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?
Neurological Disorders
- _____
- Hydrocephalus
- Intracranial ____
- Seizures
- ____ Leukomalacia
- ____ injuries
Microencephaly Hydrocephalus Intracranial Hemorrhage Seizures Periventricular Leukomalacia Birth injuries
Cardiovascular Disorders
- ____ septation
- Patent ductus ____
- Tetralogy of ____
- Truncus ____
- Cardiac septation
- Patent ductus arteriosus
- Tetralogy of Fallot
- Truncus arteriosus
Congenital Anomalies
=\_\_\_ \_\_ and \_\_\_ -Cause: -Incidence= 1 in \_\_\_ live births -More \_\_ than \_\_\_ -Many associated difficulties: =Many different syndromes \_\_\_ complications
=Cleft lip and palate
-Cause: Failure of mesenchymal masses in medial nasal and maxillary prominences to join
-Incidence= 1 in 700 live births
-More boys than girls
-Many associated difficulties:
=Many different syndromes Post-surgical complications
Congenital Anomalies (notes)
Cleft Palate Syndromes: \_\_\_ Syndrome \_\_\_\_ Syndrome \_\_\_\_\_ Syndrome CHARGE Beckwith-Wiedemann syndrome Goldenhar’s syndrome Apert’s syndrome \_\_\_ \_\_\_\_ Syndrome Freeman-Sheldon syndrome \_\_\_\_ Syndrome
Cleft Palate Syndromes: Kabucki Syndrome Mobius Syndrome Pierre Robin Syndrome CHARGE Beckwith-Wiedemann syndrome Goldenhar’s syndrome Apert’s syndrome Treacher-Collins Syndrome Freeman-Sheldon syndrome Down Syndrome
Pediatric Feeding disorders
=Inability to consume sufficient calories for optimal grown and development
=Signs of problematic Eating
1. Poor __ ___
2. Coughing, ___, or gagging during meals
3. Problems with ___
4. History of a traumatic ___ incident
5. History of eating and breathing ____ problems with ongoing respiratory issues
6. Inability to make the transition to baby food purees by ___ months
7. Inability to accept ____ by 12 months
8. Inability to make the transition from breast to bottle to cup by 16 months
9. Has not bee weaned from baby foods by 16 months
10. Aversion or avoidance of all foods of specific ____ or food groups
11 Food range of fewer than ___ foods
12. Crying or arching by the infant at most meals
13. Family fighting about food and feeding
14. Repeated parental reports that the child is difficult for everyone to feed
15. Parental history of an ____ with a child not meeting weight goals
Inability to consume sufficient calories for optimal grown and development
Signs of problematic Eating
Poor weight gain
Coughing, choking, or gagging during meals
Problems with vomiting
History of a traumatic choking incident
History of eating and breathing coordination problems with ongoing respiratory issues
Inability to make the transition to baby food purees by 10 months
Inability to accept table food solids by 12 months
Inability to make the transition from breast to bottle to cup by 16 months
Has not bee weaned from baby foods by 16 months
Aversion or avoidance of all foods of specific texture or food groups
Food range of fewer than 20 foods
Crying or arching by the infant at most meals
Family fighting about food and feeding
Repeated parental reports that the child is difficult for everyone to feed
Parental history of an eating disorder with a child not meeting weight goals
Medical Impact on Feeding
- ____
- ____ Disorders
- Esophogitis
- Eosinophilic ____ (EE)
- Celiac Disease
- Others:
1. Hirschsprung’s Disease, cyclic vomiting syndrome, ____, intestinal pseudo-obstruction, irritable bowel syndrome, dyspepsia
- Prematurity
- Gastrointestinal Disorders
- Esophogitis
- Eosinophilic Esophagitis (EE)
- Celiac Disease
- Others:
1. Hirschsprung’s Disease, cyclic vomiting syndrome, gastroparesis, intestinal pseudo-obstruction, irritable bowel syndrome, dyspepsia
Eosinophilic esophagitis
an inflammatory condition of the esophagus that affects both children and adults, and men more than women
Eosinophilic gastroenteritis may be due
allergy to an as yet unknown food allergen.
The major symptom in adults with eosinophilic esophagitis is
dysphagia (problems swallowing) for solid food.
Eosinophilic esophagitis stiffens the …
Eosinophilic esophagitis stiffens the esophagus so that solid foods have difficulty passing through the esophagus and into the stomach.
Hirschsprung’s disease is a
of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from bir
Cardiac and Respiratory Conditions
-Disorders of the ___ and ___
-Allergies
1. 2-2.5% of population has food allergies
2. 8 foods make up ____%:
==Peanuts, tree nuts, mild, eggs, wheat, soy, fish, shellfish
Disorders of the head and neck Allergies 2-2.5% of population has food allergies 8 foods make up 90%: Peanuts, tree nuts, mild, eggs, wheat, soy, fish, shellfish
Sensory Impact on Feeding
- Sensory ____ problems
- Sensory ____ problems
- Sensory defensiveness/_____
- Hyposensitivity
- Sensory modulation problems
- Sensory registration problems
- Sensory defensiveness/hypersensitivity
- Hyposensitivity
By Disorder
- Autism Spectrum Disorders
1. 62% have food ____ problems
2. ____/ Constipation - Cerebral Palsy
1. __ ____ Reflex
2. U_____ - Brain Injury
1. ____% children with TBI have feeding problems
2. Oral motor dysfunction, __ ____ problems, __ ___ involvement - ____ Syndrome
1. ___% have feeding difficulties
2. Low__ ___
Autism Spectrum Disorders 62% have food selectivity problems GERD/ Constipation Cerebral Palsy Tonic Bite Reflex Undernourishment Brain Injury 30-60% children with TBI have feeding problems Oral motor dysfunction, self-feeding problems, frontal lobe involvement Down Syndrome 80% have feeding difficulties Low muscle tone
Myofacial Anomalies
Tongue Thrust
