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PRAXIS! > Dysphagia > Flashcards

Dysphagia Flashcards

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1
Q

Left CVA lesion

A

deficits in oral phase and initiation of swallow, but better recovery of swallow function than right CVA

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2
Q

Right CVA lesion

A

deficits in pharyngeal phase and aspiration/penetration before swallow is initiated, delayed pharyngeal constriction.

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3
Q

Pons lesion

A

hypertonicity, delayed/absent swallow response, reduced laryngeal elevation, cricopharyngeal dysfunction, and slow recovery

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4
Q

Medulla lesion

A

longer pharyngeal response time, increased duration for velar and laryngeal elevation, delayed opening of UES

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5
Q

Subcortical lesion

A

mild oral and pharyngeal transit delays, aspiration, laryngeal penetration

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6
Q

Dementia clinical findings

A

trouble with bolus prep, self feeding, and food prep, prolonged oral stage

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7
Q

Basal ganglia (parkinson’s) clinical findings

A

repetitive tongue pumping, difficulty in all stages, progressive in nature

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8
Q

CN V

A

normal function: sensation in anterior ⅔ of tongue, sensation to teeth, gums, and oral mucosa, salivary flow to major and minor glands, motor control of mouth opening, mandible motion and mastication, motor innervation to floor of mouth muscles to elevate larynx and hyoid
Abnormal function: difficulty chewing, forming a bolus (oral stage deficits), inability to initiate swallow response, deficits in hyoid elevation, insufficient epiglottic tilt

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9
Q

CN VII

A

Normal function: taste in anterior ⅔ of tongue, sensation to soft palate, salivation from all salivary glands (except parotid), motor control of lip motion and bilabial seal, motor control for the facial muscles, floor of mouth, and cheeks, assists in elevation of hyoid and larynx to protect airway.
Abnormal function: loss of bolus through front of mouth, drooling, over or under salivating (oral stage deficits), pocketing of food, insufficient epiglottic tilt,

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10
Q

CN IX

A

Normal function: taste in posterior ⅓ of tongue, sensation to faucial pillars and soft palate, salivation from parotid, sensation to the pharynx and larynx, motor velopharyngeal closure, motor control of the upper pharyngeal constrictor muscle
Abnormal function: residue in the pharynx, nasopharyngeal regurgitation (incomplete seal due to decreased pharyngeal constriction), weakness in pharyngeal constriction, impaired opening of UES, impaired laryngeal elevation, inability to initiate swallow response

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11
Q

CN X

A

Normal function: controls sensory information for pharyngeal and esophageal phases, sensation for pharynx, larynx, and trachea, visceral sensory for mucosa of the valleculae, pharynx, larynx, lungs, stomach, and abdomen, motor innervation to the base of tongue and pharyngeal muscles, major innervation to the larynx, diaphragm, and lungs, pharyngeal contraction and esophageal peristalsis
Abnormal function: nasopharyngeal regurgitation (decreased pharyngeal constriction), decreased pharyngeal constriction (residue in the pharynx), aspiration due to incomplete closure of the v.f., silent aspiration due to decreased sensation in the larynx, residue in the pyriform sinuses, residue in valleculae, inability to propel the bolus, absence of peristalsis in esophagus

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12
Q

CN XI

A

Normal function: partial innervation of soft palate and uvula, assists with velopharyngeal elevation, partial innervation of muscles of upper pharynx, provides stability of shoulder and neck muscles during swallow and allow rotation of the head and neck
Abnormal function: nasopharyngeal regurgitation, residue in pharynx

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13
Q

CN XII

A

Normal function: motor for all tongue muscles, seal oral cavity and prepare bolus, motor innervation of the pharynx, aids in hyolaryngeal elevation and airway protection
Abnormal function: residue in the oral cavity, inability to form bolus, premature loss of bolus, residue in the vallecula, aspiration, penetration, insufficient epiglottic tilt

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14
Q

Temporalis

A

mandibular branch of CN V. raise/brace mandible, chewing, closing oral cavity

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15
Q

Masseter

A

mandibular branch of CN V. raise/brace mandible, chewing, closing oral cavity

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16
Q

Medial pterygoid

A

mandibular branch of CN V. raise/brace mandible, chewing, closing oral cavity

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17
Q

Lateral pterygoid

A

mandibular branch of CN V. lower/protrude/rock mandible, chewing

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18
Q

Obicularis oris

A

CN VII. seal lips/mouth

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19
Q

Buccinator

A

CN VII. push food toward teeth during mastication, help close mouth

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20
Q

Superior longitudinal

A

intrinsic tongue muscle, CN XII. shorten tip/deflect (up lateral)/concave bow tongue, bolus prep/formation/positioning/transport

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21
Q

Inferior longitudinal

A

intrinsic tongue muscle, CN XII. shorten tip/deflect (up lateral)/concave bow tongue, bolus prep/formation/positioning/transport

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22
Q

Transverse

A

Intrinsic tongue muscle, CN XII. narrow/lengthen tongue, bolus prep/formation/positioning/transport

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23
Q

Verticalis

A

Intrinsic tongue muscle, CN XII. broaden/flatten tongue, bolus prep/formation/positioning/transport

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24
Q

Hyoglossus

A

extrinsic tongue muscle, CN XII. lower/retract tongue, bolus prep/formation/positioning/transport

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25
Genioglossus
extrinsic tongue muscle, CN XII. protrude/retract tongue, bolus prep/formation/positioning/transport
26
Styloglossus
extrinsic tongue muscle, CN XII. raise/retract tongue, bolus prep/formation/positioning/transport, seal oral cavity
27
Mylohyoid
suprahyoid, CN III. raise/stabilize hyoid. stabilize tongue, FOM
28
Geniohyoid
suprahyiod, CN XII. raise/protract/stabilize hyoid bone
29
Stylohyoid
suprahyoid, CN VII. raise/retract/stabilize hyoid, elongate mouth floor
30
Anterior belly of diagastric
suprahyoid, CN III. raise/stabilize hyoid, lower mandible
31
Posterior belly of diagastric
suprahyoid, CN VII. raise/retract/stabilize hyoid, lower mandible
32
Omohyoid
Infrahyoid. Lower/stabilize hyoid
33
Sternohyoid
Infrahyoid. Lower/stabilize hyoid.
34
Thyrohyoid
Infrahyoid. Lower/stabilize hyoid, raise larynx to hyoid
35
Sternothyroid
Infrahyoid. Lower/stabilize larynx
36
Tensor veli palatini
CN V. Tense soft palate
37
Levator veli palatini
CN XI and X. Raise/retract soft palate, widen entrance to oropharynx, seal nasopharynx
38
Palatoglossus
CN XI and X. Raise uvula, brace soft palate
39
Stylopharyngeus
CN IX. Raise/shorten pharynx, raise larynx
40
Palatopharyngeus
CN XI and X. Lower palate, raise/shorten pharynx, raise larynx, seal oral cavity
41
Salpingopharyngeus
CN XI and X. Raise/shorten pharynx, raise larynx
42
Superior pharyngeal constrictor
CN XI and X. Narrow pharyngeal lumen, seal nasopharynx, bolus transport
43
Middle pharyngeal constrictor
CN X. Narrow pharyngeal lumen, bolus transport
44
Inferior pharyngeal constrictor
CN XI and X. Narrow pharyngeal lumen, bolus transport, most distal component of upper esophageal sphincter
45
Lips/face/teeth OME
Nonspeech: Symmetry at rest; labial retraction, pucker, labial seal, raise eyebrows, wrinkle forehead, smile, frown Speech: DDKs
46
Jaw OME
Nonspeech: Symmetry, open, close, resistance, lateralization, tactile sensations, range of motion Speech: bite block (not used normally)
47
Velum/pharynx OME
Nonspeech: Position at rest, breathing nasality, gag reflex (no longer used to determine problems) Speech: oral/nasal minimal pairs (note vs. dote), no nasal assimilation to oral consonant (bambi; pamper)
48
Tongue OME
Nonspeech: Protrusion, lateralization, elevation, strength against resistance Speech: DDKs, speech articulation
49
Respiratory mechanism OME
Nonspeech: breathing at rest, rate, depth, quiet/noisy Speech: MPT, habitual loudness, loudness range, syllables per breath
50
Larynx OME
Nonspeech: cough, throat clear, larynx rise during swallow Speech: sustain voice sounds; alternate voice/voiceless; voice quality (CAPE-V)
51
Benefits of clinical examination
locus of the patient's dysphagia, that is, whether it is oral or pharyngeal patient's readiness for a radiographic study patient's ability to accept food into the mouth oral reaction to placement of various tastes, temperatures, and textures in oral cavity presence of any oral apraxia, abnormal oral reflexes such as tonic bite any particular postural and behavioral needs of the patient that must be addressed during the radiographic study. Laryngeal Function as it may affect airway protection and aspiration during the swallow. Coughing status Decision on Best Posture Best Position of Food in Mouth Oral Sensitivity Best Food Consistency Selection of Optimum Swallowing Instructions (Posture or sequence of postures)
52
Limitations of clinical examination
38 - 40% of patients who aspirate are not identified on clinical examination Pharyngeal events are not observable Basis for aspiration cannot be determined
53
Benefits of VFSS (MBS)
Dynamic Thorough Unlimited review capacity Readily available in hospital setting
54
Limitations of VFSS (MBS)
``` Exposure to radiation “Snapshot” of swallow function Abnormal environment Transport to radiology may be problematic Not easily accessible outside hospital ```
55
Benefits of FEES
No radiation exposure equipment is portable, The clinician can assess VPI (velopharyngeal incompetence) and vocal cord issues Gives immediate results
56
Limitations of FEES
Invasive - Difficulty maintaining cooperation in 12 mos - 4 yrs olds doesn't give info on interaction of oral, pharyngeal and esophageal phases of swallowing
57
How is the modified evans blue dye test performed?
EBDT -Described by Cameron et al 1973 –Place 4 drops of aqueous solution of Evans blue dye on patient's tongue q 4 hours –Monitor tracheal secretions for bluish discoloration for 48 hours –Any evidence of blue dye in tracheal secretions indicates aspiration –Perform routine tracheostomy care Components of MEBDT: •Color liquids and solids with blue dye •Deflate cuff •Present boluses in order of difficulty •Suction after each bolus consistency •Examine tracheal secretions for evidence of blue tint •Recommend diet; specify compensations and conditions of PO intake
58
What are the limitations of MEBDT?
Not sensitive enough to detect trace aspiration, increased risk for sepsis, burns, shock, surgical intervention, renal failure, celiac sprue, IBD
59
Oral stage deficits
Lips don’t seal, no teeth, flaccid cheeks, drooling, poor bolus formation, prolonged oral stage, unable to propel bolus, reduced/weak lingual movement, kinking of the soft palate, loss of bolus over base of tongue, premature leakage
60
Pharyngeal phase deficits
poor soft palate seal, nasopharyngeal regurgitation, sluggish elevation of the soft palate, constrictors don't contract, unilateral asymmetry, retention in vallecula/pyriforms, absent hyoid elevation, incomplete/absent epiglottic tilt, vocal folds open during swallow, aspiration/penetration, problem with cricopharyngeus opening late/closing early
61
Esophageal stage deficits
dysmotility, reflux, spasms, stenosis, diverticulum, GERD, fistula
62
How can a tracheostomy affect swallowing?
Restriction of laryngeal elevation, decreased laryngeal sensitivity, decreased glottal pressure, interrupts the cricopharyngeus, causes difficulty in expelling air
63
Be able to state factors which increase risk of aspiration pneumonia in individuals with dysphagia
Impaired consciousness, poor mobility, COPD, medication, age, poor oral hygeine
64
State the main limitations of electrical stimulation as a therapeutic intervention.
Many limitations to existing research (ie., unequal treatment, dosage of stim unreported, multiple threats to internal/external validity) Unanswered questions (which muscles stimulated?, where place electrodes, effects LT/ST?) Potential for harm - anecdotal reports worsen swallow & ES resulted in decreased hyoid elevation Surface ES stimulates superficial, not deep muscles Lost time (family & clinician) Slowed progress Lost hope and misplaced trust Loss of credibility
65
Know the steps of a clinical/bedside swallow evaluation from referral through recommendations
- Interview patient and caregivers - Examine speech/swallow components - Observe what happens when patient is fed - Teach compensations - Tailor instrumental exam
66
Assessment of functional components
Respiratory- breathing rate, sustained phonation, loudness Laryngeal- laryngeal elevation, sustained phonation, voice quality (rough, strained), voiced/voiceless contrasts Velum/pharynx- mirror under nose, nasal sounds (look for nasal assimilation or stuffiness) Tongue- protrusion, DDK Lips/face/teeth- pucker, raise eyebrows, DDK Jaw- open against resistance, range
67
Understand how a tracheostomy cannula may preclude some swallowing strategies
``` Restriction of laryngeal elevation Decreased laryngeal sensitivity Decreased glottal pressure Interrupts the cricopharyngeus Causes difficulty in expelling air ```

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