Midterm Flashcards
(72 cards)
1
Q
Roles of swallowing?
A
1- hydration
2- salivary management
3- airway protection
4- socialization
2
Q
Oral Prep structures
A
Lips, teeth, tongue, mandible, hard palate, floor of mouth, salivary glands, cheeks
3
Q
Function of Oral Prep stage
A
prepare bolus to be swallowed
4
Q
Starting point of Oral Prep stage
A
when food enters the mouth
5
Q
Ending point of Oral Prep stage
A
anterior bolus hold- hold bolus at front of mouth (middle of tongue ramps up)
6
Q
Pressure valve of Oral Prep stage
A
labial seal
7
Q
Duration of Oral Prep stage
A
Varies depending on viscosity
8
Q
Oral Structures
A
tongue, hard palate, sensory receptors in/near/around faucal arches
9
Q
Function of Oral stage
A
AP transit
10
Q
Starting point of Oral stage
A
Anterior bolus hold
11
Q
Ending point of Oral stage
A
Swallow onset -> initiation of swallow
signal is sent from sensory receptors in/near/around faucal arches to meduallary swallowing comples (oral and pharyngeal stages overlap here)
12
Q
Pressure Valve of Oral stage
A
lingual palatal approximation
13
Q
Duration of Oral stage
A
< 1 second regardless of what you are swallowing
14
Q
Pharyngeal structures
A
sensory receptors in/near/around faucal arches
meduallary swallowing complex
velum
pharyngeal constrictors
lateral pharyngeal walls
base of tongue
valleculae & pyriform sinuses
epiglottis
true VFs
arytenoid joints
hyoid bone
15
Q
Function of Pharyngeal stage
A
move bolus inferiorl through the pharynx into the esophagus
16
Q
Starting point of Pharyngeal stage
A
Swallow onset - once info has been gathered and sent to MSC, interpreting, sending back, and beginning of swallow
17
Q
Ending point of Pharyngeal stage
A
as bolus moves through UES
18
Q
Pressure Valve of Pharyngeal stage
A
velopharyngeal closure, tongue base to posterior pharyngeal wall
19
Q
Duration of Pharyngeal stage
A
about 1 second
20
Q
Esophageal structures
A
UES, esophagus, LES
21
Q
Function of esophageal stage
A
move the bolus from UES inferiorly to the stomach
22
Q
Starting point of esophageal stage
A
as bolus moves through UES
23
Q
Ending point of esophageal stage
A
as bolus moves through LES
24
Q
Pressure valves of esophageal stage
A
UES & LES
25
Duration of esophageal stage
8-20 seconds depending on bolus
26
Manifestations of dysphagia in Oral Prep stage
Lips- cause, effect, asp. risk, possible etiologies
Cause: decreased labial seal
Effect: anterior spill, decreased intraoral pressure, oral stasis, slowed onset
Asp. Risk: Yes- after
Possible Etiologies: surgical, missing lips, hypotonia, paralysis, trigeminal neuralgia, bells palsy, cleft lip, GSW
27
Dysphagia in Oral Prep stage
Cheeks- cause, effect, asp. risk, possible etiologies
Cause: decreased buccal tone
Effect: oral stasis
Asp. Risk: Yes- after
28
Dysphagia in Oral Prep stage
Tongue- cause, effect, asp. risk, possible etiologies
Cause: decreased lingual strength, ROM, coordination
Effect: poor bolus formation, poor bolus hold, anterior or posterior spill, Oral stasis
Asp. Risk: Yes- after
Possible Etiologies: hypotonia
29
Dysphagia in Oral Prep stage
Palate- cause, effect, asp. risk, possible etiologies
Cause: Incomplete palate
Effect: Nasal regurg., decreased pressure
Asp. Risk: Yes- after
Possible Etiologies: GSW, cancer, cleft palate, Iatrogenic
30
Dysphagia in Oral Prep stage
Mandible- cause, effect, asp. risk, possible etiologies
Cause: decreased lateral mandibular movement
Effect: poor bolus formation, stasis
Possible Etiologies: ID, DS, Spasticity
31
Dysphagia in Oral Prep stage
Salivary glands- cause, effect, asp. risk, possible etiologies
Cause: Decreased saliva production
Effect: poor bolus formation, stasis, decreased pharyngeal transit, slowed AP transit
Asp. Risk: Yes- if stasis
Possible Etiologies: Xerostomia
32
Dysphagia in Oral stage
Tongue- cause, effect, asp. risk, possible etiologies
Cause: decreased strength, ROM, coordination, increased spasticity
Effect: decreased linguopalatal approximation -> decreased pressure, inefficient AP transit, oral stasis
Asp. Risk: Yes- after
Possible Etiologies: xerostomia, cancer, iatrogenic, TBI, CVA, neurogenic, developmental
33
Dysphagia in Oral stage
Palate- cause, effect, asp. risk, possible etiologies
Cause: Incomplete palate
Effect: Nasal regurg., decreased pressure, inefficient AP transit, stasis
Asp. Risk: Yes- after
Possible Etiologies: n/a
34
Dysphagia in Oral stage
Sensory Receptors- cause, effect, asp. risk, possible etiologies
Cause: Absent/delayed swallow onset
Effect: premature posterior spill
Asp. Risk: Yes- before
Possible Etiologies: radiation, missing/damage due to surgery, PD, TBI, CVA
35
Dysphagia in Pharyngeal stage
Sensory Receptors/Impaired sensory processing- cause, effect, asp. risk, possible etiologies
Cause: absent/delayed swallow onset / premature posterior spill to vallecula or PS
Effect: premature posterior spill / stasis
Asp. Risk: Yes- before / Yes- after
Possible Etiologies: radiation, missing/damage due to surgery, PD, TBI, CVA
36
Dysphagia in Pharyngeal stage
Velum- cause, effect, asp. risk, possible etiologies
Cause: decreased velopharyngeal approximation
Effect: decreased pressure propulsion, nasal regurg., decreased bolus propulsion
Asp. Risk: Yes- after
Possible Etiologies: Iatrogenic, cleft palate, neurological, pharmacological, chemo tx, TBI, CVA, VPI, radiation fibrosis
37
Dysphagia in Pharyngeal stage
Pharyngeal constrictors/ posterior pharyngeal wall- cause, effect, asp. risk, possible etiologies
Cause: decreased strength, ROM, coordination
Effect: decreased pressure propulsion, stasis in vallecula/PS, decreased tongue base to PPW approx.
Asp. Risk: Yes- after
Possible Etiologies: TBI, CVA, neurogenic, low tone, cancer, ACDF
38
Dysphagia in Pharyngeal stage
Hyolaryngeal complex- cause, effect, asp. risk, possible etiologies
Cause: decreased hyolaryngeal ROM
Effect: decreased elevation, decreased anterior excursion, incomplete laryngeal closure, decreased epiglottic retroflexion, decreased UES opening, slowed bolus in esophagus
Asp. Risk: Yes- after Yes- during
Possible Etiologies: Tumor, Paralysis, neurodegenerative, TBI, CVA, laryngeal injury, GSW, hanging injury, radiation, iatrogenic
39
Dysphagia in Esophageal stage
UES- cause, effect, asp. risk, possible etiologies
Cause: Globus
Effect: decreased UES opening, slowed bolus in esophagus
Asp. Risk: Yes- after
Possible Etiologies: Zenker's, killian jamieson, esophagectomy, gastric bypass, lap band, esophageal web, reflux
40
all causes of dysphagia in pharyngeal stage (5)
1- absent/delayed swallow onset
2- premature posterior spill to vallecula or PS
3- decreased velopharyngeal approx.
4- decreased strength, ROM, coordination of the PPW/ pharyngeal constrictors
5- decreased hyolaryngeal motion
41
all causes of dysphagia in oral stage (3)
1- decreased strength, ROM, coordination in tongue, increased spasticity in tongue
2- incomplete palate
3- absent/delayed swallow onset
42
all problems causing dysphagia in the oral prep stage (6)
1-decreased labial seal
2-decreased buccal tone
3-decreased lingual strength, ROM, coordination
4-incomplete palate
5-decreased lateral mandibular movement
6-decreased saliva production
43
head back posture
utilizes gravity to clear oral cavity
44
chin down posture
widens vallecula to prevent bolus entering airway
narrows airway entrance
pushes epiglottis posteriorly
pushes tongue base backward toward pharyngeal wall
45
Head rotated to damaged side; chin down
places extrinsic pressure on thyroid cartilage, increasing adduction
puts epiglottis in more protective position
narrows laryngeal entrance
increases VF closure by applying extrinsic pressure
46
lying down on one side
eliminates gravitational effect on pharyngeal residue
47
head rotated to damaged side
eliminates damaged side from bolus path
48
Head tilt (to stronger side)
directs bolus to stronger side
49
head rotated
pulls cricoid cartilage away from PPW, reducing resting pressure in cricopharyngeal sphincter
50
Supraglottic swallow
goal is to close VF before and during the swallow, protecting trachea from aspiration
have patient take a deep breath, hold the breath, swallow, cough on exhalation
51
Super-supraglottic swallow
close the entrance to the airway voluntarily by tilting the arytenoid cartilage anteriorly to the base of epiglottis before and during the swallow
Patient holds breath, bears down, and swallow. cough when finished
52
Effortful swallow
designed to increase posterior motion of the tongue base during the pharyngeal swallow and thus improve bolus clearance from the vallecula
tell patient as you swallow squeeze hard with all of your muscles
53
Mendelsohn maneuver
Designed to increase the extent and duration of laryngeal elevation and thereby increase the duration and width of cricopharyngeal opening
having patient to not drop their adam's apple as they swallow
54
thin liquids are best for
oral tongue dysfunction
reduced tongue base retraction
reduced pharyngeal wall contraction
reduced laryngeal elevation
reduced cricopharyngeal opening
55
thickened liquids are best for...
Oral tongue dysfunction
delayed pharyngeal swallow
56
Purees and thick foods, including thickened liquids are best for...
delayed pharyngeal swallow
reduced laryngeal closure at the entrance
reduced laryngeal closure throughout
57
complications of dysphagia
malnutrition/dehydration
pneumonia
death
58
how many muscles are in the tongue
8
59
how many cranial nerves are involved in swallowing
6
60
what four mechanisms protect the airway?
laryngeal elevation
hyolaryngeal elevation
epiglottic retroflexion
VF closure
61
Pressure valves in:
Oral stage (3)
Pharyngeal stage (4)
Esophageal stage (1)
1- labial seal
2- approx. of tongue to palate
3- velopharyngeal pressure
4- tongue base to pharyngeal constrictors
5- constriction of laryngeal vestibule
6- hyolaryngeal elevation
7- closure of VFs
8- opening of UES
62
What are some referral indicators of dysphagia?
recurrent pneumonia
chronic reflux
coughing before/after oral intake
unexplained weight loss/ FTT
diverticulum
food aversion
63
describe and discuss difference of swallowing with an open trach tube and a trach tube w/a passy muir
64
describe the process of swallowing
sensory recognition of food entering the mouth triggers oral preparatory movements. labial seal is maintained to ensure no food or liquid fall from the mouth as the mandible, tongue, and teeth chew (rotary motion) and manipulate bolus into a cohesive bolus. the bolus is placed in the anterior hold before initiating posterior movement of the bolus. The tongue ramps up and squeezes the bolus against the hard palate. as the bolus is being propelled backward, when the head of the bolus passes the faucial arches, swallow onset is triggered.
the next events happen because of the triggering of the swallow: (1) elevation and retraction of the velum and complete closure of the VP port
(2) elevation and anterior movement of the hyoid and larynx
(3) closure of the larynx at all three sphincters
(4) opening of the UES to allow material into the esophagus
(5) ramping of the tongue base to contact the anteriorly bulging posterior pharyngeal wall
(6) top to bottom contraction in the pharyngeal constrictor
once the bolus enters the esophagus, peristalsis will move the bolus inferiorly into the stomach
65
ultrasound
ultrasound of oral cavity have been used to observe tongue function and to measure oral transit times, as well as motion of the hyoid bone
66
ultrasound
ultrasound of oral cavity have been used to observe tongue function and to measure oral transit times, as well as motion of the hyoid bone
67
Videoendoscopy (FEES)
performed with a flexible scope inserted through nose down to the level of the soft palate or below
only visualizes pharyngeal stage of the swallow
no radiation exposure
can be used to provide biofeedback
68
Videofluroscopy (MBS)
recorded swallow study, examinew all four stages of swallow
radiation exposure; barium contrast is used to watch bolus move through structures
lateral and AP views
69
Scintigraphy
nuclear medicine test in which the pt. swallows measured amount of radioactive substance
amount of aspiration and residue can be measured but cause of the dysfunction cannot be determined
70
cervical auscultation
technique for listening to a swallow response, involving a stethoscope placed at the level of the larynx.
71
pharyngeal manometry
Instrumental procedure to measure pressures in the pharynx and upper esophageal sphincter
72
17 physiologic events of swallow
1- lip closure
2- tongue control/bolus hold
3- bolus prep/mastication
4- bolus transport/lingual motion
5- oral residue
6- initiation of pharyngeal swallow
7- soft palate elevation
8- laryngeal elevation
9- anterior hyoid excursion
10- epiglottic movement
11- laryngeal vestibule closure
12- pharyngeal stripping wave
13- pharyngeal contraction
14- UES opening
15- tongue base retraction
16- pharyngeal residue
17- esophageal clearance
