3.3 Neurogenic Dysphagia in Adults Flashcards
Name the following cranial areas.
A = Frontal Lobe
B = Motor Cortex
C = Sensorimotor Cortex
D = Parietal Lobe
E = Occipital Lobe
F = Temporal Lobe
What does the Frontal Lobe do?
(8)
Executive functions
Thinking
Planning
Organization
Problem solving
Emotions
Behavioral control
Personality
What does the Motor Cortex do?
Movement
What does the Sensorimotor Cortex do?
Sensations
What does the Parietal Lobe do?
(4)
Perception
Making sense of the world
Arithmetic
Spelling
What does the Occipital Lobe do?
Vision
What does the Temporal Lobe do?
(3)
Memory
Understanding
Language
What are the five portions of the brain?
Cortex
Sub-cortical structures
Brainstem
Cerebellum
Spinal cord
What makes up the Cortex?
4 lobes (Sensory and motor functions)
What makes up the Sub-Cortical Structures?
(3)
Basal Ganglia
Thalamus
Inferior Colliculus
What does the Inferior Colliculus do?
Fine control of motor movements
What makes up the Brainstem?
(4)
Midbrain
Pons
Medulla
Origin of Cranial Nerves (3-12)
What does the Cerebellum do?
(3)
Timing
Sequencing
Finer control
What do the Upper Motor Neurons do?
Connects cortex to motor neurons
What do Lower Motor Neurons do?
Connects motor neurons to the muscles
Fill in the following diagram.
A = Upper motor neuron
B = Lower motor neuron (cranial nerve)
C -= Lower motor neuron (spinal nerve)
D = Sensory (spinothalamic) tracts
E = Anterior spinal artery territory
What Cranial Nerves originate in the cortex?
I-II
What Cranial Nerves originate in the Midbrain?
III-IV
What Cranial Nerves originate in the Pons?
V-VIII
What Cranial Nerves originate in the Medulla?
IX-XIII
What three structures make up the brainstem?
(3)
Midbrain
Pons
Medulla
What is the Cortico-Bulbar area?
Brainstem
What is the Cortico-Spinal area?
Spinal Cord
85% of strokes caused by a ________ event.
Thromboembolic
What is an Embolic Stroke?
Cholesterol plaque is dislodged from vessel, travels to the brain, blocks an artery
Part of the clot breaks off and travels through the bloodstream until it gets to a vessel too narrow to pass which creates a blockage
What is an Thrombotic stroke?
Cholesterol plaque within an artery ruptures, platelets aggregate and clog a narrow artery
Plaque builds up until artery is completely blocked
What are 3 common symptoms associated with stroke?
(3)
Sensory and motor deficits
Aspiration and resulting pneumonia
Physiological parameters in all phases of swallow are affected
What are the Sensory Deficits commonly seen in Neurogenic Dysphagia?
(4)
Delayed pharyngeal initiation (delayed swallow)
Silent aspiration
Poor sensation of residue
Poor oral sensation
What are the Motor Deficits commonly seen in Neurogenic Dysphagia?
(6)
Poor tongue movement, oral coordination
Poor VPC
Poor base of the tongue contraction (to the PPW)
Poor pharyngeal propulsion wave
Poor hyoid movement, epiglottic inversion and laryngeal squeeze
Poor UES opening.
Poor coordination of breathing and swallowing
Is the representation of swallowing in the brain Bilateral or Unilateral?
Bilateral
Do Unilateral or Bilateral lesions lead to more severe forms of dysphagia?
Bilateral
Is brain plasticity for swallowing functions clear?
No
What is Parkinson’s Disease?
What causes it?
A slowly progressive neurological movement disorder
A degeneration of dopamine in the substantia niagra.
What is Dopamine responsible for?
Individual motor movements
What is the core issue in Parkinson’s?
Lack of motor inhibition
What is Hypokinetic Dysarthria?
Reduced movement of the muscles of speech and swallowing.
What are the three Classic Symptoms of Parkinson’s?
Rigidity
Tremor (pill rolling, resting)
Hypokinesia (bradykinesia)
What symptoms are seen in the Oral Stage in in Parkinson’s?
(4)
Pocketing/pooling of food or saliva.
Drooling.
Excessive secretions.
Typical repetitive anterior posterior rolling; poor lingual propulsion of the bolus
What symptoms are seen in the Pharyngeal Stage in in Parkinson’s?
(5)
Incomplete transfer of bolus from oral to pharyngeal cavity (Oral residue)
Cough/choking during or after swallowing.
Nasal /oral regurgitation
Pre-swallow pooling.
Limited pharyngeal contraction (pharyngeal stripping)
What other symptoms may be seen due to the swallowing issues caused by Parkinson’s?
(2)
Unexplained weight loss (due to aspiration).
Recurrent pneumonia.
What change does Parkinson’s cause in voice?
Reduced loudness.
What happens because of the reduced lingual range of motion and rigidity seen in Parkinson’s?
(3)
Diminished hyolaryngeal excursion.
Inadequate or incomplete distension of the UES
Incomplete airway protection - often followed by aspiration.
What is Amyotrophic Lateral Sclerosis (ALS)?
What does it eventually require?
Degenerative and progressive motor neuron disease
Non-oral feeding
What Motor Neurons are affected in Amyotrophic Lateral Sclerosis (ALS)?
UMN + LMN
What muscle qualities are seen in Amyotrophic Lateral Sclerosis (ALS)?
Which muscles are affected?
Muscle atrophy + spasticity (mixed dysarthria)
In the limbs and bulbar muscles (swallowing related muscles)
How does muscle weakness progresses in Amyotrophic Lateral Sclerosis (ALS)?
What will this create? (4)
To the muscles of mastication and the intrinsic/extrinsic laryngeal muscles
Poor control of secretions.
Drooling
Penetration/aspiration
Residue after swallow.
How are sensory functions affected by Amyotrophic Lateral Sclerosis (ALS)?
(2)
Sensory functions are usually preserved
Patients are able to defend against aspiration by clearing their throat.
What creates the greatest problems when swallowing in Amyotrophic Lateral Sclerosis (ALS)?
(2)
Liquids
Large volumes of food.
What will also be seen in Amyotrophic Lateral Sclerosis (ALS)?
Shortness of breath
What is Myasthenia Gravis?
Myo-neural junction disease.
What causes Myasthenia Gravis?
Body makes antibodies to acetylcholine receptors; make them unresponsive to Ach
What are the primary symptoms of Myasthenia Gravis?
(4)
Relapsing and remitting weakness and fatigability
Diplopia (seeing double)
Facial muscle weakness
Dysphagia (33%)
When is Fatigue seen in Myasthenia Gravis?
(3)
Prolonged use of muscles leads to weakness and loss of strength.
Prolonged pharyngeal transit
Weakness in muscular movements especially of the UES.
What is Multiple Sclerosis?
(2)
Destruction of the myelin sheath, which transmits nerve impulses
Multiple areas of myelin are replaced with scar tissue
Multiple Sclerosis could be a combination of ______ and ______deficits
Sensory
Motor
How does Multiple Sclerosis affect swallowing due to SENSORY Deficits?
(3)
Delayed swallow initiation
Pooling
Residue
How does Multiple Sclerosis affect swallowing due to MOTOR Deficits?
(3)
Weak muscular movements
Poor airway protection
Poor UES opening
What is Swallowing Apraxia?
(2)
Disorder in motor planning & programming
Subtype of dysfunction in the oral stage of swallowing.
What are the major characteristics of Swallowing Apraxia?
A delay in initiation of bolus transfer with no lingual movement or by lingual “searching motions” before initiating oral transfer.
What are the symptoms seen in Swallowing Apraxia?
What stage are these seen in?
Lack of coordination of Labial, Lingual, + Mandibular movement
During the oral stage.
The oral stage of swallowing is more ______, can be voluntarily ______, and is primarily controlled by the _______.
Volitional
Augmented
Cortex
What stage of swallowing is most impaired in Swallowing Apraxia?
Oral stage of swallowing.
