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Cuccurullo Book > Ch 1 - Stroke: Dysphagia > Flashcards

Ch 1 - Stroke: Dysphagia Flashcards

1
Q

What types of strokes are dysphagia seen in?

A

– 67% brainstem
– 28% left hemispheric
– 21% right hemispheric

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2
Q

When is dysphagia more commonly seen?

A

Bilateral> unilateral hemisphere strokes

Large>small vessel strokes

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3
Q

What is the MCC of dysphagia?*

A

Delayed pharyngeal swallow

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4
Q

What is the gold standard of evaluating dysphagia?*

A

Videofluorographic swallowing evaluation (VFSS)

Also called modified barium swallow (MBS)

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5
Q

Describe Fiberoptic endoscopic evaluation of swallowing (FEES).*

A

Visualizes anatomic structures that might cause potential bolus obstruction and natural
bolus flow and containment

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6
Q

What stage of swallowing does Fiberoptic endoscopic evaluation of swallowing (FEES) evaluate?*

A

Pharyngeal stage of swallowing

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7
Q

What is aspiration?

A

Entry of a substance through the vocal folds (true vocal cords) into the trachea

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8
Q

What percentage of aspiration is missed on bedside swallow evaluation?*

A

40-60% of patients have silent aspiration

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9
Q

How does aspiration appear on videofluorographic swallowing study (VFSS)?

A

Penetration of contrast material below the true vocal cords

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10
Q

What are predictors of aspiration on penetration on videofluorographic swallowing study (VFSS)?

A

– Delayed initiation of the swallow reflex

– Decreased pharyngeal peristalsis

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11
Q

What are predictors of aspiration on penetration on bedside swallow exam?*

A 
– Abnormal cough
– Cough after swallow
– Dysphonia
– Dysarthria
– Abnormal gag reflex
– Voice change after swallow (wet voice)
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12
Q

What are risk factors for aspiration pneumonia?*

A 
– Decreased level of consciousness
– Tracheostomy
– Emesis
– Reflux
– Nasogastric tube (NGT) feeding
– Dysphagia
– Prolonged pharyngeal transit time
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13
Q

What are the four phases of swallowing?*

A
  1. Oral preparatory phase
  2. Oral phase
  3. Pharyngeal phase
  4. Esophageal phase
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14
Q

Is the oral preparatory phase of swallow voluntary or a reflex?

A

Voluntary

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15
Q

Describe the duration of the oral preparatory phase of swallow.

A

Variable duration based on food consistency and number of times a person chews

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16
Q

What are the hallmarks of the oral preparatory phase of swallow?

A

Preparation of bolus

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17
Q

What does the oral preparatory phase of swallow require?

A
  • Tension of labial/buccal musculature to close mouth
  • Circular motion of jaw for mastication
  • Depression and forward movement of soft palate to seal oral cavity posteriorly
  • Saliva
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18
Q

What are problems with the oral preparatory phase of swallow?

A
  • Drooling

* Pocketing

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19
Q

Is the oral phase of swallow voluntary or a reflex?

A

Voluntary

20
Q

Describe the duration of the oral phase of swallow.

A

Lasts usually less than 1 second

21
Q

What are the hallmarks of the oral phase of swallow?

A
  • Tongue that elevates and occludes the anterior oral cavity and compresses the bolus toward the oropharynx
  • Contraction of the palatopharyngeal folds
  • Elevation of the soft palate
22
Q

What does the oral phase of swallow require?*

A

• Closure of anterior and
lateral sulci.
• Tongue to move bolus to the pharynx.
• Soft palate elevation and velopharyngeal port closure to close off the nasal cavity and prevent regurgitation into the nasopharynx

23
Q

What are problems with the oral phase of swallow?

A
  • Drooling
  • Pocketing
  • Head tilt
24
Q

Is the Pharyngeal phase of swallow voluntary or a reflex?

A

Reflex

25
Q

Describe the duration of the Pharyngeal phase of swallow.

A

Lasts ~ 0.6 to 1 sec

26
Q

What are the hallmarks of the Pharyngeal phase of swallow?

A

• Bolus propelled from mouth to esophagus
• Aspiration most likely to occur during this phase*
• Inhibition of breathing occurs to
prevent aspiration

27
Q

What does the Pharyngeal phase of swallow require?*

A

Airway protection with soft palate/laryngeal elevation, velophraryngeal closure, vocal cord adduction and pharyngeal constriction and cricopharyngeal relaxation to facilitate bolus transport to esophagus

28
Q

What are problems with the Pharyngeal phase of swallow?

A 
Food sticking
Choking and coughing
Aspiration
Wet/gurgling voice
Nasal regurgitation
29
Q

Is the Esophageal phase of swallow voluntary or a reflex?

A

Reflex

30
Q

Describe the duration of the Esophageal phase of swallow.

A

Longest phase—lasts 6 to 10 sec

31
Q

What are the hallmarks of the Esophageal phase of swallow?

A

• Bolus pass from pharynx > esophagus > stomach
• Esophageal clearance is assisted by gravity but requires relaxation of
the gastroesophageal sphincter

32
Q

What does the Esophageal phase of swallow require?

A
  • Cricopharyngeal muscle contraction

* Coordinated peristalsis and LES relaxation

33
Q

What are problems with the Esophageal phase of swallow?

A

Heartburn

Food sticking

34
Q

What are treatments of dysphagia?

A 
Modified diets
NPO
Posture and head position
Elevate HOB
Feeding upright position
Compensatory strategies
Oral/motor exercises
Thermal stimulation
35
Q

What does a chin tuck prevent?*

A

Preventing bolus entry into larynx and allowing airway protection

36
Q

Where does food bolus travel with a chin tuck?*

A

Dec space b/w tongue and posterior pharyngeal wall to inc pressure to move bolus through pharyngeal region

37
Q

How should the head be rotated in dysphagia?*

A

Turn head towards paretic side to force bolus into contralateral pharynx

38
Q

How does head tilt guide food bolus?

A

Uses gravity to guide bolus into ipsilateral pharynx

39
Q

Describe a supraglottic swallow for dysphagia treatment.

A

Concomitant breath holding and swallowing closes the vocal folds to protect the trachea

40
Q

Describe a super supraglottic swallow for dysphagia treatment.

A

Adds Valsalva maneuver to maximize vocal fold closing

41
Q

Describe a Mendelsohn maneuver for dysphagia treatment.

A

Patient voluntarily holds the larynx at its maximal height to lengthen the duration of the cricopharyngeal opening

42
Q

How does thermal stimulation treat dysphagia?

A

Sensitize the swallowing reflex

43
Q

How do oral/motor exercises treat dysphagia?

A

Improve tongue and lip strength, ROM, velocity, and precision, and vocal fold adduction

44
Q

What is malnutrition in stroke patients associated with?

A 
Prolonged LOS
Slower functional gains
Higher stress reaction
Higher infection rates
Higher decubitus ulcer rates
45
Q

What did the Ickenstein et al research on dysphagia find?*

A

72hr post stroke: 1 to 3 on functional communication measure of swallowing and level 5 to 8 on penetration-aspiration scale were 11.8x less likely to be orally fed 90 days post-stroke

46
Q

What causes nasal speech?*

A

Partial or complete failure of soft palate to close off nasal cavity from oral cavity or incomplete closure of hard palate

47
Q

What prevents nasal speech?*

A

Uplifting soft palate

Cuccurullo Book (91 decks)

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