Dysphagia Flashcards Preview

Adult Comps* > Dysphagia > Flashcards

Flashcards in Dysphagia Deck (28):
1

damage to cortex

affects the oral prep/oral stage, lack of awareness of bolus, possible apraxia of swallowing (difficulty initiating the swallow)

2

damage to the UMN

delayed initiation (slow, not confused)

3

damage to subcortex

dont swallow salvia spontaneously (PD), difficulty initiating swallow, hypokinesia/rigidity = reduced movements

4

damage to the brainstem/CN

V = jaw weak
VII = lips weak
IX/X =pharynx and larynx weak
XII = tongue weak

--in general probably a weak swallow and airway closure leak

5

effects of aging on dysphagia

-reduced anterior hyoid strength
-increased airway penetration o ver 50y/o
-esophageal motor activity decreases

***aging does NOT cause a dysphagia

6

3 valves

-VP closure
-Laryngeal valving
-UES opening

7

coughing prior to the swallow means...

incomplete airway protection (pen/asp prior to swallow)

-likely due to mistiming or late laryngeal closure

8

coughing after the swallow means...

presence of residue resulting in pen or asp after the swallow

--likely due to reduced bolus clearance

9

multiple swallows means...

residue preset

10

aspiration during the swallow...

due to reduced laryngeal closure (which is likely due to reduced hylolaryngeal excursion or reduced glottis closure)

11

swallowing timing guidelines

1-2 = normal
3=outside limit

-on command.... .5 seconds is normal

12

what about if complaining of secretions?

**Murray et al. (1996) --- secretions are predictive of aspiration in elderly hospitalized pts

13

swallow apraxia

significant delay or inability to elicit swallow w/ verbal command

-- they can complete more automatic OMEs

symptoms --- searching movements of tongue, holding bolus w/o initiating oral activity

14

chin down/chin tuck

reduced depth of penetration (Bulow, 2001)

---delayed swallow onset
-reduced BOT retraction
-decrease airway protection
-aspiration during the swallow

15

chin up

-aids in bolus transport to pharynx using gravity

...use with problems in the oral stage

16

head turn

-closes off weak side
-positions damaged VF in midline
-reduces UES pressure & Increased duration of UES relaxation

17

shaker

-includes isometric and isokenitic movements

-improves excursion
-emlinates aspiration
-improves UES opening which lets residue go down

18

IOPI

-tongue strengthening exercises

"improved tongue strength" - Yeates, 2008

19

LVST

-for people with poor lingual ROM and coordination
-slow transit time

---"improved lingual ROM/coordination; quicker swallow" (El Sharkawi et al., 2002)

20

EMST

expiratory muscle strength training

-used for people who pen/asp
-----decreases pen/asp scores and improves cough, speech, breathing, swallow fan

21

pharyngeal squeeze

-for people with poor pharyngeal constrictors

22

effortful pitch glide

for people with:
-weak pharyngeal squeeze
-pharyngeal residue

----increases hylolaryngeal excursion, pharyngeal approximation

23

mendelsohn maneuver

"increased laryngeal movement and prolonged elevation keeps the UES open longer (Kahrillas, 1991)

use for patients who:
-decreased range/duration of hyolaryngeal elevation
-decreased range/duration of UES opening
-decreased swallow coordination

24

effortful swallow

"increased effort increased posterior movement of BOT (Logemann, 1990)

use for pts:
-poor tongue based retraction
-residue in valleculae

25

supraglottic swallow

"good to close the VF's/airway before swallowing to reduce aspiration (Logemann, 1997)

for pts:
-aspiration during the swallow
-reduced airway protection @ level of VF

26

controlled swallow

-direct technique to alter timing
-controls bolus at swallow onset

27

McNeil Dysphagia Treatment Protocol (MDTP)

--> swallow hard and fast

"improved swallow in chronic dysphagia after 3 weeks of this" - Carnaby-Mann, 2011

28

Protocol 201

RCT regarding efficacy of thickened liquids

-better to do thin liquids w/ chin down instead of increasing consistency (Robbins & Hind, 2008)

--no sig difference in PNA incidence