chapter 4: disorders of deglutition Flashcards
in dysphagia, the anatomic and/or neuromuscular dysfunctions are the actual _____ leading to the _____ for which treatment is designed.
disorder, symptoms
________ and _________ are symptoms, not the disorder
aspiration, penetration
a radiographic study (MBS) should be completed on any patient who is suspected of having _________ or who may be __________.
pharyngeal dysphagia, aspirating/penetration/coughing
An MBS should provide three types of information
a. anatomic/neuromuscular dysfunction or cause
b. whether oral eating is recommended (and bolus consistency)
c. plan treatment/ therapy
(d. trial treatments)
a patients description of his/her swallowing problem can be ______
erroneous
OTT stands for
oral transit time
OTT begins from the initiation of the ________ and ends when the bolus head reaches _________
posterior propulsion, faucal pillars/ base of tongue
The OTT time is approximately
1 second
when does the pharyngeal DELAY time (PDT) begins?
the bolus head reaches the base of the tongue and ends when the swallow is triggered
the pharyngeal TRANSIT time (PTT) is the time
from the time the trigger occurs until the bolus tail passes the UES
the PTT takes
less than 1 second
it is critical to know whether aspiration occurs …
before, during or after the pharyngeal swallow
normal mastication requires
- intact mandible
- intact maxilla
- intact buccal musculature
- intact lingua musculature
the purpose of the oral preparation for the swallow is to break down food, mix it with saliva, and form it …
into a cohesive bolus
what are the disorders in oral preparation of the swallow
a. cannot hold food in the mouth anteriorly-reduced lip closure
b. cannot hold a bolus reduced tongue shaping/coordination
c. cannot form a bolus reduced range of tongue motion or coordination
d. material falls into anterior sulcus reduced labial tension/tone
e. material falls into lateral sulcus reduced buccal tension/tone
f. abnormal hold position-reduced tongue control/tongue thrust
if food falls from the mouth, check if the patient is a ________ _________, check for reduced _____ closure.
mouth breather, lip
could be the result of a stroke or lack of sensory information from cranial nerve VII
inability to hold a bolus of liquid or paste can be the result of the inability to _____________ around the material.
shape the tongue
during the oral prep phase the ____ _______ contacts the back of the tongue to prevent premature spillage
Soft palate
premature spillage is normal during _______ but not while holding a liquid or pudding bolus.
mastication
premature spillage can result in
coughing/aspiration/penetration
inability to hold bolus shape is due to reduced ________, while premature spillage is due to ______ or ________.
tongue movement, weak velar position, poor buccal control
reduced tongue motion/coordination will prevent the formation of the _____ resulting in food spread throughout the oral cavity just prior to the swallow.
bolus
food falling into the anterior cavity is the result of reduced _____ and _______ tone
labial and facial
the dominate muscle of the cheeks is the ________ innervated by the ______ branch of the ____ cranial nerve.
buccinatior, buccal, VII
normally the bolus is held between the tongue and the hard palate (tippers) or on the _____ of the mouth (dippers)
floor
an abnormal position would be if the bolus was held immediately behind the front _____ possible resulting in a _______________
teeth, tongue thrust
the oral phase is the ________ of the bolus through the oral cavity
propulsion
the oral phase ends when the __________ is triggered
normal swallow
the pharyngeal swallow is predominately triggered via sensory information from the ___________
glossopharyngeal nerve (IX)
the oral phase transit time is typically around
1 second
when a bolus is held in the mouth with no lingual movement, 3 possible causes are:
a. swallow apraxia
b. reduced sensation in mouth
c. tactile/oral agnosia
the text gives ___ ways to increase sensory stimulation.
5
true or false: patients may not react to liquid or pureed material in the mouth but may react to a cookie
true or false: allowing the patient to feed himself may increase oral activity
true
true
apraxia of swallow is often accompanied by
oral apraxia (the reverse is not true)
true or false: refraining from giving an commands to eat/swallow may be helpful in a patient presenting with apraxia of swallow.
true
at times , a __________ may cause the tongue to thrust forward toward the ______ incisors
neurological disorder, central
a tongue thrust may be preceded by an abnormal ___________
bolus position
labial buccal rension is generated by this major lip muscle
orbicularis oris
buccal muscles may provide __________ or _________ in the lateral walls of the oral cavity to help with the backward movement of the bolus.
resistance or pressure
food collecting in the anterior or lateral floor of the mouth is the result of
a. ______
b. ______
a. reduced ability to shape and coordinate the tongue around the bolus
b. reduced contact between the tongue and the alveolar ridge
during a swallow scar tissue cannot move in this direction
up ( it cannot bulge upward)
any residue left on the tongue surface indicates reduced tongue ______
movement
if the residue increases as food becomes more viscous it is an indication of reduced tongue _______
strength
inability to propel the bolus _________ is likely the result of lingual discoordination
posteriorly
when the tongue cannot elevate to touch the palate the bolus may be _______
spread
residue on the hard palate indicates reduced tongue ________
elevation
greater residue from more viscous food indicates reduced tongue ______
strength
if the front to back action of the tongue is broken into multiple small tongue movements it is a sympton of ______________.
reduced lingual coordination
in parkinsons patients the posterior tongue fails to lower at the appropriate time so the bolus only reaches the ____________ before it rolls forward again.
back of the hard palate
this incomplete posterior propulsion behavior may last up to ___ seconds before a swallow is initiated
10
when liwuid or pudding is placed in the mouth the soft palate contacts the ___________- sealing the bolus in the mouth posteriorly to prevent spillage
back of the tongue
the soft palate does not contact the back of the tongue on foods requiring _________
chewing
premature spillage may fall into the ________, the _______________, or the __________
vallecule, pyriform sinuses, larynx
premature spillage indicates reduced lingual _______ or possibly ______ incompetency
control, velar
premature spillage into the pharynx does not _________ the oharyngeal swallow.
trigger
a patient who requires two three or more repeated swallows to empty the oral cavity is called __________
piecemeal deglutition
during a MBS the small amount of food given should be cleared from the oral cavity in a _____________-
single swallow
the normal oral transit time is ___, increasing _____ seconds in individuals over the age of 60
1 seconds, 1/4
the glossopharyngeal nerve monitors _________, and _______ from the ____________ one third of the tongue
sensation, taste, posterior
it is motor to the ________ muscle whch raises the pharynx during swallowing and speech.
stylopharyngeous
the glossopharyngeal nerve receives motor impulses from its nucleus in the nucleus ambiguous area. this nucleus receives its motor impulses from both hemispheres. therefore the glossopharyngeal nerve is said to be ________ innervated. damage to one hemisphere will have little to no effect on the glossopharyngeal function
bilaterally
draw the glossopharyngeal motor innervation
delayed phayngeal swallow occurs when the head of the bolus enters the ______ and the pharyngeal swallow has NOT been triggered.
pharynx
a delay in triggering the pharyngeal swallow increases the risk of
penetration/ aspiration, (the longer the delay the greater the chances of this occuring)
a delay in the pharyngeal swallow may cause the bolus to land in the
a. valleculaw
b. pyriform sinuses
c. airway
the critical aspect of delay is the ________________
location of the bolus
the ________ must be differentiated from the premature bolus loss
bolus
premature bolus loss does not ________ the pharyngeal swallow
trigger
if the bolus lands into the ______________ the bolus is at a high risk of being dumped into the _____ when the pharyngeal swallow is triggered
pyriform sinus, airway
the chin down posture changes only the ____________ dimensions which occurs ___ the level level of the pyriform sinuses.
anterior posterior pharyngeal, above
the chin down posture neither changes the degree of ______ shortening nor prevents contents in the ____________ from emptying into the airway.
pharyngeal elevation, pyriform sinuses (is for airway protection)
material in the pyriform sinuses is not a _____- disorder
cricopharengeal (UES)
the pharyngeal delay is measured from the time when the __ passes the point where the lower edge of the mandible crosses the tongue base to the point in time when the larynx and hyoid begin to ______
bolus, elevate
the pharyngeal swallow actually begins with ________-of the larynx and hyoid AND IS FOLLOWED BY THE REST OF THE SWALLOW
elevation
in normal young adults the pharyngeal delay is _______ seconds
0-0.2
in adults over 60 the delay may be ___________ seconds
up to 0.5
a delay of _ seconds is abnormal at any age especially if aspiration occurs
2
in infants and young children, the bolus may collect in the _____- before the pharyngeal swallow is triggered.
vallecula
in infants an abnormal delay is defined as more than ___ second between the last _____________- and the onset of the pharyngeal swallow.
1, tongue pump
the pharyngeal stage ends when the bolus passes through the _______
UES
normal pharyngeal transit time is a maximum of _________
1 second
nasal regurgitation occurs when ____________________
the velopharyngeal port closure is inadequate and backflow occurs
when a liquid or pudding is put in the mouth the soft palate makes complete contact with the ___________ and during the swallow the soft palate makes complete contact with the _________________
posterior tongue, posterior pharyngeal wall
this latter contact only lasts a __________ second and occurs only as the bolus passes through the _____________
fraction of a, velopharyngeal port
when a bolus cannot pass through the pharynx into the esophagus, material will move back upward, which is called _________
regurgitation/backflow
a pseudoepiglottis is a ____________ located at the vase of the tongue after a total laryngectomy
flap of tissue
upon swallowing the pseudo epiglottis is pulled ____________ narrowing the ___________ so that the patient can barely move food past this point.
towards the larynx, pharynx
bony projectiles into the pharynx from the vertebrae are called __________
osteophytes (spurs)
these growths may cause patients to think that there is _____________
something there
a weak pharyngeal wall may result in food _____________ as well as food collecting in the __________ on the same side.
clinging to the wall, pyriform sinus
little to no residue is left in the _________ in normal individuals after a swallow. only when there is apparent density of material on the walls is it considered a symptom of reduced __________
pharynx, pharyngeal contraction
these patients may ____ swallow if they are aware of the residue.
dry
when residue remains on the wall, the patient is at risk for _________ upon inhalation
aspiration
in a normal swallow, 2/3 of the distance between the tongue base and posterior pharyngeal wall is closed by posterior movement of the ______ while the remaining 1/3 of the distance is closed by the anterior movement of the _________
tongue, pharynx
clearing of residue in the valleculae is largely the result of ___________
tongue base movement
large amounts of residue in the valleculae may put the patient at risk for _________ upon a subsequent inhalation
aspiration
careful examination of a lateral radiograph may show slight residue in a depression along the pharyngeal wall. this could be due to _______________ or _____________ possibly resulting from a previous ___________
pharyngeal pouches, scare crease, fistula
in a normal swallow the larynx tucks itself under the ______________ to protect the _________
tongue base, airway
the larynx typically moves _____ upward during the swallow
2 cm
if the larynx does not reach this elevation, residue may remain _________ of the larynx putting the patient at risk for __________ following deglutition
on top, aspiration
during a normal swallow, the _________ tilt forward to contact the base of the epiglottis closing off the airway
arytenoids
if the larynx does not elevate adequately this art-epiglottic contact will not occur leaving the entrance to the airway slightly ____ allowing ________ of the bolus into the airway
open, penetration
subsequently the penetrated residue will usually be _____________ after the swallow
penetrated
some patients can compensate for reduced laryngeal elevation by __________ the arytenoids more ____________ than normal
tilting, anteriorly
penetration and or aspiration can occur _____ or _______ the swallow
before, after
penetration can occur if the larynx lifts ______ leaving the airway entrance slightly ____
inadequately, open
penetration can occur if the arytenoids fail to ___________ closing off the _________
tilt anteriorly, airway/laryngeal entrance
In a normal swallow the ray tenpins fully tilt to contact the ______
The epiglottis base
penetration can occur if the larynx lifts ______ during the swallow
during
Penetration can occur if the bonus falls into the airway entrance before the__________
Swallow is initiated
Any penetration material that is not cleared from the airway entrance by the swallow may be __________when the patient subsequently inhales
Aspirated
The longer the pharyngeal delay the lower the ______ may either _________ the airway entrance or even pass the vocal folds causing __________. Especially if the patient is a _______________.
Bolus, penetrate, aspiration, silent aspirator
During a normal swallow the three levels of protection for the airway are
A. True vocal folds
B. False vocal folds, arytenoids to epiglottis base
C. Epiglottis and army epiglottis folds
The only etiology for aspiration during the swallow is_________
All three valves are not working
In a normal swallow little to no residue is left in the pyro form sinuses. If residue remains the three main causes are:
A. Little laryngeal movement
B. Cricopharyngeal dysfunction
C. UES stricture (too narrow)
If the pharyngeal swallow has not triggered a crick pharyngeal disorder cannot be _______
Diagnosed
_____________ hyolaryngeal movement triggers the opening of the cricopharyngealsphincter
Anterior and vertical
If residue is left in the pyro form sinus, valleculae and pharyngeal walls, it is probably the result of generalized dysfunction in _________________ resulting from reduced posterior movement of the tongue, reduced anterior movement of the pharyngeal wall and reduced elevation of the larynx.
Pharyngeal pressure
Normal pharyngeal transit time is ______ second regardless of age or food.
Less than 1
Esophageal disorders can _____ as pharyngeal phase disorders because they can cause __________ of the material out of the esophagus into the pharynx causing _________
Mask, back flow/reflux, aspiration
Back flow into the pharynx may be caused by:
Achalasia, reflux, tumor, etc
Reflux may cause _______ of the arytenoids as well as a ____________ sensation.
Redness, burning
A fistula between the _______________________ may cause back flow
Trachea and esophagus
A diverticulum is a side pocket(hernia) in the pharynx that takes the shape of a _______which traps residue that could possibly fall into the airway if the diverticulum is in the pharynx causing ___________. A diverticulum in the upper esophagus is called a __________ diverticulum.
Pocket, aspiration, zenkers
The correct use of the term reflux is when food or stomach acid from the stomach enters the _________ because of failure of the _____ to keep food in the stomach.
Esophagus, LES
