maggie praxis 2 Flashcards
(54 cards)
CNs involved in swallowing
Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X), Hypoglossal (XII)
Describe oral preparatory phase of swallow (adults)
Food/liquid is manipulated in the oral cavity, chewed (if necessary), and made into a bolus, which is sealed with the tongue against the hard palate
Describe oral phase of swallow
Tongue moves food or liquid toward the back of the mouth (toward the anterior faucial pillars). To achieve this, the tongue presses the bolus against the hard palate and squeezes the bolus posteriorly
Describe pharyngeal phase of swallow
:Swallow reflex triggered and bolus is carried through the pharynx. These simultaneous actions occur: (a) the velopharyngeal port closes; (b) the bolus is squeezed to the top of the esophagus (cricopharyngeal sphincter); (c) the larynx elevates as the epiglottis, false vocal folds, and true vocal folds close to seal the airway; and (d) the cricopharyngeal sphincter relaxes to allow the bolus to enter the esophagus
Esophageal phase
Bolus is transported through the esophagus into the stomach
Neurological causes associated w/ dysphagia
CVA, TBI, muscular dystrophy, Parkinson’s, myasthenia gravis, ALS, MS, CP
Non-neurologic causes associated w/ dysphagia
Head and neck cancer, GERD, esophageal tumors
Diagnostic tests for dysphagia
Videofluoroscopy, fiber-optic endoscopy, scintigraphy
Videofluoroscopy
e.g. modified barium swallow): a moving radiograph of the mouth, pharynx, larynx, and cervical esophagus during swallowing. can identify the specific nature of the oropharyngeal dysphagia; it can define abnormality of movements, trace progress of bolus, and demonstrate aspiration
Fiber-optic endoscopy
useful in assessing swallowing by providing direct observation of pharyngeal activity during the swallowing process
Scintigraphy
produces an image of the swallowing mechanism by first covering the vocal tract with a specific nuclide and recording the distribution of the radioactivity w/ a scanning external scintillation camera
Laryngeal penetration
occurs when swallowed material penetrates laryngeal side of epiglottis, aryepiglottic folds, or spills over arytrenoid cartilages above level of true VFs
Aspiration
swallowed material has entered the trachea below the level of the true vocal folds
Tx for dysphagia
Lip exercises, tongue exercises, jaw exercises, swallowing exercises
Postural tx methods for dysphagia
Chin tuck, head turn, head tilt, head back, chin tuck w/ head turn
Chin tuck
pushes base of tongue towards pharyngeal wall; expands vallecular recesses; narrows entrance to laryngeal vestibule by moving epiglottis posteriorly. Used for delayed onset pharyngeal swallow; reduced base of tongue retraction to posterior pharyngeal wall approximation; decreased airway protection; aspiration DURING swallow
Head turn (to weak side)
blocks bolus from traveling down weak side by twisting the pharynx; applies pressure to the vocal fold to increase approximation; reduces resting pressure or the cricopharyngeus by pulling the larynx away from the posterior pharyngeal wall (increasing the space)used for unilateral pharyngeal weakness; unilateral laryngeal weakness; cricopharyngeal dysfunction
Head tilt (to stronger side)
directs bolus to stronger side of oral/pharyngeal cavities used for unilateral oral weakness; unilateral pharyngeal weakness
Head back posture
used for oral transit dysfunction. gravity helps clear the oral cavity
Chin tuck w/ head turn
increases epiglottic deflection to narrow the entrance to the laryngeal vestibule; increases VF approximation by applying extrinsic pressure used for reduced airway closure
Swallow maneuvers (not appropriate for those w/ cognitive deficits)
Supraglottic swallow, super-supraglotic swallow, Mendelsohn Maneuver, effortful swallow
Supraglottic swallow
Patient holds breath and coughs immediatly following a swallow to close VFs before and during swallow. Used when there is reduced airway protection (at the vocal fold level); Aspiration DURING the swallow
Super-supraglottic swallow
Patient holds breath, bears down, and coughs immediately following swallow and immediately swallows hard again. Used when there is reduced airway closure; aspiration BEFORE and DURING the swallow
Mendelsohn Maneuver
Increased laryngeal movement stretches/opens the CP; Prolonging hyolaryngeal elevation keeps the CP open longer. used for 1) Decreased range/duration hyolaryngeal elevation; (2) Decreased range/duration cricopharyngeal opening; (3) Decreased pharyngeal swallow coordination
