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Dysphagia > Chapter 5, Class 5- Exam 2 > Flashcards

Chapter 5, Class 5- Exam 2 Flashcards

1
Q

More damage in_____ that effects swallowing than ______

A

UMN

LMN

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2
Q

• Functional Neuroanatomy

Table 5-1

A
  • Cortical
  • Subcortical
  • Brainstem
  • Cerebellum
  • Peripheral Nerves
  • Muscles and Sensory Receptors
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3
Q

• Cortical Functions

A
  • Where is swallowing represented?

* fMRI studies show wide range of areas cortical, subcortical, brainstem involved

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4
Q

• Strokes

A
  • Right versus left hemisphere
  • Dysphagia in both right and left hemisphere CVAs
  • Left side CVA greater incidence of oral dysphagia and right side CVA greater incidence of pharyngeal dysphagia
  • Swallowing is bilaterally represented
  • Cortical plasticity may occur over time
  • Plasticity to retrain and reengage the neurological system to improve the swallow
  • Treatment Considerations/Decisions
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5
Q

• Deficits after Hemispheric CVA

A
  • Reduced initiation of saliva swallow
  • Delayed triggering f pharyngeal swallow
  • Poor co-ordination of oral movements in swallow
  • Oral prep should be less than 10 seconds
  • Oral transit should be less than 1 second
  • Increased pharyngeal transit time
  • Reduced pharyngeal constriction
  • Aspiration
  • Pharyngo-esophogeal segment dysfunction
  • Impaired lower esophageal sphincter relations.
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6
Q

• Treatment Considerations, Dysphagia following CVA

A

(See Table 5-2, page 79)
Acute: 0-1 month
• Resolving dysphagia
• Malnutrition

Improving (1-6 months)
• Feeding routes established
• Malnutrition

Chronic (+ 6 months)
• Feeding Routes established
• Compensations
• Continue therapy?

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7
Q

• Dysphagia with Dementia

A 
Symptoms/Swallowing deficits seen in patients with cognitive decline
•	Unexplained weight loss (more common)
•	Oral stage dysfunction (more common)
•	Could also have anticipatory issues 
•	Pharyngeal stage dysfunction
•	Flash penetration, bolus in triangular space of VFs and coughed out 
•	Combined oral & pharyngeal dysfunction
•	Minor aspiration
•	Feeding limitations
•	No appetite, don’t want to eat 
•	Anticipatory stage problems
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8
Q

• Examples of swallowing and feeding deviations in mild-stage dementia
(See Box 5-4, page 81)

A

Swallowing deviations
• Slow oral movements
• Slow or delayed pharyngeal response
• Overall slow swallowing duration

Feeding deviations
• Increased self-feeding cues needed
• Direct assistance with utensil use and food preparation
• Imitation of feeding behavior from meal partner

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9
Q

• Dysphagia and TBI

A
  • Ranges from 60%-90% with dysphagia
  • Based on severity of trauma
  • Glascow Coma Scale (GCS)
  • Rancho Coma Scale (RLAS)
  • Functional Independence Measure (FIM)
  • Pneumonia is frequently seen
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10
Q

• Dysphagia in Subcortical Impairments

A
  • Basal ganglia deficits
  • Parkinson’s Disease (Page 86)
  • Progressive Supranuclear Palsy
  • Dysphagia Considerations (Box 5-5)
  • Treatment Considerations in general
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11
Q

• Deficits in PD (See Table 5-3)

A 
Oral stage:
•	Lingual tremor
•	Tongue pumping
•	Pumping food up and down, no  A-P transport
•	Ramplike posture
•	Piecemeal deglutition
•	Velar tremor
•	Buccal retention
Pharyngeal State
•	Vallecular retention
•	Pyriform sinus retention
•	Impaired laryngeal elevation
•	Airway penetration
•	Aspiration
•	Phayrngo-esophageal segment dysfunction
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12
Q

• Dysphagia after Brainstem CVA

See Box 5-7, page 87

A
  • Absent or delayed pharyngeal response
  • Reduced hyolaryngeal elevation
  • Reduced oro-pharyngeal constriction
  • Reduced pharyngeal constriction
  • Reduced laryngeal closure
  • Reduced pharyngo-esophageal segment opening
  • Brief swallow event
  • Generalized in-coordination with breathing
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13
Q

• Lower Motor Neuron/Muscle Diseases

A 
Amyotrophic lateral sclerosis (ALS) (Box 5-8 page 89)
•	Oral control of bolus
•	Peri-oral weakness
•	Lingual weakness
•	Reduced transport
•	Velar leak
•	Reduced tongue pump
•	Reduced pharyngeal contraction
•	Residue
•	Airway protection
•	Bradykinisia
•	Residue
•	Table 5-4—Swallowing interventions with ALS
•	Specifics on Boxes 5-8 and  5-9
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14
Q

• Ideopathic/Iatrogenic Disorders

A
  • Vascular deficits (TIAs, mini-strokes)
  • Advancing age
  • Complex medical conditions
  • Medication
  • Progressive diseases
  • Post surgical changes
  • Resemble Neurogenic Dysphagia but no overt neurologic disease
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15
Q

• The role of Executive Function in Eating

A
  • Anticipatory Stage
  • Meal planning
  • Portion judgment
  • Appetite judgment
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16
Q
  • Treatment Considerations: Dementia and dysphagia

* Focus on:

A
  • QOL
  • Dignity
  • Comfort
17
Q

• Treatment Considerations-Brainstem CVA

A
  • Recover function over time
  • Symptomatic and change over time
  • May be more direct and aggressive
18
Q

• The Cerebellum and Swallowing

A
  • Adjacent to the brainstem
  • Role in swallowing poorly understood
  • Activation on functional imaging
  • Volitional swallowing
  • Ataxia,
  • Intention tremor
  • Hypotonia
19
Q

• Dysphagia in ALS (Box 5-9)

A 
Oral Stage:
•	Leakage
•	Mastication problems
•	Bolus formation
•	Bolus Transport
•	Residual pooling
Pharyngeal Stage
•	Nasopharyngeal regurgitation
•	Valleculae pooling
•	Pyriform sinus pooling
•	Airway spillage
•	Ineffective airway clearance
•	Shortness of breath
20
Q

• Dysphagia Tx with ALS

A
  • See Table 5-4, page 91
  • Early Swallowing Problems
  • Dietary Consistency Changes
  • Results of Reduced Intake
  • Salivary Problems
21
Q

• Other Lower Motor Neuron Disorders with Dysphagic Symptoms

A
  • Polyneuropathy- system diseases such as Diabetes, Guillain-Barre syndrome
  • Myesthenia Gravis
  • Polymyositis
  • Scleroderma
  • Systemic Lupus Erythematosus
  • Muscular Dystrophy
22
Q

2 hallmarks of dysphagia:

A

Two hallmarks of dysphagia:

  1. Delay in propulsion from mouth to stomach
  2. Misdirection of bolus – enters airway
23
Q

Delay in propulsion:

A

What could be impaired neurologically?
What would it look like?
o Slow

What do you predict could be done therapeutically?
o Change consistency
o Oral-motor exercises
o Compensatory strategies to speech propulsion
o Children- oral motor strengthening and awareness

24
Q

Aspiration

A

Langmore et al. 2008
Aspiration pneumonia
o 13-48% of nursing home infections
o Second most common cause of mortality 20-50%, some say 80%

25
Q

Best predictors of aspiration were__________.

A

Dysphagia is an important risk for aspiration pneumonia, is it the only one?
o Oral care
o Bacteria

26
Q

Although poorly understood the _______plays a role in the swallowing process

A

Cerebellum

27
Q

3 neurological diseases that could display dysphagic symptoms

A

Myasthenia Gravis
Muscular Dystrophy
Guillian Barre Syndrome

28
Q

Some diseases do not display overt neurological problems but patients can still report dysphagic symptoms. Among those diseases that the textbook authors call ideopathic or ‘iatrogenic’ are people with complex medical conditions such as

A

severe chronic respiratory problems (COPD), etc…

29
Q

A person who has experiences dysphagic symptoms for over 6 months would be considered in the _______stage of dysphagia

A

Chronic

30
Q

______phase is most commonly impaired in persons with mild dementia

A

Oral

31
Q

As many as _____% of individuals with TBI experience dysphagia

A

60-90%

32
Q

What is meant by people with PD often display “ramplike posture”

A

Their tongue bunches in the back, preventing a coordinated anterior to posterior tongue movement

33
Q

Is it possible to see tremors in both the _____and _____ of a person with PD?

A

tongue and velum

34
Q

Video 5-5 Evolve: Person has diagnosis of

A

A tumor to CN X and XII on the left

35
Q

In working with an individual with a brainstem CVA it is recommended that the course of treatment be

A

Direct and more aggressive because recovery facilitates an overall improvement in the patient’s health status

Dysphagia (8 decks)

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