Class 5 - Exam 2 Flashcards
Functional Neuroanatomy (6)
Cortical Subcortical Brainstem Cerebellum Peripheral Nerves Muscles and Sensory Receptors
Cortical Functions
Where is swallowing represented?
fMRI studies: wide range of areas___,__, ___ involved
Where is swallowing represented?
fMRI studies: wide range of areas cortical, subcortical, brainstem involved
Strokes
- __ vs ___
- Swallowing is __ __
- ___ ___ may occur over time
- ___ Considerations/Decisions
- Right versus left hemisphere
- Swallowing is bilaterally represented
- Cortical plasticity may occur over time
- Treatment Considerations/Decisions
Deficits after Hemispheric CVA
- Reduced initiation of __ __
- Delayed triggering of __ __
- ___of __ __ in swallow
- Increased __ ___ ___
- Reduced ___ ___
- ___
- ___-____ segment dysfunction
- Impaired__ ___ ___ __
- Oral transit – should be less than __ __
- Reduced initiation of saliva swallow
- Delayed triggering f pharyngeal swallow
- Incoordination of oral movements in swallow
- Increased pharyngeal transit time
- Reduced pharyngeal constriction
- Aspiration
- Pharyngo-esophogeal segment dysfunction
- Impaired lower esophageal sphincter relations.
- Oral transit – should be less than one second
Timeline
- ___: 0-1 month
1. Resolving ___
2. ___ - ___ (1-6 months)
1. __ ___established
2. ___ - ___ ( + 6 months)
1. __ ___ established
2. ____
3. Continue therapy?
- Acute: 0-1 month
1. Resolving dysphagia
2. malnutrition - Improving (1-6 months)
1. Feeding routes established
2. Malnutrition - Chronic ( + 6 months)
1. Feeding Routes established
2. Compensations
3. Continue therapy?
Dementia
-Swallowing deficits seen in patients with \_\_ \_\_\_ 1. Unexplained \_\_ \_\_\_ 2.\_\_ \_\_\_ dysfunction 3. \_\_ \_\_\_ dysfunction 4. Combined \_\_ & \_\_ \_\_\_\_ a. Minor \_\_\_ b. \_\_\_ limitations
- Swallowing deficits seen in patients with cognitive decline
1. Unexplained weight loss
2. Oral stage dysfunction
3. Pharyngeal stage dysfunction
4. Combined oral & pharyngeal dysfunction
a. Minor aspiration
b. Feeding limitations
Examples of swallowing and feeding deviations in mild-stage dementia
- ___ deviations
1. __ ___ movements
2. __ or ___ pharyngeal response
3. Overall __ ____ duration - ____ deviations
1. Increased __-____ cues
2. Direct assistance with __ ___
3. Imitation of __ ____ from meal partner
- Swallowing deviations
1. Slow oral movements
2. Slow or delayed pharyngeal response
3. Overall slow swallowing duration - Feeding deviations
1. Increased self-feeding cues
2. Direct assistance with utensil use
3. Imitation of feeding behavior from meal partner
TBI
- Ranges from ___%-___% with dysphagia
- Based on ____ of trauma
1. __ ___ ___
2. ___ ___ ___ - ____ is frequently seen
- Ranges from 60%-90% with dysphagia
- Based on severity of trauma
1. Glascow Coma Scale (GCS)
2. Rancho Coma Scale (RLAS) - Pneumonia is frequently seen
Subcortical Issues
- __ ___ deficits
1. ___ Disease (Page 86)
2. ___ ____ Palsy
- Basal ganglia deficits
1. Parkinson’s Disease (Page 86)
2. Progressive Supranuclear Palsy
Deficits in PD
- oral stage:
1. Lingual ___
2. Tongue ___
3. ____ ___
4. ____ deglutition
5. __ ___
6. ____ retention - Pharyngeal State
- ____ retention
- __ ____ retention
- Impaired laryngeal ____
- Airway ____
- ____
- _____ segment dysfunction
-Oral stage: Lingual tremor Tongue pumping Ramplike posture Piecemeal deglutition Velar tremor Buccal retention -Pharyngeal State -Vallecular retention -Pyriform sinus retention -Impaired laryngeal elevation -Airway penetration -Aspiration -Pharyngoesophageal segment dysfunction
Brainstem functions
-Reduced __ ___
-Reduced ___ ___
-Reduced __-___ ___
-Reduced __ ___
-Absent or delayed __ ___
-Reduced __ ____ segment opening
___ swallow event
-Generalized in-coordination with ____
- Reduced hyolaryngeal elevation
- Reduced laryngeal closure
- Reduced oro-pharyngeal constriction
- Reduced pharyngeal constriction
- Absent or delayed pharyngeal response
- Reduced pharyngo-esophageal segment opening
- Brief swallow event
- Generalized in-coordination with breathing
Lower Motor Neuron/Muscle Diseases
- __ ___ __
- __ ___ of bolus
- Reduced ____
- ____
- ____ protection
- Amyotrophic lateral sclerosis (ALS)
- Oral control of bolus
- Reduced transport
- Residue
- Airway protection
Ideopathic/Iatrogenic Disorders
- ___ ____ (TIAs, mini-strokes)
- Advancing ___
- Complex __ ____
- ____
- ____ diseases
- __ ____changes
- Vascular deficits (TIAs, mini-strokes)
- Advancing age
- Complex medical conditions
- Medication
- Progressive diseases
- Post surgical changes
delay in propulsion
- what could be impaired neurologically?
- what would it look like? what do you predict -could be done therapeutically?
CN impairments related to swallow could be cortical or subcortical
time the entire swallow
change consistency of food, do oral motor exercises, teach compensatory strategies
when working with kids - oral motor awareness and strengthening activities
Aspiration
- aspiration pneumonia
1. __-___% of nursing home infections
2. 2nd most common cause of ____ (20%-50% and some say 80%) - best predictors of aspiration were ___
1. dysphagia is an important risk for aspiration.
2. Is it the only one?
aspiration pneumonia
13-48% of nursing home infections
2nd most common cause of mortality (20%-50% and some say 80%)
best predictors of aspiration were ___
dysphagia is an important risk for aspiration. Is it the only one?
