Midterm Flashcards
(40 cards)
Oral Preparatory Phase
involves formation of food/liquid into a cohesive bolus; may include oral anticipatory stage including seeing, smelling, and getting ready to taste food items
Oral Phase
stage in swallowing process which involves the transport of the bolus from the front to the back of the oral cavity to the point of entry into the pharynx and initiating the swallow response (A/P transit)
Pharyngeal Phase
stage of swallow which involves the movement of bolus through the pharynx into the esophagus; includes the swallow reflex; squeezing motion of the pharyngeal constrictors; airway protection, and relaxation of the esophagus to permit entry of the bolus
Esophageal Phase
aka pharyngoesophageal phase
when the bolus travels through the esophagus
Importance of Oral Health
If they rely on someone else for oral care, increase risk of pneumonia since they dont get as good of a clean
decayed teeth and higher dental plaque increase risk
mouth has a lot of germs and bacteria so when you aspirate on saliva, germs go into the lungs.
Continuum of Care
There is no guideline
1) referral/screening
2) bedside assessment/ clinical swallow evaluation
- if oral stage is the problem, set treatment
- if pharyngeal involvement, do instrumental assessment
3) instrumental assessment ( also try compensatory strategies)
4) identify and implement habilitative/rehabilitative techniques and compensatory strategies
5) monitor progress via periodic reassessment
6) train others in safe oral intake procedures: patient, care givers
7) discharge from active treatment
8) continue to monitor progress and safety in PO intake
Silent Aspiration
No outward signs of aspiration. Only symptom may be recurrent pneumonia
Overt Aspiration
displays signs of aspiration, like coughing, wet vocal quality, globus sensation, etc.
Lesions in Lower Brainstem
Medulla
significant oropharyngeal impairments,
1st wk post stroke: absent pharyngeal swallow
2st wk post stroke: delay of 10-15 seconds
- often have submandibular tongue base and hyoid movement but not true swallow
- when swallow does initiate, reduced laryngeal elevation and anterior movement with reduced cricopharyngeal opening
- may have unilateral pharyngeal weakness
- some have vocal fold paresis/paralysis
3rd week post stroke: sufficient recovery for functional swallow and full oral intake (maybe modified diet)
Subcortical Stroke
Mild delays in oral transit time (3-5 seconds)
mild delays in initiating swallow response (3-5 secs)
mild to moderate impairments in timing neuromuscular control in pharynx
may demonstrate aspiration before due to delay in initiating swallow or after due to neuromotor control issues in pharynx
recovery to full oral intake may take 3-6 wks
Cortical Stroke - left hemisphere
may result in apraxia of swallow (delay in initiating swallow with no tongue movement in response to presentation of food or mild to severe searching motions of tongue prior to initiating swallow)
mild oral transit delays (3-5 secs)
mild delays in intitiating pharyngeal swallow (3-5 secs)
TBI - General Considerations
swallowing problems can be complex depending on extent and site of head injury, other body injuries, nature of emergency care
swallowing issues more severe the longer patient is in coma
injuries from direct head trauma; contra-coup damage, twisting of brain stem, potential puncture wounds, laryngeal fractures
Usually Tracheostomy (can sometimes be too high and damage larynx, prolonged intubation)
Alzheimer’s
Food agnosia - don’t recognize food as food
feeding apraxia - difficulty in using utensils
swallowing apraxia - holding food in mouths, unable to initiate swallow response
decreased lateral tongue motion for chewing
delay in initiating pharyngeal swallow
bilateral pharyngeal wall weakness
reduced laryngeal elevation
reduced tongue base retraction
ALS - Corticospinal Tract
Carries motor signals from the primary motor cortex in thebrain, down thespinal cord, to themuscles of the trunkandlimbs.
Thus, this tract is involved in thevoluntary movementof muscles of the body.
Slow to develop swallowing problems
reduced velar movement with food in nasal cavity
reduced pharyngeal wall contraction
first sign may be slow progressive weight loss and little/no awareness of a swallowing problem
ALS - Corticobulbar Tract
Carries motor, information from the primary motor cortex to themuscles of the face,headandneck. It does this by synapsing with motor cranial nerves in thebrainstem. Therefore the corticobulbar tract is responsible for innervating the muscles of the face, head and neck, as well as the muscles involved inswallowing, phonation and facial expression.
Decreased tongue mobility; less able to control material in oral cavity
unable to increase tongue pressure to handle thicker foods (reduced lip closure)
reduced velar function
reduced tongue base retraction with reduced pharyngeal contraction resulting in residue in pharynx
delay in initiating pharyngeal swallow
reduced laryngeal elevation and reduced cricopharyngeal opening
complete laryngeal closure is impaired with laryngeal penetration
respiratory compromise
Parkinson’s Disease
Typical repetitive anterior to posterior tongue rocking pattern in oral transit; hallmark behavior for Parkinson’s
slight delay in initiating swallow response
decreased tongue base retraction
reduced laryngeal wall contraction with residue in pharynx and pyriform sinuses after each swallow
reduced laryngeal closure, incomplete vocal fold closure
some cricopharyngeal dysfunction may occur
end stage of disease may include dementia and severe rigidity making postural changes difficult
(may improve after medication)
Multiple Sclerosis
multiple plaques from cortex to brainstem and cerebellum to corticospinal tracts
delay in triggering pharyngeal swallow, reduced tongue base retraction, reduced pharyngeal contraction with residue in valleculae
depends on CN
CN 12 - reduced lingual control, reduced control of chewing and oral transport of bolus
CN 10 - reduced tongue base movement; reduced pharyngeal wall movement; reduced laryngeal function
CN 11 - reduced triggering of pharyngeal swallow
Some have no issues
Muscular Dystrophy
muscle deterioration
reduced pharyngeal wall contraction
Myotonic dystrophy - prolonged contraction and difficulty relaxing involved muscles, UES, muscles of mastication
Oculopharyngeal dystrophy - selectively involves ocular and pharyngeal muscles, reduced pharyngeal contraction,dysfunction of muscular portion of UES (doesn’t relax)
COPD
airflow limitations; failure to exhale sufficient amount of CO2
No aspiration found but there are differences
aspiration may occur during periods of exacerbation, may swallow on inhale
experience more GERD, aspiration due to reflux
COPD does not cause dysphagia
Uvula
no direct function but can help identify anterior faucial arches
Valleculae
space between tongue and base of tongue
pyriform sinuses
base of the pharynx
if food sits here, its right next to the opening of the airway
laryngeal vestibule
area in larynx about true vocal folds
Peristaltic Action/Wave
wavelike squeeze
