Midterm

Question 1

Mandible function

Answer 1

provides lateral and rotary movement for chewing

Question 2

Function of the cheek

Answer 2

keeps food on the tongue and the tension keeps the bolus together

Question 3

Function of the gums

Answer 3

cheeks push up against the gums to keep the food on the tongue

Question 4

Function of the lips

Answer 4

includes pressure during closure to remove food from the utensil; maintain closure to keep food in mouth when chewing

Question 5

Function of the teeth

Answer 5

masticates food

Question 6

Function of the tongue

Answer 6

forms food into a bolus, propels bolus backwards, and assists in triggering the pharyngeal swallow reflex

Question 7

Hard palate

Answer 7

bony part of the roof of the mouth

Question 8

Soft palate function

Answer 8

lifts up to close the nasal cavity

Question 9

Faucial Arches function

Answer 9

triggers the swallow when bolus passes them

Question 10

Uvula

Answer 10

structure that hands from the soft palate

Question 11

Vallaculae

Answer 11

spaces located between the base of the tongue and epiglottis where food may collect

Question 12

Function of the epiglottis

Answer 12

covers the opening of the airway during the swallow

Question 13

Pyriform sinuses

Answer 13

base of pharynx, food can collect here

Question 14

Function of the larynx

Answer 14

protects airway and houses the vocal folds

Question 15

Laryngeal Vestibule

Answer 15

area in the larynx above the true vocal folds

Question 16

Trachea

Answer 16

airway/windpipe

Question 17

Oral Prep stage

Answer 17

involves formation of food/liquid into a cohesive bolus

Question 18

Oral stage

Answer 18

involves the transport of the bolus from the front to the back of the oral cavity to the point of entry int other pharynx and intimating the swallow response

Question 19

Oropharyngeal stage

Answer 19

overlap between oral and pharyngeal stages

Question 20

Pharyngeal stage

Answer 20

involves the movement of the bolus through the pharynx into the esophagus; includes the swallow reflex: squeezing motion of the pharyngeal constrictors, airway protection, and the relaxation of the esophagus to permit entry of the bolus

Question 21

Esophageal stage

Answer 21

food moves into the esophagus

Question 22

Does aspiration risk increase if the patient is being fed by someone else?

Answer 22

Yes

Question 23

Which way does the larynx move

Answer 23

Up and forward

Question 24

Aspiration

Answer 24

entry of material into the airway below the level of the vocal folds

Question 25

Penetration

Answer 25

material at the level of the vocal folds

Question 26

Cough definition

Answer 26

brainstem reflex protecting the entrance of the airway from foreign material

Question 27

Deglutition

Answer 27

acts associated with bolus transfer and transport of food from the mouth to the stomach

Question 28

pharyngeal pocketing

Answer 28

food lodging/remaining in the pharynx after the swallow reflex is completed

Question 29

swallow response

Answer 29

a one second coordinated action that momentarily stops respiration; closes off airway and permits opening of the esophagus for the entry of the bolus

Question 30

Importance of oral health

Answer 30

good oral hygiene prevents bacteria, saliva is very important in this, reduces risk of aspiration pneumonia

Question 31

Oral health risks

Answer 31

dysphagia, dependency on others for oral care, number of decayed teeth, and tube feeding

Question 32

Continuum of care

Answer 32

1. Referral/screening 2. Bedside Assessment 3. Instrumental assessment 4. Identify and implement elements of treatment both habilitative/rehabilitative techniques and compensatory strategies 5. Monitor progress via periodic reassessment 6. Train others in safe oral intake procedures 7. Discharge from active treatment 8.Continue to monitor progress and safety in PO intake

Question 33

silent aspiration vs overt aspiration

Answer 33

silent- no signs or symptoms of aspiration overt- obvious signs of aspiration

Question 34

mylohyoid function

Answer 34

elevates hyoid and floor of mouth

Question 35

geniohyoid function

Answer 35

elevates hyoid and larynx and depresses mandible

Question 36

digastric function

Answer 36

elevates hyoid and larynx; depresses the mandible

Question 37

Palataglossus function

Answer 37

elevates posterior tongue

Question 38

Palatopharyngeus function

Answer 38

constricts oropharynx to channel bolus

Question 39

Stylopharyngeus muscle

Answer 39

raises larynx

Question 40

Typical outcomes of lesions in the lower brainstem

Answer 40

significant oropharyngeal impairments 1st week post stroke: absent pharyngeal swallow 2nd week post stroke: delay of 10-15 seconds, reduced laryngeal elevation and anterior movement with reduced cricopharyngeal opening 3rd week post stroke: sufficient recovery for functional swallow and full oral intake with modified diet

Question 41

Typical outcomes of subcortical stroke

Answer 41

-mild delays in oral transit time (3-5 seconds) -mild delays in initiating swallow response -mild to moderate impairments in timing neuromuscular control in the pharynx -recovery to full oral intake may take 3-6 weeks

Question 42

Typical outcomes of cortical stroke: Left hemisphere

Answer 42

-may result in apraxia of the swallow -mild oral transit delays -mild delays in initiating the pharyngeal swallow

Question 43

Typical outcomes of cortical stroke: Right hemisphere

Answer 43

-mild oral transit delays (2-3 seconds) -pharyngeal delays -once swallow is initiated, slight delay in laryngeal elevation -slower recovery than left CVA

Question 44

TBI outcomes

Answer 44

-poor bolus control -abnormal reflexes -reduced laryngeal elevation

Question 45

Other considerations of TBI

Answer 45

-impulsivity -cognitive difficulties -reduced sensation

Question 46

Agnosia

Answer 46

don't recognize food as food

Question 47

Apraxia

Answer 47

feeding- difficulty using utensils swallowing-holding food in mouth, unable to initiate the swallow response

Question 48

Other factors of Alzheimer's that impact feeding

Answer 48

-reduced laryngeal elevation -decreased lateral tongue motion for chewing -reduced tongue base retraction

Question 49

Corticospinal tract ALS impact on swallowing

Answer 49

-slow to develop swallowing problems -reduced pharyngeal wall contraction

Question 50

Corticobulbar tract ALS impact on swallowing

Answer 50

-decreased tongue mobility -reduced velar function -respiratory compromise

Question 51

Parkinson's impact on swallow

Answer 51

-slight delay initiating swallowing response -decreased tongue base retraction -reduced laryngeal closure

Question 52

Nerves involved with MS

Answer 52

-hypoglossal XII- reduced lingual control of bolus, reduced control of chewing and oral transport -vagus X- reduced tongue based movement, reduced pharyngeal wall movement -glossopharyngeal IX- reduced triggering of pharyngeal swallow

Question 53

Myotonic dystrophy

Answer 53

prolonged contraction and difficulty relaxing involved muscles, reduced pharyngeal wall contraction

Question 54

COPD effects on swallow

Answer 54

-airflow limitations -more GERD

Question 55

Oral swallowing concerns

Answer 55

-apraxia of swallow -trismus- reduced mouth opening -reduced lip strength -poor dental status

Question 56

Pharyngeal swallowing concerns

Answer 56

-reduced velopharyngeal strength -reduced tongue based retraction -reduced vocal fold closure

Question 57

Esophageal swallowing concerns

Answer 57

-TEF -aclasia- lower esophageal sphincter fails to relax -GERD