different preparation of food materials: Liquid
A
tongue cups around the bolus
6
Q
Describe different preparation of food materials: puree
A
tongue manipulates and holds bolus (no signal to masticate, shred, grind)
7
Q
Describe different preparation of food materials: solid
A
body gets signal to prepare to chew!
8
Q
Process of mastication in an adult
A
- Upper/lower teeth crush bolus 2. Rotary/lateral movement of the jaw to manipulate bolus 3. Saliva mixed with bolus by tongue and by chewing 4. Posterior aspect of oral cavity is closed 5. Anterior aspect of oral cavity is closed by lips
9
Q
What is Larynx doing dueint the oral prepatory stage?
A
resting.
10
Q
Oral stage duration
A
1-1.5 seconds (.3 seconds longer for persons over 60)
11
Q
Steps in oral stage
A
- Tongue tip and sides are elevated 2. Tongue sequentially presses bolus to the hard palate, front to back. 3. Tongue pressure increases with increase in viscosity 4. arynx begins to elevate
12
Q
When does the pharyngeal phase begin?
A
When bolus passes by the ramus of the mandible
13
Q
When does oral transit start?
A
when the tongue begins to propel bolus posteriorly alonghard palate.
14
Q
Other Structures in oral cavity that can pocket material
A
-Labial sulcus -Buccal sulcus -Faucial arches/pillars
15
Q
Why is sensory information imporant to the swallowing process?
A
act as feedback mechanisms
16
Q
What triggers the swallowing reflex?
A
sensory input
17
Q
When the pharyngeal phase begins, what 3 things are concomitantly inhibited.
A
-chewing -breathing -vomiting
18
Q
Where is the swallow center located in the brain?
A
medulla
19
Q
Swallowing reflex can take place (triggered) from stimulation to the:
A
-Velum -Posterior aspect of the pharynx -The weight of the bolus
20
Q
Bolus stimulates superficial and deep sensory receptors, many of which project via IX, X, and XI to a medullary reticular formation called the ________________.
A
nucleus tractus solitarius (NTS)
21
Q
Events of the pharyngeal stage:
A
- Begins as the bolus passes the ramus of the mandible 2. Anterior and superior displacement of the hyolaryngeal complex 3. Closure of the false vocal and true vocal folds 4. Progressive pharyngeal contraction 5. Opening of UES
22
Q
Lateral Channels:
A
passage alongside and outside of the main laryngeal structures, bypassing laterally the opening into airway
23
Q
Pyriform Sinuses
A
Inferior and posterior to valleculae.
24
Q
When does velopharyngeal closure happen?
A
end of oral phase
25
Why does velopharyngeal closure happen?
to keep bolus from moving superiorly
26
The Pharyngeal Transit Stage of the pharyngeal stage:
The bolus moves inferiorly via a combination of gravity, base of tongue retraction, pharyngeal wall contraction, and pressure differentials
27
Peristalsis
refer to constriction that is rhythmic and repetitive -pharyngeal stage is not peristalsis
28
What do the constrictors do?
decrease diameter in sequential way to move bolus inferiorly
29
What do BOT retraction and pharyngeal wall contraction help to establish?
changes in pressure which facilitates bolus movement.
30
Four Mechanisms of Airway Protection
1.Hyoid/laryngeal elevation away from path of bolus 2. Best airway protection: movement of the Epiglottis 3. . Adduction of the true vocal chords 4. Closure of the laryngeal vestibule:
31
What is the best airway protection mechanism?
epiglottic inversion
32
Describe the opening of the UES (or cricopharyngeus) (in summation)
1. UES relaxes during the swallow (crucial) 2. Elevation of the larynx pulls UES/PES open 3. Duration of opening increases as bolus volume increases 4. Contraction of pharynx also contributes to opening
33
Duration of esophageal phase
8-12 seconds
34
Esophageal Stage
1. PES/UES already opened 2. bolus is carried to stomach via gravity and esophageal peristalsis 3. LES must open and then close after bolus 4. Esophagus joins stomach through an opening in diaphragm called diaphragmatic or esophageal hiatus.
35
Problems at esophageal stage
difficulty opening and closing these sphincters the lack of peristalsis food material can travel in the wrong direction
36
Premature spillage into valleculae: when is it normal?
Considered normal as long as pharyngeal phase is triggered as TAIL of bolus is leaving ramus of mandible
37
General differences in elderly during swallowing
Overall slower Reduced sensory information Changes in structure (normal for aging)
38
Purpose of a clinical swallow assessment
1. Determine as much as possible the physiologic factors contributing to the dysphagia 2. Stage of impairment 3. Make determination for the need for other tests 4. Make recommendations for safest means of intake, including diet (PO Substances)
39
Left sided vs right sided CVA-Who is more likely to have dysphagia?
LCVA
40
Why would you be concerned about dyphagia in someone who had a brainstem lesion?
may affect swllowing center
41
Why be concerned about dysphagia in a TBI patient?
1. Changes in cognition may affect ability to eat safely (decisions pt makes while eating) 2. Sensory and motor impairments
42
Anytime you have delayed pharyngeal swallow or piecemeal deglutition, you can be concerned about \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Silent aspiration.
43
Common swallowing deficits found in Parkinson's patients?
1. Impaired lingual movement 2. minimal jaw opening while eating 3. abnormal head and neck posture 4. impulsive eating behavior 5. delayed oral transit time (tongue pumping and piecemeal deglutition) 6. Pooling in valleculae and pyriform sinuses 7. Silent aspiration
44
Swallowing Characteristics of an individual with MS.
1. spasticity and incoordination of the oropharyngeal and respiratory muscles 2. inefficient oral transit 3. difficulty coordinating with respiration 4. delay and incoordination of laryngeal movements 5. pharyngeal constrictor dysmotility
45
Swallowing Chacteristics of an individual with Huntington's Disease.
1. too much swallowing 2. initiated too early 3. overall pattern of lack of control and coordination of swallowing structures
46
Swallowing Chaacteristics of persons with ALS.
1. difficulty with lingual movement in the early stages 2. difficulties in control of velum=premature spillage in early stage and hypernasality
47
What populations are swallowing exercises contraindicated?
ALS Myasthenia Gravis
48
Dysphagia symptoms of dementia:
1. Sensory impairments 2. lack of awareness
49
What is Guilliane Bare Syndrome?
Acute onset disease of the peripheral nerves affects gross motor movement and muscles of respiration, etc.
50
Dysphagia symptoms in individuals with Guillian Barre?
1. rapid onset of weakness/paralysis in muscles of the tongue and pharynx (and other body parts) 2. abnormal sensation including lack of sensory input 3. report a tingling feeling
51
Dysphagia symtoms in people with Myasthenia Gravis:
progressive fatigue
52
What is Myasthenia Gravis?
disease that affects how nerve impulses are transmitted to the muscle at the neuromuscular junction
53
Which common meds affect swallowing?
Sedatives and anti-seizure meds
54
Which common meds affect saliva production?
Tricyclic antidepressants and antihistamines
55
Dyspnea
difficulty breathing
56
Tachypnea
rapid breathing exceeding 20 bpm
57
Normal adult BPM?
12
58
Persons with restrictive pulmonary diagnosis (reduces ability of respiratory apparatus to expand) are more at risk for aspiration/penetration because......
more likely to inspire immediately after the swallow
59
What is COPD (not what it stands for...)?
Increased resistance of airflow through the pulmonary airway with the resistance being greater during expiration than on inspiration
60
What are restrictive diseases? (definition)
Typically progressive diseases that make it difficult for the lungs to expand to get enough of the gas in the lungs for the gas exchange
61
Esophageal Motility Disorders of Swallowing
Zenker’s Diverticulum Strictures/constrictions GERD Tracheoesophageal Fistula Diffuse Esophageal Spasms (DES) Achalasia
62
failure of the lower esophageal sphincter (LES) to relax, or relaxation is incomplete, preventing passage of the bolus into the stomach
Achalasia
63
Simultaneous prolonged contraction of two (2) parts of the esophagus rather than the normal top to bottom sequential contractions
Diffuse Esophageal Spasms (DES)
64
outpouching or pocket that forms in the pharyngeal wall just superior to the UES/PES, within the UES/PES or just below the UES (upper part of the esophagus)
Zenker’s Diverticulum
65
A fistula (hole) develops between the soft tissue common wall of the trachea and esophagus
Tracheoesophageal Fistula
66
often the result of formation of fibrotic tissue that can develop after prolonged irritation/inflammation of the esophagus (esophagitis) secondary to GERD
Strictures/constrictions
67
First step in clinical bedside swallow eval?
check for doctors order
68
Odynophagia
Pain when swallowing
69
Why check for damage to CN V
jaw, lip, hyolaryngeal excursion
70
Why check for damage to CN IX (glossopharyngeal)?
damage associated with impaired pharyngeal stage possibly velum
71
Why check for damage to CN X (vagus)?
damage associated with impaired pharyngeal stage possibly velum
72
Why check for damage to CN XI (spinal accessory)?
damage associated with impaired pharyngeal stage possibly velum
73
Why check for damage to CN VII (facial)?
Lip closure Buccal strength
74
Why check for damage to CNXII (hypoglossal)?
Tongue strength ROM
75
What is it clled when you check strength/presence of voluntary cough (cough on command)?
Addington study
76
Reduced intra-oral sensation or alertness may result in what?
pooling in mouth or overt drooling
77
Dry mouth or insufficient saliva may be due what?
meds
78
Daniels et al (1998) showed that an abnormal voluntary cough and coughing during feeding predicted aspiration (MBSS) in \_\_\_\_% of persons. Changes in vocie correlatee even less.
78
79
Coughing/throat clearing during or immediately after the swallow and/or wet vocal quality (new) \_\_\_\_\_\_\_\_\_represent penetration/aspiration but their absence does \_\_\_\_\_\_\_\_\_
probably note rule it out
80
Reflexive cough is a neurologically impaired population may be \_\_\_\_\_\_\_\_\_\_\_\_\_rather than absent
diminished
81
Straws
1. May be helpful for those with poor oral control 2. Allows substance to enter hypopharynx sooner (bobsled idea of swallowing!)
82
Different PO Subtances (Liquids)
Liquids Thin Nectar Honey Spoon
83
Different PO Subtances (solids)
Solids Puree Mechanical soft Mechanical chopped Mechanical ground Regular\*
84
NDD Level 1
Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing
85
NDD Level 2-
Dysphagia-Mechanically Altered (cohesive, moist, semisolid foods, requiring some chewing)
86
NDD Level 3
Dysphagia-Advanced (soft foods that requiring more chewing ability)
87
NDD Level 4
-regular (all foods allowed)
88
MBSS benefits
1.‘default’ study 2. Unknown medical etiology, vague symptoms. 3. Visualize the submucosal anatomy. 4. Assess the oral stage 5. UES/PES structure/hypertonicity 6. Examine movement of multiple structures at the height of the swallow
89
INDICATIONS FOR FEES: logistic reasons
1. Transportation risky/medically fragile pt. 2. Transportation is problematic 3. Family input desired during an exam 4. Positioning problematic: contractures, quad, neck halo, obese, on a ventilator 5. Concern about radiation
90
INDICATIONS FOR FEES: clinical reasons
1. Visualize surface anatomy, mucosal abnormalities, resection, etc. 2. Velopharyngeal incompetence (VPI) 3. Visualize laryngeal movement/vocal fold mobility (someone with a paralyzed VF) 4. Severe dysphagia; need a conservative exam: comprised pulmonary clearance (Is the airway compromised?) 5. Extended therapeutic exam needed or desired 6. Biofeedback is desired-want to ensure technique is working
91
Types of Interventions
Free water protocol Diet management Oral motor exercises Shaker exercise Tactile-thermal stimulation Electrical stimulation of muscles Swallowing maneuvers Postures and positions for protection of the airway
92
Oral Motor Exercises: best evidence for what?
strengthen -tongue -vf closure -suprahyoid muscles
93
Lee Silverman Voice therapy can strengthen what?
VF closure)
94
Shaker exercise can strengthen what?
suprahyoid muscles
95
Psotures
chin tuck head turn
96
Chin tuck is for what patients?
residue in vallecula delay in triggering swallowing
97
Chin tuck does what?
-base of tongue closure to pharyngeal wall -Narrows opening to airway. -Reduces premature spillage -Widens vallecular space (some ppl) -Decrease opening into laryngeal vestibule
98
Head turn to left or right is used for who?
unilateral pharyngeaal weakness
99
Head turn to left or right does what?
-Increased TVC closure -Promotes passage of bolus through stronger side -Promotes opening of UES
100
Maneuvers
effortful supraglottic super supraglottic
101
Effortful swallow (most effective) does what?
Promotes stronger tongue palate contact Promotes stronger BOT to posterior pharyngeal wall contact
102
Effortful swallow is for what patient?
-residue on valleculae -pyriform sinus -diffuse residue
103
Supraglottic swallow does what?
protect against aspiration before the swallow.
104
Supraglottic swallow is for who?
epiglottis removed delayed initiation of swallow
105
Super supraglottic swallow does what?
Brings arytenoid cartilage close to the anterior wall of the thyroid cartilage, closing laryngeal vestibule.
106
Mendelsohn maneuver does what?
increased duration/extend of CP opening
107
Tongue Hold/Masako Maneuvedoes what?
OT and pharyngeal constrictors to work harder
108
Cervical auscultation
evaluating pharyngeal swallow by listening to sounds through a stethoscope placed on the surface of the neck
109
Who are artificial used for?
Used for patients who have airway obstruction
110
Effect of Trach Tube on Swallowing
-No voicing -Decreased laryngeal elevation -desensitize the cough reflex - 6+ months tends to form scar tissue and reduced TVC closure -Pressure can affect bolus transport -Decreased subglottic pressure
111
Mechanical Ventilator (aka Respirators)
Used when the gas exchange is impaired (long ago called ‘respirators’)
112
Effects of Ventilator Dependency on Swallowing
-not have any musculature available to breathe for swallowing -can push air in at the same time the airway should be protected -Stress ulcers can lead to gastrointestinal bleeding
113
Primary Goals for diagnostic report
-Provide a permanent record of status and abilities at the time of evaluation -Facilitate communication between professionals
114
Rehabilitation potential:
if they are basically healthy, if it's right after the onset of a very mild TBI or auto accident if you know the patient is alert and seems to have good comprehension good cognitive status
115
a patient who is stable is NOT considered to be close to \_\_\_\_\_\_.
EOL
116
a patient who is critical condition or is in crisis would be considered quite close to\_\_\_\_\_\_
EOL
117
End of Life and Ethical Issues
1) Ethical principles 2) Legal issues 3) Cultural, spiritual, and family customs and wishes
118
Principles of bioethics (ethics)
Autonomy Beneficence Nonmaleficence Justice
119
Beneficence
(Described as active kindness and active good)
120
Nonmaleficence
(Hippocratic maxim: primum non nocere- “first do no harm”)
121
Justice
(Fair and equitable treatment for all patients)
122
Autonomy
(Respecting a patient’s individual self )
123
pt rating scale on dysphagia and QOL
Swal-QOL
124
What we can do to help with QOL
-Free water protocol -anticipatory suggestions -Visually – appealing foods -Regular food that meets dietary needs (mashed potatoes with thickened gravy)
125
Blastoderm is made up of 3 germ layers
1. Ectoderm 2. mesoderm 3. endoderm
126
endoderm
[digestive/respiratory system]
127
mesoderm
[smooth muscles, blood vessels, connective tissue]
128
Ectoderm
[skin/nervous system]
129
The 3 layers become the \_\_\_\_\_\_\_\_\_\_\_\_\_
6 branchial arches –
130
Infant anatomy compared to adult anatomy
-tongue takes up more space in the oral cavity -Tongue is solely in the oral cavity -Structures tend to be higher – the pharynx and the larynx are elevated in the neck
131
What is the general length of soft palate at birth?
Short
132
In the newborn the mandible is __________ . It begins to \_\_\_\_\_\_at the end of the ____ year
not fused fuse first
133
The angle of the relationship between the nasal and oral cavities moves from ________ to _______ around age 5
oblique 90 degrees
134
when do most reflexes diminish? Which reflex stays until 24 months? Which reflex stays forever?
1 year sucking gag
135
In the first \_\_\_\_\_\_\_\_\_\_, infants belly-breath (using the diaphragm to breathe...once postural control is established, breathing becomes thoracic
5-6 months
136
Physiology of sucking
-Breastfeeding requires nipple contact between the tongue and hard palate -Lip seal around the nipplecreates negative pressure -Mandible drops during feeding increase the size of the oral cavity and drop in intra-oral pressure (creates a vacuum). -Both compression and negative pressures are required
137
Suckling
0-6 months -Loose lips, reduced lip seal, tongue seals around nipple --Wide mandibular excursions --Tongue moves in and out
138
Sucking
6-9 months -
- tight seal, reduced tongue seal
- reduced mandibular excursion
- tongue moves up/down
139
Why is Non-nutritive suck(l)ing valuable in medically fragile kids? (3 things)
Promotes nutritive sucking behavior
Increases feeding behaviors
Improves O2 sats
140
Non-nutritive suck(l)ing
-Breathing is continuous (no swallows): intermittent but not timed to the sucking behavior
141
If the child cannot produce a ________ then he/she will not be ready to produce a _______ and will _________ ready for oral feeds
normal NSS normal NS not be
142
Pediatric dysphagia assessment: four important physiologic factors for neonates
1. Relationship between swallowing/feeding and respiration
2. Tonicity
3. “primitive reflexes”
4. Maturity of gastrointestinal system
143
The specialconsiderations for PO intake with infants
1. As and Bs: Apnea and Bradycardia: Baby stops breathing or breathes quite slowly
2. Very sick: poor endurance (Fatigue easily)
3. Poor coordination of suck-swallow-breathe sequence
4. Oral defensiveness, hypersensitivity
144
Gavage feeding
- NG tube
- common if premature with weak sucking/suckling reflexes (not ready for oral intake)
145
Themes for intervention with infants:
Normalization of oral-motor function
Tonicity and Stability
Sensory responses
Coordination of respiration and swallowing
146
Themes for intervention with infants: Normalization of oral-motor function in infants and older children
development of coordination of movement
- exercises /positioning
- sensory stimulation
147
Themes for intervention with infants: Tonicity and Stability of Structures
positioning providing support for weakend structures
148
Themes for intervention with infants: Sensory Responses
-Reduce oral aversions (hypersensitivity) by stim “outside to inside” -
NNS – associate sucking with calming and more normal responses to oral stim
-Change environment: NO bright lights or noise!
149
Themes for intervention with infants: Coordination of Respiration and Swallowing
- Establish “suck, swallow, breathe”
- Pacing via nipple choice, tipping bottle down (control flow) after # of safe sucks
150
position for low tonicity?
UPRIGHT to challenge muscles
151
Position for high tonicity?
MORE NECK FLEXION, chin down
152
Themes for intervention with older babies:
1. Continued importance of meeting nutritional needs for normal growth
2. Developing skills for solids and extending inventory of food (e.g. mastication)
3. Adaptive feeding equipment as needed
4. Self-calming and sensory modulation 5. Airway protection
153
Concerns When Treating School Age Children Who will facilitate feeding the educational environment?
- Overall safety of PO around other children
- Reliability of use of strategies
- time needed
- Social consequences
154
14. The laryngeal vestibule is an openign into the \_\_\_\_\_\_\_\_\_\_\_, suprior to the \_\_\_\_\_\_\_\_\_\_\_.
larynx ventricle
155
The muscles of the tongue play an important role in organizing and containing the bolus. Which of the following statements are accurate with regard to their function?
a. the longitudinal muscle moves the tongue tip up
B. the vertical muscle flattens and lowers the tongue
C. the transverse muscles narrows and extends/lengthens the tongue
D. all of the options
E. longitudinal and verticle muscle options only
D. all of the options
156
anterior tilting of the arytenoids does what?
-helps with closure of laryngeal vestibule
157
reflexive cough (caused by material entering deeply into the laryngeal vestibule happens due to what?
by either sensory/motor information from CN X
158
For older adults who are "normally aging" (without disease or medical disorder that interferes with normal acts of daily living), which of the following is/are true?
a.taste sensation is often reduced as we age, affected by decreased olfactory sensation
B. sarcopenia can make some foods difficult to chew, and can result in fatigue
C. older adults sometimes have difficulty in taking in sufficient calories to sustain acceptable nutrition levels, particularly if they live alone
D. cognitive deficits (such as decreased attention and memory loss) in normally aging adults can interfere with eating and swallowing
E. all of the options above are true
F. all but the last choice (cognitive changes) affect normal older adults in acts of daily living
F. all but the last choice (cognitive changes) affect normal older adults in acts of daily living
159
Some medications can negatively impact the swallowing process. These include:
a. the flu vaccine
b. oral birth control medications
c. antidepressants and or anti-insomnia medications
D. none of these affect swallowing
c.antidepressants and or anti-insomnia medications
160
How is blue dye used in assessment of the swallowing ability of an individual who has a tracheostomy?
a. it is used to provide contrast to p.o. material during an MBS
B. it is used to provide distinctive color to food that has not been adequately masticated
C. it is used to provide distinctive color to saliva or food that may have entered the airway
D. it is used to be certain that excess air has not entered the esophagus
E. the first and last options only
C. it is used to provide distinctive color to saliva or food that may have entered the airway
161
Which of the following is the most accurate regarding the relationship between a tracheostomy tube and the use of a ventilator by a patient in a medical center?
a. trach tubes are inserted as a respiratory pathway in all ventilator patients
B. a ventilator can be used with a trach tube or a mask to regulate and direct airflow
C. the presence of a trach tube and/or the use of a ventilator indicate serious respiratory problems that preclude assessment of swallow function
D. none of the options
B. a ventilator can be used with a trach tube or a mask to regulate and direct airflow
162
hyolaryngeal complex elevation does what to the bolus.
move airway away from bolus path
163
The Functional Communication Measures that make up the ASHA NOMS (National Outcome Measures System):
a. help clinicians to rank the nature and severity of a patient's dysphagia
B. facilitates communication between SLPs concerning the overall level of functioning of their patients
C. helps clinicians track improvement in functional levels of their patients with dysphagia
D. helps clinicians determine when a patient is ready for an instrumental assessment of their dysphagia
E. all but the last choice above
F. none of these characterize the use of the ASHA NOMS
E. all but the last choice above
164
According to the article on electrical stimulation of muscles used in the swallowing mechanism, what are some of the difficulties in using this form of intervention for patients with dysphagia?
a. the muscles involved in swallowing function are small and difficult to locate in the neck, making it difficult to stimulate the desired anatomical structures
b. many SLPs are not well prepared in the area of anatomy, making the placement of e-stim devices questionable in terms of accuracy
c. research regarding the improvement in swallowing function does not consistently support improvements claimed by manufacturers of e-stim devices
D. all of the options above can be difficulties with the use of this intervention
D. all of the options above can be difficulties with the use of this intervention
165
What do we know about the use of specific postures (e.g. chin tuck, head turn) by patients with dysphagia during swallowing?
a. the literature indicates that these postures can facilitate a better swallow, but studies have had small numbers of subjects, making results somewhat unclear
b. the literature indicates that these postures have no significant effect on improving a swallowing disorder
c. these postures have been proven to be ineffective in most cases unless they are accompanied by NMES, or electrical stimulation of swallowing muscles
d. factors such as attention skills and fatigue need to be taken into account in determining whether or not to use these techniques in dysphagia management with a given patient
E. a) and d) only
E. a) and d) only
166
Screening for dysphagia:
a. is only completed by SLPs or OTs at the beginning of their swallowing assessment
b,typically involves administering small amounts of water and watching for overt signs of aspiration, such as coughing
c. typically involves administering 1 trial of all p.o. consistencies (thin liquid, thick liquid, puree and solid)
d. is used to identify
b,typically involves administering small amounts of water and watching for overt signs of aspiration, such as coughing
167
Question 40 Surgical treatment of swallowing disorders:
a. is contraindicated in patients with neurogenic causes of dysphagia
b. can occur as part of an overall dysphagia management program whenever a procedure might establish or maintain a functional and safe swallow
c. should precede any other swallowing treatment
d. is restricted to patients with poor esophageal motility
E. none of the options
b.can occur as part of an overall dysphagia management program whenever a procedure might establish or maintain a functional and safe swallow
168
Which of the following are true with regard to options for patients who cannot safely tolerate an oral diet?
a. nasogastric (NG) tubes are often used as short-term solutions for nonoral diets
b. gastrostomy tubes, including PEGs, are preferred for short-term solutions for nonoral diets
c. decisions about when to move to nonoral feeding are based strictly on the results of instrumental testing
d. feeding tubes generally eliminate medical problems associated with nutritional intake for patients with dysphagia
e. all but the first choice
a.nasogastric (NG) tubes are often used as short-term solutions for nonoral diets
169
A VFSS/MBS/VDSW is valuable in assessment if:
a. silent aspiration is suspected
b. timing aspects of the pharyngeal stage may be affected
c. esophageal stage difficulties are suspected
d. all of the options above
e. first and second choices only
d.all of the options above
170
Cranial nerve that innervates these two muscles?
a. omohyoid
B.sternohyoid
CN XII
171
a. mylohyoid
B superior pharyngeal constrictor
C. stylohyoid
D.inferior pharyngeal constrictor
