Review Swallow Flashcards
(40 cards)
If observe repetitive tongue pumping in oral stage swallow, could be sing of?
Parkinsons
Signs of aspiration during swallow trials
5
- absent swallow
- reflexive cough after swallow/choking
- difficulty handling secretions
- change of voice
- pulse oxymetry
Why look at range of motion of tongue in OME?
bc odds of liquid aspiration are ++ higher for individuals w/ reduced lingual ROM
(Leder et al, 2013)
why do a cog-ling screen?
bc odds of liquid aspiration are ++ higher for Pts not oriented to person, place and time.
odds of liquid + puree aspiration are ++ for Pts who can’t follow 1 step commands
(Leder et al, 2009)
why consider dysarthria in dysphagia Ax?
bc presence of dysarthria is ++ associated with increased aspiration risk in individuals w stroke (Daniels, 2005; Muccolloug, 205)
what can voice quality tell you in clinical beside eval?
- dysphonia (breathiness, hoarseness, harshness) is predictive of aspiration
- wet vocal quality (hard to perceive)
- reduced pitch elevation is predictive of higher penetration-aspiration scale scores
do gag reflex in clinical swallow?
The absence of a gag reflex does not appear to be a predictor of dysphagia (Leder, 1996)
what do you hear with cervical auscultation?
(hearing sounds of swallow with stethoscope)
should hear 2 bursts (bolus entrance into pharynx, leaving pharynx) ; 3rd small burst in some (glottal release)
delay in hearing these sounds could signify swallow abnormality
why do pulse oximetry w clinical bedside?
- measure oxygenation of peripheral blood flow (measures amount of light absorbed by blood in tissue, which varies w/ oxygen content)
95-100% normal rance, <90% suggests problems
some studies suggest 2% drop in SPO2 are not related to aspiration events but are more likely to be found in Pts symptomatic for dysphagia
can clinical swallow tell us who aspirates?
no. clinical swallow gives us information on Pts who are at risk for aspiration and/or dysphagia. no info on bolus flow or swallow physiology (always remember natural variation).
what is important to note about dentition?
missing teeth
decay
dentures
(+ ask about impact on swallow (fit well?, etc.))
importance of cranial nerve 5 (trigeminal)
- motor for muscles of mastication/jaw (masseter, temporal, medial pterygoids, lateral pterygoids) + 2 extrinsic larynx muscles (mylohyoid, anterior belly of digastric) + 2 tensors (tensor veli palatini, tensor tympani)
- sensory for face (3 branches, top lip V2 and bottom lip V3)
innervation of tongue
motor = all intrinsic and extrinsic muscles of the tongue is hypoglossal nerve (CN XII) EXCEPT palatoglossus (vagus nerve - CN X)
sensory =
anterior 2/3rds of tongue : taste VII, sensation V3
posterior 1/3rd of tongue : taste and sensation IX
base of tongue : sensation X (superior laryngeal branch)
importance of cranial nerve VII (facial)
motor for face (bilat superior, unilat inferior) + 2 extrinsic laryngeal muscles (posterior bello of digastric, stylohyoid)
special sensory (taste) for anterior 2/3rds of tongue.
importance of cranial nerve IX (glossopharyngeal)
motor for stylopharyngeus (only motor component of IX)
special sensory (taste) for posterior 1/3rd of tongue
importance of cranial nerve X (vagus)
motor for velopharyngeal muscles (levator veli palatini, salpingopharyngeus, palatoglossus, palatopharyngeus, superior middle and inferior pharyngeal constrictors) + cricothyroid + intrinsic laryngeal muscles
sensory for pharynx and back of throat (gag reflex) + for larynx
importance of cranial nerve XII (hypoglossal)
motor for all extrinsic and intrinsic muscles of tongue, except for the palatoglossus (X vagus)
what could involuntary movements of structures during clinical swallow be a sign of?
hyperkinesia
what signs of parkinsons would be observable in OME of face?
- “mask” face
- lips tremor
why make raise eyebrows during OME?
bc absence of forehead wrinkling = can differenciate UMN (bilat) vs LMN damage (unilat)
what’s the name of restriction in opening of the jaw
trismus
role of changes in pressure within oro-pharyngeal structures in a normal swallow?
allows the bolus to move rapidly from zones of high pressure to zones of low pressure.
(for example, laryngeal elevation creates negative zone of pressure in pharynx in region of PES)
cranial nerves responsible for salivation?
VII - submandibular and submaxillary glands (autonomic aspect of nerve)
IX - parotid gland (autonomic aspect of nerve)
which cranial nerve would be most important for swallow initiation and sensory protective mechanisms of upper airway?
superior laryngeal nerve (CN X vagus)
