Deck 3

Question 1

What are the different methods utilized to feed infants who may not be eating by mouth

Answer 1

nasogastric NG
orogastric OG
gastrostomy- directly into stomach
paraenteral- into bloodstream

Question 2

How does Pierre Robin sequence affect swallowing

Answer 2

1. respiratory distress when feeding infants

2. ; coughing, grunting, sputtering

Question 3

what is eosinophilic esophagitis

Answer 3

1. allergic inflammatory of esophagus

2. causes food impaction, poor appetite, and reflux

Question 4

Can SLP’s be feeding therapists also?

Answer 4

Yes! But we split the job w/ OTs. 
Oral motor skills-SLP
Mealtime behaviors-SLP
Reaction to food types/textures -SLP
self feeding and posturing--OTs

Question 5

Know the differences between swallowing and feeding disorders in infants

Answer 5

see google doc

Question 6

How do you know if the infant is having a sensory issue

Answer 6

1. unable to sort solids and liquids
2. holds food under tongue and cheeks
3. demonstrates nipple confusion with breast-feeding and bottle feeding

Question 7

Why is posture so imporatnt

Answer 7

oral phase- the tongue would be retracted, poor lip seal, and reduced lingual movement and higher risk for aspiration
esophageal phase- higher incidence of frelux because of gravity helping freflux so if child is hyperextended you want them to be more forward

Question 8

How do you know a premie is ready to eat

Answer 8

see google doc

Question 9

What is OST

Answer 9

oral sensorimotor treatment- using sensory stimulation to improve eating and drinking. You are trying to desensitize patient from different compnents (lip, tongue, jaw). Not giving them anything edible, just stimulating their senses

Question 10

WHy are there differences in bottles and nipples for infants?

Answer 10

infants have different needs. 
Dr. Brown’s → reduces air, makes sucking easier
syringe bottles → controls volume
chu chu→ for cleft palates
wide neck nipples → improves lip closure

Question 11

What are teh goals of behavior treatment

Answer 11

basically counseling! -least intrusive treatment
addressing importance/impact of lighting and family dynamics
educating, reducing stress, create best environment possible, providing resources!
operant conditioning to let child know they can receive rewards when they eat
Operant Conditioning
Rewards throughout when child reaches food goals
When they reach a certain food goal, increase complexity of food
Systematic desensitization
Playing games and activities with child with food and increasing complexity

Question 12

Upper motor neurons and lower motor neuron control which nervous system/

Answer 12

UMN: Central nervous system
LMN: peripheral system

Question 13

the degree of cortical impairments depends on a variety of factors. WHat are they

Answer 13

Location of damage
Extent of damage
Type of damage (trauma vs blunt force)
Unilateral vs. Bilateral

Question 14

What swallowing deficits (be specific) would a lower brainstem stroke exhibit?

Answer 14

Difficulty triggering the pharyngeal swallow
absent pharyngeal swallow
delayed pharyngeal swallow
Reduced laryngeal elevation
Reduced UES opening
Information regarding taste, cough, and gag reflexes
Can GROSSLY aspirate, can have absent cough reflex

Question 15

What is oral apraxia

Answer 15

happens from LH stroke. voluntary movement disorder of sequencing (inability to sequence motor movements)

Question 16

As a swallowing therapist, the goal is two fold…..to achieve that the patient swallow safely but also maintain or maximize

Answer 16

nutrition

Question 17

Many Dementia and Alzheimer patients exhibit oral agnosia. What is it? Give an example.

Answer 17

inability to recognize food

Question 18

Why can patients with TBI (traumatic brain injuries) difficult to treat for dysphagia?

Answer 18

Behavioral Issues: Impulsive, poor awareness (no awareness of deficits or what has happened to them), attention issues

Question 19

What are some of the specific clinical features of parkinson

Answer 19

resting tremor
bradykinesia
mask expression
cogwheeling
dysarthria

Question 20

Name a few of the swalloing defects associated with parkinsons

Answer 20

poor oropharyngeal control (bolus control)
tongue pumping
weak swallow reflex
incoordination of swallow and respiration
drooling (increased risk of silent aspiration)

Question 21

Name the generalized treatments for parkinsons

Answer 21

see google doc

Question 22

What affect does anti-psychotic medication have on the stages of swallowing? WHY?

Answer 22

see google doc

Question 23

name a lower motor neuron disease and the effects on swallowing

Answer 23

amyotrophic lateral sclerosis 
Effects on swallowing
reduced tongue base movement
reduced pharyngeal wall constriction
reduced laryngeal elevation
decreased labial closure

Question 24

What are the side effects of radiation and how does it affect swallowing

Answer 24

side effects
mucositis (inflammation of mucous membranes)  
edema
trismus
odynophagia (painful swallowing)
xerostomia
dental changes
fibrosis (scarring of tissue)
how does it affect swallowing?

Question 25

why is dry mouth (xerstomia) a problem in head and neck cancer patients

Answer 25

because salivary glands are radiated When should swallow treatment begin for a head and neck cancer patient? need to build up muscle strength before the event so they come out where they were pre-treatment

Question 26

Why is it important to keep a head and neck cancer patient swallowing EVEN if they are aspirating? (Think what changes in the muscles occur)

Answer 26

if they don’t keep swallowing they will develop fibrosis DO NOT LET THE MUSCLES ATROPHY AND TURN FIBROTIC, KEEP THEM SWALLOWING! DO NOT MAKE THEM NPO! If they don’t swallow, those muscles will turn to scar (fibrosis), the more they don’t use it, the more the muscles will turn to stone (become fibrotic).

Question 27

what is trismus

Answer 27

inability to open the mouth very much

Question 28

What is a total laryngectomy-how does this affect swallowing?

Answer 28

``` Physical separation of GI tract from the respiratory tract or removal of larynx OR separation of the airway from the esophagus. affects swallowing because of reduced laryngeal clearance additional problems related to swallowing include: pseudoepiglottis backflow of material into pharynx poor pharyngeal pressure nasal regurgitation fistula pouch formation reduced hyolaryngeal excursion reduced UES or PES opening reduced pharyngeal stripping wave complaints of food sticking ```

Question 29

What specific swallow changes would you see in an oral cancer patient?

Answer 29

``` Reduced tongue/bolus control — Reduced tongue elevation — Slowed oral transit with disorganized tongue movement — Delayed pharyngeal swallow — Reduced tongue base retraction — Reduced pharyngeal wall contraction — Reduced Laryngeal Elevation — Reduced UES/PES opening — Reduced velopharyngeal closure — Reduced epiglottic inversion ```

Question 30

What specific swallow changes would you see in a laryngeal cancer patient?

Answer 30

Reduced Laryngeal Elevation — Reduced Glottal and Laryngeal Closure — Reduced UES or PES opening — Reduced Pharyngeal Wall contraction