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Flashcards in maggie praxis 2 Deck (54):
1

CNs involved in swallowing

Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X), Hypoglossal (XII)

2

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

3

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

4

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

5

Esophageal phase

Bolus is transported through the esophagus into the stomach

6

Neurological causes associated w/ dysphagia

CVA, TBI, muscular dystrophy, Parkinson's, myasthenia gravis, ALS, MS, CP

7

Non-neurologic causes associated w/ dysphagia

Head and neck cancer, GERD, esophageal tumors

8

Diagnostic tests for dysphagia

Videofluoroscopy, fiber-optic endoscopy, scintigraphy

9

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

10

Fiber-optic endoscopy

useful in assessing swallowing by providing direct observation of pharyngeal activity during the swallowing process

11

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

12

Laryngeal penetration

occurs when swallowed material penetrates laryngeal side of epiglottis, aryepiglottic folds, or spills over arytrenoid cartilages above level of true VFs

13

Aspiration

swallowed material has entered the trachea below the level of the true vocal folds

14

Tx for dysphagia

Lip exercises, tongue exercises, jaw exercises, swallowing exercises

15

Postural tx methods for dysphagia

Chin tuck, head turn, head tilt, head back, chin tuck w/ head turn

16

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

17

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

18

Head tilt (to stronger side)

directs bolus to stronger side of oral/pharyngeal cavities used for unilateral oral weakness; unilateral pharyngeal weakness

19

Head back posture

used for oral transit dysfunction. gravity helps clear the oral cavity

20

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

21

Swallow maneuvers (not appropriate for those w/ cognitive deficits)

Supraglottic swallow, super-supraglotic swallow, Mendelsohn Maneuver, effortful swallow

22

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

23

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

24

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

25

Effortful swallow

Used to clear residue in valleculae. The increased effort increases the posterior movement of the base of tongue

26

Shaker Exercise & Mendelsohn exercise

Rehab swallowing exercises to improve function of strap muscles

27

Gastrostomy

creating an opening of a stoma in the stomach wall when normal food ingestion is not possible or ill-advised

28

Odynophagia

pain during swallow

29

Surgical/medical tx to protect airway

Stents, laryngotracheal separation, laryngectomy, trach tubes, feeding tubes

30

Surgical treatments to improve glottal closure

Medialization thyroplasty and injection of biomaterials

31

Medialization thryoplasty

surgical procedure which moves the paralyzed vocal fold closer to the mid glottis to allow better compensation by the unaffected fold

32

Surgical/medical tx to improve opening of pharyngoesophageal segment

Dilatation, Myotomy, Botox Injection

33

Bedside swallow exam

Obtain case history. Observe function of jaw, lips, tongue, phayrnx, larynx, and eating various textures

34

Blom-Singer

indwelling low-pressure voice prosthesis kit (laryngectomy)

35

ProVox

low-resistance indwelling prosthetic (laryngectomy)

36

Servox

transcervical electrolarynx

37

Cooper-Rand

intraoral electrolarynx

38

HME device

Heat and moisture exchanger. Filter placed on tracheostoma which heats and humidifies air. laryngectomy)

39

7 Extrinsic muscles of larynx

Digastric,Stylohyoid, Mylohyoid, Geniohyoid,Hypoglossus, Genioglossus, Thropharyngeus

40

7 Intrinsic muscle of larynx

Cricothyroid, Lateral cricoarytenoid(lateral), Posterior cricoarytenoid, Arytenoid, Thyroarytenoid,Aryepiglottis, Thyroepiglottis

41

Muscle with greatest control of fundamental frequency

Cricothyroid

42

Muscles of abduction

Posterior cricoarytenoid

43

Muscles of adduction

Lateral cricoarytenoid, transverse arytenoid

44

Spastic dysphonia

overadduction of VFs = strained, choked, or creaky voice

45

Functional dysphonia

Likely results in no voice due to underadducted VFs.

46

Vocal cord paralysis-vocal characteristics

hoarse, breathy, decreased vocal intensity, loss of pitch range

47

Ventricular dysphonia

Patient adducts & vibrates ventricular bands instead or in addition to the vocal cords

48

Laryngeal web

Web grows btw VFs, usually triggered by mucosal surface laryngeal injury or irritation. Can cause severe dysphonia and shortness of breath but NOT total absence of voice

49

Acute laryngitis

person may lose the use of voice and may become aphonic during episode. **not approriate to provide voice tx to these individuals

50

Vocal nodules characteristics

hoarse voice quality, hard glottal attacks, and lowering of pitch

51

Ventricular phonation

Person uses false VFs- A rough type of phonation that, when used in conjunction with the true VFs, can result in diplophonia

52

Spastic dysphonia

involves aphonic breaks due to sudden over adduction or under adduction of VFs

53

Contact ulcers

stress, use voice extensively in daily life, has a tense, hard-driving personality, and exhibits glottal fry

54

Glottal fry

when VFs vibrate very slowly and the vibration causes a slow, low pitch vocal burst making the voice sound crackly or creaky, airflow rate and air pressure that produces the VF vibration are both low and lung volume is less