Neuro and Structural Dysphasias Flashcards
(108 cards)
1
Q
2 types of dysphagia
A
Neurological/neurogenic and structural
2
Q
Dysphagia is usually attributed to (neurogenic/structural) causes:
A
neurogenic
3
Q
Neurogenic dysphagia (definition):
A
any type of swallowing disorder that is caused by the central or peripheral nervous system
4
Q
Causes of neurogenic dysphagia
A
CVA, PD, Huntington’s, TBI, MS, ALS, Alzheimer’s disease, Guillian-Barre syndrome, Brain tumors, myasthenia gravis
5
Q
T/f: Dysphagia can be due to disease and/or an acute insult (someone hitting you in the head with a bat)
A
True
6
Q
Two types of CVA
A
ischemic (a blockage) and hemorrhagic (brain bleed)
7
Q
Most common type of stroke
A
ischemic, specifically targeting the MCA (middle cerebral artery)
8
Q
Sequelae for CVA depend on (2):
A
site of lesion and extent/severity of lesion (cerebral cortex, subcortical structures, brainstem)
9
Q
Name 3 sequalae of a CVA:
A
hemiparesis, oral acceptance, lingual/labial coordination, sensory impairments, pharyngeal swallow timing, reduced contraction, reduced laryngeal excursion
10
Q
If a CVA occurs in the cerebral cortex we would expect what from their swallow?
A
Some amount of intact swallow function
11
Q
If a CVA occurs in subcortical regions we would expect what from their swallow?
A
Some amount of swallow function, less than cerebral cortex, may have difficulties with sensory or motor impairments
12
Q
If a CVA occurs in the brainstem we would expect what from their swallow?
A
A lot less functional swallow (due to issues with NTS/NA)
13
Q
The ___ parts of the brain are more “thinking” while the _____ parts of the brain are more “reflexive”
A
cortex/cortical structures are “thinking” while the brainstem and subcortical structures are more reflexive
14
Q
Sequelae for Brain Injury depend on:
A
severity of damage, open or closed injury, multisystem trauma, type of force causing damage (blunt force, blast injury)
15
Q
Meninges and intraparenchymal:
A
bleeding in the meninges are intraparenchymal. Meninges are small vessels on the outside of the brain (may break and bleed but won’t drain into cerebrospinal fluid) causes pressure on the brain tissues that control the body
16
Q
T/f: multi-system trauma is not common in TBI
A
False- it is very common!
17
Q
Why is dysphagia hard to treat in Brain injury patients:
A
often a more diffuse injury (damage not localized)!! Also due to other issues such as respiratory issues, behavioral issues, and impulsivity
18
Q
To treat someone in the beginning of their TBI rehab or someone severe we should (compensate/rehabilitate)
A
compensate. Focus on positioning, diet modifications, altering their environment
19
Q
To rehab someone with a TBI you should focus on:
A
strengthening muscles and reigniting sensory receptors
20
Q
T/F: If a person with a TBI has cranial nerve damage you should choose rehabilitative strategies
A
FALSE!! You cannot rehab that, will need to compensate
21
Q
Multiple Sclerosis means ____ ____
A
Multiple scars
22
Q
t/f: Multiple Sclerosis is an immune-mediated disorder
A
True, causes inflammation which results in demyelination
23
Q
Demyelination is a component of which neurological etiology of dysphagia?
A
MS
24
Q
t/f: MS is hereditary:
A
FALSE, but genetics can influence
25
t/f: people with MS tend to have many smaller lesions in either the brain or spinal cord
True
26
Sequelae for someone with MS depends on
site(s) of lesion(s) (brainstem, cerebellum, corticospinal tracts, cranial nerves), oral dysphagia (motor component), pharyngeal dysphagia (sensory/constriction/delay)
27
Oral dysphagia in MS indicates...
Incoordination and/or decreased strength of the oral musculature
28
Pharyngeal dysphagia in MS indicates what?
Likely to see a sensory delay, aka a delayed swallow trigger. (sensory/constriction/delay)
29
Most common type of MS
Secondary progressive
30
What happens in progressive-relapsing MS?
patient gets worse, periodically has flare ups and gets better, but their baseline does not go 100% back down (close but always a little worse off after a flare up).
31
What happens in Secondary Progressive MS?
flare up, goes back to almost baseline and plateaus for a while, then flares up again.
32
What happens in primary progressive MS?
progressively gets worse over time.
33
T/f: we would want to take an aggressive approach to strengthening the musculature in individuals with MS
False... focus on maintaining strength they have
34
Medical management is a big role in which neurological etiology of dysphagia?
MS
35
Rehabilitative/Compensatory approach to MS should include:
giving the patients educational information, work on positioning, thermal/tactile stimulation, use of specific maneuvers (supraglottic, cough), supplemental/non-oral nutrition
36
Parkinson's Disease includes cell death in the _____ ____ (part of the midbrain and basal ganglia)
Substantia Nigra
37
Parkinson's Disease 3 main takeaways (from lecture)
Substantia nigra, basal ganglia, trouble initiating
38
PD results from a reduction in what neurotransmitter specifically?
Dopamine.. not enough is created
39
Treatment for PD should focus on
staying "fit" rather than "body building"
40
Characteristics for PD include:
reduction in dopamine, movement disorder, difficulty initiating/slowed movements, tremors, cognition/mood/behavior differences
41
Sequelae for PD:
oral movement deficits (tremors, difficulty forming and containing bolus, presents with tongue rocking/pumping), pharyngeal deficits (some delay, reduced pharyngeal wall contraction, reduced laryngeal excursion, reduction in strength), towards the end they may experience rigidity
42
Type of Neurological etiology of dysphagia where the patient experiences tongue rocking or tongue pumping:
PD
43
People with PD typically have trouble with what stage of swallow the most and why?
Oral phase due to tongue pumping
44
Huntington's disease is a ____ neurogenic genetic disorder:
Progressive
45
T/f: Huntington's disease is genetic
True- autosomal dominant mutation carried on the male gene
46
The primary cause of death in patients with HD is what?
Pneumonia
47
Characteristics of Huntington's Disease:
autosomal dominant mutation that causes gradual damage, excessive involuntary movements
48
Sequelae of Huntington's Disease:
involuntary movements, rigidity, chorea, difficulty self-feeding, decreased bolus control, decreased effective mastication, delayed pharyngeal swallow onset, uncoordinated oropharyngeal swallow
49
The biggest problem in which neurological etiology of dysphagia is aspiration due to the fact the patient doesn't have a chance to control the bolus as they should?
Huntington's Disease
50
Chorea is closely related to which neurogenic etiology of dysphagia?
Huntington's Disease
51
Huntington's disease is most impactful to what stage of swallowing and why?
Oral phase due to uncontrollable movements
52
Why is it important to know the site of lesion?
Helps to prepare for what kind of symptoms we will see, will determine if we should use compensatory strategies (ALS) or rehabilitative strategies (CVA)
53
Which neurological etiology of dysphagia is associated with lingual fasciculations?
ALS
54
T/F: people with ALS lose cognition throughout their life
False- cognition stays intact
55
T/F: all patients with ALS will exhibit dysphagia at some point
True
56
Name 3 sequelae for ALS:
corticobulbar/corticospinal tract involvement, reduced tongue movement, decreased bolus formation/intraoral pressures, decreasing ability to orally handle viscous foods/liquids, reduces labial seal/drooling, velopharyngeal port involvement
57
When the bulbar neurons are affected the muscles responsible for ____, ____, and ____ will atrophy (ALS):
speech, chewing, and deglutition (swallowing)
58
People with ALS typically present with dysphagia in what stage(s)?
Oral and pharyngeal
59
T/f: we should give our patients with ALS more viscous food to help with bolus formation
false. Typically, viscous foods cause too much interference that the individual with ALS does not have strong enough muscles to deal with it
60
Later developments of ALS include:
reduced BOT retraction, reduced pharyngeal contraction, reduced airway protection, delayed pharyngeal swallow initiation
61
Myasthenia Gravis is a disease where antibodies block post-synaptic receptors from accepting what?
Acetylcholine
62
The key characteristic of Myasthenia Gravis is what?
Easily fatigued musculature
63
T/f: individuals with MG have remissions and exacerbations
True
64
Most often the first thing people with MG complain of is what?
Difficulty swallowing/dysphagia
65
For people with what neurological etiology of dysphagia should we be concerned with fatigue?
Myasthenia Gravis
66
t/f: The best way to assess someone with MG is an MBS
FALSE- FEES b/c it is more appropriate to assess fatigue
67
eating smaller, high-calorie meals is a good strategy for someone with what neurological etiology of dysphagia?
MG
68
3 sequelae of MG
dysphagia is the sentential presentation, flaccid dysarthria, hypernasality, bulbar symptoms, oral dysphagia is usually milder than pharyngeal phase, reduced pharyngeal contraction, delayed pharyngeal swallow, decreased base of tongue retraction
69
With what kind of neurological etiology of dysphagia would we want to work closely with physicians to determine the time of day medications are given?
MG
70
Types/causes of structural dysphagia:
endotracheal intubation, tracheotomy, cervical spinal surgeries/abnormality, carotid endarterectomy, infections, esophageal changes, head and neck cancer(s)
71
Describe endotracheal intubation/why you would use one
used to ventilate patients in emergencies/during surgeries. A tube placed through the VF to provide air to the lungs
72
Prolonged ET intubation leads to increases the risks of:
post-extubation dysphagia, vocal fold immobility during intubation, aspiration, granulomas (cell build up due to irritation; like a callus for VF), and subglottic tracheal stenosis (narrowing of the trachea)
73
Prolonged ET intubation is ___ hours or longer
48
74
What happens after 48 hours of ET intubation
muscles begin to atrophy (not die, but weakness occurs)
75
Describe a tracheostomy and why you may use it:
it is a tube that allows the patient to inhale/exhale. There is an inflated cuff tethered in the larynx. Used when the client needs air/for longer than ET intubation will allow.
76
T/F: a tracheostomy blocks airflow through the upper airway
True, there is not airflow
77
Sensation in the oropharynx and Tracheostomy:
there is a lack of sensation- the client is not smelling or swallowing saliva (aka not dry swallowing), lack of taste as well. While using the trach tube you shut off certain portions of your sensory receptors
78
The vocal folds remain in the (open/closed) position while the patient has a trach:
Open
79
"No natural PEEP leading to decreased oxygenation" what does this mean
there is not enough pressure in the lungs at the end of the exhale. The client can breathe but the body is not as oxygenated as if they had a closed system. PEEP = positive end expiratory pressure
80
Why use a PMSSV?
gives a person a voice while they have a trach tube. Allows air from outside but forces the exhale through the mouth or nose which restores phonation, resonance, and sensation.
81
T/F: the cuff of trach tube should be inflated before putting on a PMSSV
FALSE!!! It needs to be deflated
82
List 3 Physiological benefits of PMSSV
increased sensation, restored sense of smell and taste, better cough, restored PEEP (positive end expiratory pressure), improved gas exchange, exhaling through upper airway aids in weaning
83
Restored "closed system", deflated cuff allows larynx to elevate and epiglottis to invert, restored airflow through upper airway improving sensation, taste, and smell, improved airflow through vocal cords allowing them to close and protect swallow, restored subglottic pressure allowing increased PEEP/oxygenation is a benefit of what?
PMSSV (passy-muir speaking and swallowing valve
84
Describe the finger occlusion test and why you would use it
use it when putting a PMV on a trach, use a gloved finger on the front of the trach tube, covering the hole. Observe the patient and their oxygen levels while occluded versus not
85
What are Cervical Spine Surgeries/abnormalities?
where screws are placed to secure the neck. There is less movement but more safety for the client
86
What may osteophytes impinge upon and what does that interfere with?
Impinge upon the hypopharynx and interfere with bolus propulsion and/or airway protection (it is dependent on location on the cervical spine)
87
A diverticulum above the UES is called what?
Zenker's diverticulum
88
What is the first complaint of someone with a diverticulum?
Bad breath
89
T/f: dysphagias may be caused by the cancer itself, or by the treatment used to cure/mitigate the cancer
True
90
What is a mandibulectomy
removal of the anterior portion of the mandible
91
What are symptoms of someone with a mandibulectomy?
Drooling, decreased oral manipulation of bolus, reduced hyolaryngeal elevation. Expected to see reduced efficacy of mastication of solids
92
Someone with a mandibulectomy will likely have problems with what phase(s) of swallow?
Oral prep and oral
93
4 types of glossectomy:
partial glossectomy (part of the tongue is removed), hemiglossectomy (half of the tongue), anterior resection with flap (oral dysphagia), base of tongue retraction (pharyngeal deficits)
94
What of the 4 types of glossectomy usually does not cause substantial dysphagia?
Hemiglossectomy
95
What of the 4 types of glossectomy affects the oral phase the most?
Anterior resection with flap
96
What of the 4 types of glossectomy affects the pharyngeal phase the most?
BOT retraction
97
What is a laryngectomy?
Removal of part of larynx
98
Name the 3 types of laryngectomies
hemilaryngectomy, supraglottic laryngectomy, total laryngectomy
99
What is a hemilaryngectomy
removal of one vertical half of the larynx (includes one false VF, one true VF, one ventricle, part of the thyroid cartilage) on the involved side
100
Does a hemilaryngectomy involve the hyoid and epiglottis?
No. they need to stay in place so they're not hanging
101
When they remove ½ the larynx in a hemilaryngectomy, what fills the space? what does this allow?
Fat from another part of the body. This allows the remaining VF to come to midline, touch the fat, close off the airway, and produce voice.
102
What is a supraglottic laryngectomy?
Part of all of hyoid & epiglottis, aryepiglottic folds, and FVCs (removal of structures that contribute to airway protection)
103
What stays intact to protect the airway in a supraglottic laryngectomy?
Base of tongue, arytenoids, and true VF. Still collapses the laryngeal vestibule due to no hyoid bone to attach the muscles to
104
What type of laryngectomy can extend inferiorly to include part of one True VF and arytenoid or can extend superiorly to include part of the tongue base?
Supraglottic Laryngectomy
105
t/f: someone with a supraglottic laryngectomy may require a permanent trach?
True
106
Total laryngectomy
Removal of the entire cricoid cartilage, thyroid cartilage, epiglottis, hyoid bone, arytenoids, true and false VF
107
Radiation and Chemotherapy may result in ____ (list 3 symptoms):
weight loss, xerostomia, tissue necrosis (death), edema, sensory changes, fibrosis, trismus
108
Name one way a person with a total laryngectomy can aspirate
If they swim or take a shower
