Class 1 Flashcards
Within families, towns, cities, regions, countries and religions there are different _______ associated with _____,______ and _______.
rituals, eating, drinking, swallowing.
Why is being able to drink and eat crucial?
To sustain life and maintain homeostasis of a variety of bodily functions.
Without nutrition what happens to our bodies?
Our bodies slow, become fatigued and can’t regulate the processes that manage toxins.
Why do babies and children need good nutrition?
To aid brain and body growth.
Why do older adults need good nutrition?
To reduce recovery times from falls and surgery as these increase in later life.
What can unsafe/difficult swallowing do?
It can cause mild coughing
It can cause malnutrition
It can cause material to enter the lungs prompting a chest infection.
As well as physical symptoms, dysphagia has _______ and _________ consequences.
emotional, economic.
Name some physical consequences of dysphagia.
Weight Loss Lack of nutrition Choking Coughing Dehydration Fatigue Chest Infection Breathlessness Death
Name some practical consequences of dysphagia.
Changes to meal time preparation
Changes to social engagements.
Name some emotional consequences of dysphagia.
Fear around choking on food
Embarrassment at needing a modified diet.
Name some economic consequences of dysphagia.
Equipment for food preparation.
Have to be off work.
An SLT’s role is to minimise practical ______ that dysphagia can cause.
disruptions.
What is an SLT’s role regarding emotional consequences of dysphagia?
To counsel and support them.
Explain the dysphagia/dehydration cycle.
Dysphagia > Dehydration > Confusion generalised organ failure > Weakened system energy for swallowing > Dysphagia.
The normal swallow is divided into ______ parts.
3
Name the 3 parts of the swallow.
Oral Phase
Pharyngeal Phase
Oesophageal Phase
Oral Phase:
_______ the bolus.
________ the bolus.
SEE
SMELL.
After seeing and smelling the bolus- what happens after that? (until jaw openers activate)
- Saliva starts flowing
- Vocal cords adduct (they close to protect the airway)
- Orbicularis Oris opens (lips open)
- Primary masticatory closers relax ( to open jaw)
- Jaw openers activate
After Jaw activators have opened, what happens?
- Base of tongue approximates palate to contain bolus orally.
- Lingual surface grooves with midline drop to collect bolus
- Midline of tongue elevates and moves bolus between teeth
- Bolus is moved around mouth to breakdown solids (mixes with saliva) and get bolus cohesion
- Tongue tip followed by blade to palate pushes bolus into oropharynx.
When does the the pharyngeal phase start?
When the bolus is pushed into the oropharynx.
In the pharyngeal phase, many things happen in ….
rapid succession.
Name the things that happen in rapid succession during the pharyngeal phase.
Hyolaryngeal Excursion
Velopharyngeal Closure (nothing from the nose)
Base of tongue to posterior pharyngeal wall approximation
Shortening of the pharynx (contracts)
Airway Protection (eppiglotis tips up and over airway)
Opening of the Upper Oesophageal Sphincter.
What is the last phase of swallowing?
Oesophageal Phase.
What are involved in controlling the oral and pharyngeal phases?
The Cranial Nerves.
What is the function of the trigeminal nerve?
motor- jaw open to resistsnce, bite
sensory- sensory to face, hard palate and tongue
If you see reduced mastication and reduced bolus preparation- what can we infer?
That there's a problem with the Trigeminal Nerve. We can also infer: Reduced hyolaryngeal excursion Poor anterior displacement of tongue Hyoid larynx
Name the nerve:
Motor- closes eyes, wrinkle brow
Sensory- taste to anterior 2/3, sensory to soft palate.
Facial Nerve.
What is a sign of a faulty facial nerve?
Lack of facial control.
If there is reduced facial control, what can we infer?
Reduced elevation of hyoid
Reduced superior, posterior placement of tongue
Hyoid
Larynx
This leads to implications for oral containment of bolus.
Implications for Base of tongue to posterior pharyngeal wall approximation.
What nerve is responsible for the gag reflex?
Glossopharyngeal Nerve
How do you assess the glosssopharyngeal nerve?
Gag
Swallow
Acknowledgement of taste.
If you had the following problems, what nerve would be damaged?:
Reduced pharyngeal contraction
Post swallow residue
Impaired airway protection (part, supraglottic protection)
Decreased Base of Tongue to Posterior Pharyngeal Wall approximation.
Glossopharyngeal Nerve
What is the function of the vagus nerve?
Motor- Vocal Quality, volitional cough
Sensory- Reflexive cough/ inhalation cough challenge
How do we know the vagus nerve is damaged?
We can see very little but can hear dysphonia.
What happens if the vagus nerve is damaged?
Reduced capacity for airway protection
Potential difficulty for supraglottic airway closure
Upper Oesophageal Sphincter (UES) Impairment
What is the function of the hypoglossal nerve?
Motor only- lingual movement
How do we test for the hypogloassal nerve?
There should be lingual movement in all planes.
Name the problems associated with hypoglossal nerve damage.
Poor bolus control
Premature spillage with pooling
Decreases base of tongue to posterior pharyngeal wall with vallecular residue.
What conditions impacting neurological functioning could have a potential Impact on swallowing?
Stroke
Parkinsons Disease
Motor Neuron Disease
Dimentia
What conditions impacting normal anatomical structure could have a potential Impact on swallowing?
head and neck cancer eg. glossectomy
Cleft palate
Anything that interrupts normal _____ ______ function or ______ _______ has the potential to impact swallowing.
Cranial Nerve
Physical Movement
A referral to SLT may be made by a number of professionals eg. ____, hospital physician or other _______ ____ _______. It can also be made by a _____ ______, a paid ______ or a key worker.
GPS
Allied Health Professionals
family member
carer
It is the SLTs duty after referral to assess the ______ and ________.
Signs
Symptoms
Upon assessment what 4 things does the SLT have to decide?
- If the patient does indeed have DYSPHAGIA
- What FURTHER ASSESSMENT is requires to establish a baseline function and decide if the patient is safe to eat and drink
- What INTERVENTION is required to manage the dysphagia, whilst maintaining positive quality of life and reducing medical costs.
- How the dysphagia can be MONITORED for change.
Name the 4 main factors we must consider for data collection.
Medical
Wider Health
Mental Health
Personal
Give some examples of medical information we must gather.
Acuity of condition Diagnosis History of respiratory infections frequency of aspiration Length of dysphagia Mobility Nutritional status Mobility and oromotor control. Respiratory status
Give some examples of wider health information to collect.
Alertness Cognition Compliance Dental Hygiene Desire to eat Language skills Feeding independence
Give some examples of mental health information to collect.
Anxiety Depression Eating disorders Schizophrenia Treatment (or not) Mental well being of caregiver.
Name personal factors to take into account.
Patient Wishes
Family Wishes
Support network status
Presence of caregiver
Following on from case history taking, a range of _______________ methods are available (depending on patient).
assessment
What test might have been done prior, that can help inform SLT decision making?
A screening test.
What must be done before giving a patient food or drink?
- An oromotor assessment to evaluate cranial nerve function
- A cough reflex test to assess how well the patient can protect their airway.
When giving trials of food fluid, what will the clinical bedside swallowing assessment include?
Observation of feeding process
Laryngeal palpation to evaluate the externally accessible features of swallowing eg. speed and strength of laryngeal movement
Number of swallows
Effort with which the patient is swallowing
With laryngeal palpation we can only ______ aspects of swallow function, why?
Infer
Can’t see inside the patient to know exactly what’s happening.
What does pulse oximetry measure?
Oxygen Saturation.
_________ ________ ____________ may be reflected in a drop in oxygen saturation.
Reduced Airway Protection.
What is a cervical auscultation?
A stethoscope is used to listen for sound differences in swallowing.
The bigger the _______ volume, and the _______ the _______, the l_____ the swallowing-associated sound lasted.
Bolus
Thicker the consistency
longer.
What provides useful information on how patients cope with larger portions, a variety of textures within 1 meal and how they can self feed or are fed?
Mealtime assessment.
Name 2 instrumental assessments.
Viseofluoroscopy
Fibreoptic endoscopic examination of swallowing (FEES).
What is videofluoroscopy known as?
A moving x ray.
What can videofluoroscopy capture?
Internal Images of the swallowing process- from the fist sip/mouthful to clearance of the bolus.
Give the disadvantages of videofluoroscopy.
Exposure to radiation
Need to attend a clinic (away from home/ward)
Costs
Snap shot nature of this assessment.
What is fibreoptic endoscopic examination of swallowing (FFES)?
A flexible scope through the nose monitors aspiration and pharyngeal residue can be used for the duration of a whole meal as the scope is left in place while the patient eats.
________ are objective measurements of behaviours that people elicit during a physical examination.
Signs
At time of assessment, the SLT is looking out for a number of ______ ________ that indicate …
Stress signals
the presence of dysphagia
Name some signs of dysphagia.
Coughing Gurgling Voice Watering eyes Shortness of breath Change of colour in the patient's face Evidence of aspiration on videofluoroscopy
The SLT will note what ______ ___ _________ or _______ prompted a reaction (indicating dysphagia).
Consistency of food or fluid.
What does a SLT note about a cough?
The strength of a cough.
the SLT notes the ______ of a ______ taken before the difficulties.
size
mouthful
What else must an SLT note?
The number of swallows
The effort with which the patients swallowed.
SLTS can only _____ the risk of _______.
Infer, Aspiration.
Name the 8 stages of Rosenbek’s scale.
1- Safe > material doesn’t enter airway.
2- Laryngeal penetration with cough (above vocal folds)
3- Laryngeal penetration with no cough (above vocal folds, not ejected)
4- Deeper laryngeal penetration with cough (contacts v. folds)
5- Deeper laryngeal penetration without a cough. (contacts v. folds , not ejected)
6- Aspiration with cough (below v. folds)
7- Aspiration with ineffective cough (below v. folds, not ejected from trachea despite effort)
8- Silent Aspiration (below v. folds, no effort is made to eject).
What swallows are considered safe?
1
2
4
What levels become concerning, and why?
3,5 and 6
as residue is still in the laryngeal vestibule but not below v. folds.
What levels are of most concern?
7- ineffective cough
8- no cough :(
Name some consequences of dysphagia.
Malnutririon and dehydration
Poor oral intake
recurring chest infections from repeated aspiration
these can lead to death :(
What is the role of the SLT when it comes to physical factors of dysphagia?
Assess swallowing and make recommendations as to how physical effects of dysphagia can be reduced.
