Midterm Study Guide Flashcards
(44 cards)
What is the CPG?
CPG: Central Pattern Generator - a biological neural network located in the reticular formation of the brainstem that produces rhythmic patterned outputs WITHOUT sensory feedback (can’t stop pharyngeal swallow once it begins)
CPG is organized into TWO main groups of interneurons: Dorsal Swallowing Group (DSG) and Ventral Swallowing Group (VSG)
CPG is organized into TWO main groups of interneurons: Dorsal Swallowing Group (DSG) and Ventral Swallowing Group (VSG)
DSG: SENSORY; comes first –> ascending → sensory drives motor response; located in nucleus tractus solitarus (NTS) of medulla (brainstem) involved in the triggering, shaping, and timing of the sequential swallow pattern (unstoppable swallow)
VSG: MOTOR; descending –> located in ventrolateral medulla (brain), involved in distributing the motor drive to other motoneurons in the brainstem which execute the motor events; CN V, VII, IX, X, XII and C1-3
What is the difference between screening for dysphagia and a clinical exam?
Screening is not assessment; designed to determine which patients require an assessment; can be administered by anyone; designed to detect presence of overt aspiration (response to overt aspiration is to cough)
Clinical exam is clinician-driven of gathering info including medical history, feed, OSME, observations of swallowing function not good at id’ing pharyngeal abnormalities, competence of airway protection, silent aspiration; enables SLP to form hypotheses that guide diagnostic procedures
What are the parts of a clinical swallow exam?
Core components of CSE:
medical history
swallowing history interviewing
OSMEf
food/liquid trials
documenting plan
T/F silent aspiration is common after CVA. Why?
True
dysphagia in 29-80% of acute stroke -> often show rapid improvement to near baseline function but persistent dysphagia continues in 20-50% of cases
What is an example of a primitive reflex that can affect swallow function? In what type of pt do we often see these primitive reflexes?
tongue pumping, sucking, tongue thrust
TBI can present with primitive reflexes
Does CP usually cause spastic or flaccid presentation?
spastic → high tone due to cortical involvement → most typical in UMN lesion
Polymositis, dermatomyositis, and inclusion body myositis are all examples of what category of disorders?
inflammatory myopathies (peripheral neurogenic causes of dysphagia → infiltration of skeletal muscle by inflammatory cells like t-cells)
T/F - Pt’s with Duchenne’s muscular dystrophy often see recovery of their swallow function
false –> NO recovery
genetic defeat prevents normal muscle protein production; suffer from progressively worsening oral and pharyngeal weakness resulting in post-swallow residue aspiration (type of peripheral neurogenic causes of dysphagia)
Are swallow exercises indicated for a pt with Myasthenia Gravis? Why/why not?
exercise is NOT effective due to muscle fatigue and exercise depletes acetylcholine (ACH) (type of peripheral neurogenic causes of dysphagia)
What is the name for swallow changes that occur as part of normal aging?
presbyphagia (swallowing is NOT inherently impaired in aging)
Name 3 presbyphagic changes that may occur?
- muscle atrophy (aka sarcopenia) of tongue
- mastication and pharyngeal constrictors
- reduced strength and endurance in tongue and lips
- sensory changes like later and lower pharyngeal swallow response ( MBSImp 6)
How do we decide if an elderly person’s pharyngeal residue should be considered “dysphagia”?
dysphagia is impaired safety (aspiration or penetration are present) and efficiency (how much bolus remains indicates increased risk of aspiration → residue is expected due to aging but too much remaining indicates increased risk of aspiration)
What are some common complaints that may lead us to think a pt has esophageal phase dysphagia….
food sticking in throat, difficulty with solids but not liquids, painful swallowing (aka odynophagia), no overt signs of dysphagia
What should you do if you suspect esophageal dysphagia?
not the scope of SLP → GI for esophagram
Name the 4 types of esophageal tests
- esophagram → fluoroscopy with barium to visualize esophagus and stomach performed supine
- Upper endoscopy → endoscope through mouth to visualize esophageal lining, stomach and upper portion of small intestine
- esophageal manometry → tube passed through nose into esophagus; esophageal function assessed during swallow by taking pressure readings of muscle contractions of UES and LES
- ambulatory 24-hr pH probe → small tube through nose into esophagus to LES. pH sensor measures acid exposure to the esophagus for 24 hrs; this test is gold standard for determining acid reflux
What does organ preservation refer to in cancer tx?
keep the structure and treat with chemo/rad instead of removing structure via surgery and rad
T/F pt’s with lip tumor/excision have difficulty initiating pharyngeal swallow
true —> oral incompetence creates difficulty with generating maintaining oral pressures for initiating pharyngeal swallow
Does floor of mouth cancer/tumor removal often result in oral or pharyngeal phase dysphagia?
both → tongue stabilization can impact bolus manipulation and propulsion as well as pharyngeal residue
Which structures, when removed, would you expect to cause pharyngeal residue?
posterior resection of tongue and floor of mouth (mylohyoid CN V3 trigeminal branch 3)
What does TEP stand for?
A tracheoesophageal voice prosthesis is a device which is positioned between the trachea and the esophagus to allow air from the lungs into the esophagus and out of mouth. The air vibrates and resonates with the pharynx and produces sound in the absence of a larynx. finger occlusion or one-way valve is required to direct air through the TEP
List some acute and long term radiation effects
acute → xerostomia (dry mouth), mucositis (mucosa inflammation)
long term → fibrosis and xerostomia both make swallowing difficult due to reduced ROM and poor bolus lubrication
Why might SLPs advocate for the needs-based placement of G-Tube for HNC pts?
because G-tube placement may cause disuse of swallowing muscles
What is the difference between tracheostomy and tracheotomy?
Tracheotomy is the procedure, tracheostomy is the opening
