3.3 Neurogenic Dysphagia in Adults Flashcards by Jamie Bevill

Name the following cranial areas.

A = Frontal Lobe

B = Motor Cortex

C = Sensorimotor Cortex

D = Parietal Lobe

E = Occipital Lobe

F = Temporal Lobe

How well did you know this?

Not at all

Perfectly

What does the Frontal Lobe do?

(8)

Executive functions

Thinking

Planning

Organization

Problem solving

Emotions

Behavioral control

Personality

How well did you know this?

Not at all

Perfectly

What does the Motor Cortex do?

Movement

How well did you know this?

Not at all

Perfectly

What does the Sensorimotor Cortex do?

Sensations

How well did you know this?

Not at all

Perfectly

What does the Parietal Lobe do?

(4)

Perception

Making sense of the world

Arithmetic

Spelling

How well did you know this?

Not at all

Perfectly

What does the Occipital Lobe do?

Vision

How well did you know this?

Not at all

Perfectly

What does the Temporal Lobe do?

(3)

Memory

Understanding

Language

How well did you know this?

Not at all

Perfectly

What are the five portions of the brain?

Cortex

Sub-cortical structures

Brainstem

Cerebellum

Spinal cord

How well did you know this?

Not at all

Perfectly

What makes up the Cortex?

4 lobes (Sensory and motor functions)

How well did you know this?

Not at all

Perfectly

What makes up the Sub-Cortical Structures?

(3)

Basal Ganglia

Thalamus

Inferior Colliculus

How well did you know this?

Not at all

Perfectly

What does the Inferior Colliculus do?

Fine control of motor movements

How well did you know this?

Not at all

Perfectly

What makes up the Brainstem?

(4)

Midbrain

Pons

Medulla

Origin of Cranial Nerves (3-12)

How well did you know this?

Not at all

Perfectly

What does the Cerebellum do?

(3)

Timing

Sequencing

Finer control

How well did you know this?

Not at all

Perfectly

What do the Upper Motor Neurons do?

Connects cortex to motor neurons

How well did you know this?

Not at all

Perfectly

What do Lower Motor Neurons do?

Connects motor neurons to the muscles

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What Cranial Nerves originate in the cortex?

I-II

How well did you know this?

Not at all

Perfectly

What Cranial Nerves originate in the Midbrain?

III-IV

How well did you know this?

Not at all

Perfectly

What Cranial Nerves originate in the Pons?

V-VIII

How well did you know this?

Not at all

Perfectly

What Cranial Nerves originate in the Medulla?

IX-XIII

How well did you know this?

Not at all

Perfectly

What three structures make up the brainstem?

(3)

Midbrain

Pons

Medulla

How well did you know this?

Not at all

Perfectly

What is the Cortico-Bulbar area?

Brainstem

How well did you know this?

Not at all

Perfectly

What is the Cortico-Spinal area?

Spinal Cord

How well did you know this?

Not at all

Perfectly

85% of strokes caused by a ________ event.

Thromboembolic

How well did you know this?

Not at all

Perfectly

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?

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.