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NESPA Studying Guides > Dysphagia and Swallowing > Flashcards

Dysphagia and Swallowing Flashcards

including physiology, disorders, screening and assessment, and treatment (75 cards)

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1
Q

swallowing physiology

A
  • oral phase (voluntary)
  • pharyngeal phase (involuntary)
  • esophageal phase (involuntary)
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2
Q

oral phase (voluntary)

A
  • oral preparation
  • oral transport
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3
Q

oral preparation

A
  • manipulation and mastication of food into a bolus
  • structures/muscles involved: lips, jaw, tongue, soft palate, buccal and mastication muscles
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4
Q

oral transport

A
  • tongue tip and sides in contact with alveolar ridge
  • anterior to posterior movement
  • bolus and tongue motion near faucial pillars + tongue base: pharyngeal swallow triggered
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5
Q

pharyngeal phase (involuntary)

A
  • pharyngeal phase initiated
  • bolus near tongue base
  • bolus nears upper esophageal sphincter (UES)
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6
Q

pharyngeal phase initiated

A
  • laryngeal and hyoid elevation
  • velopharyngeal closure
  • epiglottis closes airway
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7
Q

pharyngeal phase: bolus near tongue base

A

walls of pharynx contract

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8
Q

pharyngeal phase: bolus nears UES

A

walls of pharynx contract

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9
Q

esophageal phase (involuntary)

A

food transports from pharynx to stomach

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10
Q

labial

A

lips

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11
Q

dental

A

teeth

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12
Q

lingual

A

tongue

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13
Q

buccal

A

cheeks

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14
Q

palatal

A

hard and soft palate

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15
Q

palatal arches

A

palatopharyngeal/palatoglossal arch

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16
Q

tongue muscles: intrinsic

A

originate and extend within tongue
- superior longitudinal
- inferior longitudinal
- transverse
- vertical

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17
Q

tongue muscles: external

A

originate outside tongue and extend within
- genioglossus
- hyoglossus
- styloglossus
- palatoglossus

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18
Q

oral preparation swallow disorder: reduced lip closure

A

cannot hold food in mouth anteriorly

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19
Q

oral preparation swallow disorder: reduced tongue ROM, coordination

A

cannot form cohesive bolus

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20
Q

oral preparation swallow disorder: reduced tongue shaping, velar movement

A

premature loss of bolus

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21
Q

oral preparation swallow disorder: aspiration

A

aspiration before the swallow

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22
Q

oral preparation swallow disorder: labial labial tension, tone

A

food falls into anterior sulcus

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23
Q

oral preparation swallow disorder: reduced buccal tension, tone

A

food falls into lateral sulcus

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24
Q

oral preparation swallow disorder: tongue thrust, reduced control

A

bolus abnormally held in front of tongue

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25
oral phase swallow disorder: apraxia of swallow, reduced sensation
delayed oral onset of swallow
26
oral phase swallow disorder: apraxia of swallow
searching tongue movements
27
oral phase swallow disorder: tongue thrust
tongue moves forward to start swallow
28
oral phase swallow disorder: reduced tongue movement, strength
food/residue remains on the tongue
29
oral phase swallow disorder: reduced tongue elevation
incomplete tongue to palate contact
30
oral phase swallow disorder: oral onset time (OTT)
normal is 1-1.5 seconds in duration
31
triggering pharyngeal phase swallow disorder: delayed pharyngeal swallow
duration of delay in seconds
32
triggering pharyngeal phase swallow disorder: pharyngeal swallow not triggered
bolus head enters pharynx before trigger
33
pharyngeal phase swallow disorder: reduced velopharyngeal closure
nasal penetration
34
pharyngeal phase swallow disorder: reduced pharyngeal contraction
residue on pharyngeal walls
35
pharyngeal phase swallow disorder: reduced posterior tongue base movement
vallecular residue after swaallow
36
pharyngeal phase swallow disorder: reduced laryngeal elevation
residue at top of airway
37
pharyngeal phase swallow disorder: reduced closure of airway
penetration/aspiration may occur
38
pharyngeal phase swallow disorder: reduced anterior laryngeal motion
residue (stasis) in both pyriform sinuses
39
esophageal phase swallow disorder: tracheoesophageal fistula
abnormal hole between trachea and esophagus
40
esophageal phase swallow disorder: Zenker's Diverticulum
pharynx herniation, food collects in pouch
41
esophageal phase swallow disorder: reflux (GERD)
back flow of food, stomach to esophagus
42
dysphagia screening and assessment: prior to initiation
assess if patient is alert and can follow simple directions
43
OFSME: facial symmetry
at rest and during movements
44
OFSME: velar symmetry
open mouth wide, prolonged "ah"
45
OFSME: dentition, oral
open mouth wide, examine teeth + hygiene
46
OFSME: lingual symmetry
stick out tongue
47
OFSME: lingual ROM
movement of tongue left/right, up/down
48
OFSME: lingual strength
tongue against resistance (e.g. IOPI)
49
OFSME: lingual coordination
observe coordination during movements
50
OFSME: labial symmetry
at rest, during smile + pucker
51
OFSME: labial ROM
protrude (pucker) and retract (smile)
52
OFSME: labial strength
resistance against tongue blade
53
OFSME: labial closure
puff cheeks, hold air inside cheeks against resistance
54
OFSME: jaw ROM
open + close jaw, move side to side
55
OFSME: diadochokinetic rate (DDK)
- repetition of "puh", "tuh", and "kuh" - repetition of "puhtuhkuh"
56
OFSME: soft palate movement
production of "ah"
57
OFSME: voicing
sustained phonation "ahhh" (for as long as possible)
58
bedside clinical swallowing examination
assess and identify signs/symptoms of dysphagia, refer for instrumental testing
59
disorders/conditions that may have a higher risk of developing dysphagia
- stroke (CVA) - mechanical ventilation - oral cancer - ALS and MS - GI ulcers - dementia - head injury/TBI - tracheostomies - motor neuron diseases - myasthenia gravis - dystonia - diabetes - cervical fusion/surgery - laryngectomies - Parkinson's disease - hiatal hernia - Huntington's disease - sepsis, renal disease
60
instrumental examination
- Videofluoroscopic Swallowing Study (VFSS) - Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
61
compensatory or postural strategies
- swallowing maneuvers (motor with swallow) - focus on eliminating symptoms of dysphagia (e.g. altering food flow), not on eliminating the condition
62
examples of compensatory strategies
- positioning strategies: chin tuck, head turn - food/liquid modification: texture/consistency diet changes, volume/rate, etc.
63
sensory stimulation
- muscle strengthening exercises (motor without swallow) - goal is to increase sensory stimulation
64
examples of direct therapeutic sensory techniques
- thermal-tactile stimulation to anterior faucial pillars to stimulate swallow trigger - increased downward pressure of spoon, changes to bolus (sour/sweet), electrical stimulation
65
swallowing maneuvers - motor with swallow
*patient must be alert and able to follow directions to complete* - breath-holding techniques - Mendelson maneuver - effortful swallow
66
breath-holding techniques
- supraglottic swallow - super-supraglottic swallow
67
breath-holding techniques: supraglottic swallow
- airway protection at level of true vocal folds - instructions: take a deep breath (inhale) and hold, keep holding your breath as you swallow, cough immediately after swallow
68
breath-holding techniques: super-supraglottic swallow
- airway protection at level of laryngeal vestibule - instructions: take a deep breath and hold (while bearing down), keep holding breath + bearing down as you swallow, cough immediately after
69
Mendelson maneuver
- aimed to improve upper esophageal sphincter (UES) opening and bolus flow - instruct patient to place fingers on Adam's apple + feel swallow (up/down movement) - instructions: swallow and try to hold the larynx in the elevated (up) position for as long as possible (1-3 seconds), then complete the swallow
70
effortful swallow
- aimed to improve base of tongue retraction + pressure, bolus clearance - instructions: push + squeeze muscles to swallow as "hard" as you can, may be done with or without food/liquid
71
muscle strengthening exercises - motor without swallow
- lingual resistance - CTAR - shaker head lift - EMST
72
lingual resistance
- strengthening tongue muscles - may use tongue depressor, device such as IOPI, etc.
73
chin tuck against resistance (CTAR)
- designed to improve UES opening - squeezing of rubber ball and tucking chin in using maximum pressure
74
shaker head lift
- designed to improve UES opening - patient lays flat, raises their head (looks to toes), + holds that position for about 1 minute x 3 reps
75
expiratory muscle strength training (EMST)
designed to improve maximal expiratory pressure, strengthen expiratory muscles

NESPA Studying Guides (18 decks)

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