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ECU Dysphagia > 3.3 Neurogenic Dysphagia in Adults > Flashcards

3.3 Neurogenic Dysphagia in Adults Flashcards

1
Q

Name the following cranial areas.

A

A = Frontal Lobe

B = Motor Cortex

C = Sensorimotor Cortex

D = Parietal Lobe

E = Occipital Lobe

F = Temporal Lobe

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2
Q

What does the Frontal Lobe do?

(8)

A

Executive functions

Thinking

Planning

Organization

Problem solving

Emotions

Behavioral control

Personality

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3
Q

What does the Motor Cortex do?

A

Movement

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4
Q

What does the Sensorimotor Cortex do?

A

Sensations

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5
Q

What does the Parietal Lobe do?

(4)

A

Perception

Making sense of the world

Arithmetic

Spelling

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6
Q

What does the Occipital Lobe do?

A

Vision

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7
Q

What does the Temporal Lobe do?

(3)

A

Memory

Understanding

Language

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8
Q

What are the five portions of the brain?

A

Cortex

Sub-cortical structures

Brainstem

Cerebellum

Spinal cord

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9
Q

What makes up the Cortex?

A

4 lobes (Sensory and motor functions)

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10
Q

What makes up the Sub-Cortical Structures?

(3)

A

Basal Ganglia

Thalamus

Inferior Colliculus

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11
Q

What does the Inferior Colliculus do?

A

Fine control of motor movements

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12
Q

What makes up the Brainstem?

(4)

A

Midbrain

Pons

Medulla

Origin of Cranial Nerves (3-12)

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13
Q

What does the Cerebellum do?

(3)

A

Timing

Sequencing

Finer control

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14
Q

What do the Upper Motor Neurons do?

A

Connects cortex to motor neurons

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15
Q

What do Lower Motor Neurons do?

A

Connects motor neurons to the muscles

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16
Q

Fill in the following diagram.

A

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

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17
Q

What Cranial Nerves originate in the cortex?

A

I-II

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18
Q

What Cranial Nerves originate in the Midbrain?

A

III-IV

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19
Q

What Cranial Nerves originate in the Pons?

A

V-VIII

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20
Q

What Cranial Nerves originate in the Medulla?

A

IX-XIII

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21
Q

What three structures make up the brainstem?

(3)

A

Midbrain

Pons

Medulla

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22
Q

What is the Cortico-Bulbar area?

A

Brainstem

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23
Q

What is the Cortico-Spinal area?

A

Spinal Cord

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24
Q

85% of strokes caused by a ________ event.

A

Thromboembolic

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25
Q

What is an Embolic Stroke?

A

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

26
Q

What is an Thrombotic stroke?

A

Cholesterol plaque within an artery ruptures, platelets aggregate and clog a narrow artery

Plaque builds up until artery is completely blocked

27
Q

What are 3 common symptoms associated with stroke?

(3)

A

Sensory and motor deficits

Aspiration and resulting pneumonia

Physiological parameters in all phases of swallow are affected

28
Q

What are the Sensory Deficits commonly seen in Neurogenic Dysphagia?

(4)

A

Delayed pharyngeal initiation (delayed swallow)

Silent aspiration

Poor sensation of residue

Poor oral sensation

29
Q

What are the Motor Deficits commonly seen in Neurogenic Dysphagia?

(6)

A

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

30
Q

Is the representation of swallowing in the brain Bilateral or Unilateral?

A

Bilateral

31
Q

Do Unilateral or Bilateral lesions lead to more severe forms of dysphagia?

A

Bilateral

32
Q

Is brain plasticity for swallowing functions clear?

A

No

33
Q

What is Parkinson’s Disease?

What causes it?

A

A slowly progressive neurological movement disorder

A degeneration of dopamine in the substantia niagra.

34
Q

What is Dopamine responsible for?

A

Individual motor movements

35
Q

What is the core issue in Parkinson’s?

A

Lack of motor inhibition

36
Q

What is Hypokinetic Dysarthria?

A

Reduced movement of the muscles of speech and swallowing.

37
Q

What are the three Classic Symptoms of Parkinson’s?

A

Rigidity

Tremor (pill rolling, resting)

Hypokinesia (bradykinesia)

38
Q

What symptoms are seen in the Oral Stage in in Parkinson’s?

(4)

A

Pocketing/pooling of food or saliva.

Drooling.

Excessive secretions.

Typical repetitive anterior posterior rolling; poor lingual propulsion of the bolus

39
Q

What symptoms are seen in the Pharyngeal Stage in in Parkinson’s?

(5)

A

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)

40
Q

What other symptoms may be seen due to the swallowing issues caused by Parkinson’s?

(2)

A

Unexplained weight loss (due to aspiration).

Recurrent pneumonia.

41
Q

What change does Parkinson’s cause in voice?

A

Reduced loudness.

42
Q

What happens because of the reduced lingual range of motion and rigidity seen in Parkinson’s?

(3)

A

Diminished hyolaryngeal excursion.

Inadequate or incomplete distension of the UES

Incomplete airway protection - often followed by aspiration.

43
Q

What is Amyotrophic Lateral Sclerosis (ALS)?

What does it eventually require?

A

Degenerative and progressive motor neuron disease

Non-oral feeding

44
Q

What Motor Neurons are affected in Amyotrophic Lateral Sclerosis (ALS)?

A

UMN + LMN

45
Q

What muscle qualities are seen in Amyotrophic Lateral Sclerosis (ALS)?

Which muscles are affected?

A

Muscle atrophy + spasticity (mixed dysarthria)

In the limbs and bulbar muscles (swallowing related muscles)

46
Q

How does muscle weakness progresses in Amyotrophic Lateral Sclerosis (ALS)?

What will this create? (4)

A

To the muscles of mastication and the intrinsic/extrinsic laryngeal muscles

Poor control of secretions.

Drooling

Penetration/aspiration

Residue after swallow.

47
Q

How are sensory functions affected by Amyotrophic Lateral Sclerosis (ALS)?

(2)

A

Sensory functions are usually preserved

Patients are able to defend against aspiration by clearing their throat.

48
Q

What creates the greatest problems when swallowing in Amyotrophic Lateral Sclerosis (ALS)?

(2)

A

Liquids

Large volumes of food.

49
Q

What will also be seen in Amyotrophic Lateral Sclerosis (ALS)?

A

Shortness of breath

50
Q

What is Myasthenia Gravis?

A

Myo-neural junction disease.

51
Q

What causes Myasthenia Gravis?

A

Body makes antibodies to acetylcholine receptors; make them unresponsive to Ach

52
Q

What are the primary symptoms of Myasthenia Gravis?

(4)

A

Relapsing and remitting weakness and fatigability

Diplopia (seeing double)

Facial muscle weakness

Dysphagia (33%)

53
Q

When is Fatigue seen in Myasthenia Gravis?

(3)

A

Prolonged use of muscles leads to weakness and loss of strength.

Prolonged pharyngeal transit

Weakness in muscular movements especially of the UES.

54
Q

What is Multiple Sclerosis?

(2)

A

Destruction of the myelin sheath, which transmits nerve impulses

Multiple areas of myelin are replaced with scar tissue

55
Q

Multiple Sclerosis could be a combination of ______ and ______deficits

A

Sensory

Motor

56
Q

How does Multiple Sclerosis affect swallowing due to SENSORY Deficits?

(3)

A

Delayed swallow initiation

Pooling

Residue

57
Q

How does Multiple Sclerosis affect swallowing due to MOTOR Deficits?

(3)

A

Weak muscular movements

Poor airway protection

Poor UES opening

58
Q

What is Swallowing Apraxia?

(2)

A

Disorder in motor planning & programming

Subtype of dysfunction in the oral stage of swallowing.

59
Q

What are the major characteristics of Swallowing Apraxia?

A

A delay in initiation of bolus transfer with no lingual movement or by lingual “searching motions” before initiating oral transfer.

60
Q

What are the symptoms seen in Swallowing Apraxia?

What stage are these seen in?

A

Lack of coordination of Labial, Lingual, + Mandibular movement

During the oral stage.

61
Q

The oral stage of swallowing is more ______, can be voluntarily ______, and is primarily controlled by the _______.

A

Volitional

Augmented

Cortex

62
Q

What stage of swallowing is most impaired in Swallowing Apraxia?

A

Oral stage of swallowing.

ECU Dysphagia (31 decks)

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