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COMDIS415 EXAM 2 > COMDIS 415 SWALLOWING DISORDER > Flashcards

COMDIS 415 SWALLOWING DISORDER Flashcards

1
Q

Dysphagia

A

“difficulty in swallowing” or “inability to swallow”
can occur at different stages of the swallow
a secondary disorder, results from a variety of etiologies

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2
Q

What other etiologies can dysphagia result from?

A

cerebral vascular accident (CVA)
CNS disease (e.g., Parkinson’s, Alzheimer’s) neurodevelopmental disorders (e.g., Cerebral Palsy) acquired brain traumas (e.g., TBI, CVA)
obstructions (e.g., tumor)
and more!

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3
Q

Cranial nerve 5

A

mastication - motor muscle
helps open and close jaw

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4
Q

Cranial nerve 9

A

motor supply to constrictors, moves food down

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5
Q

cranial nerve 12

A

supplies motor function to tongue

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6
Q

SWALLOWING MECHANICS: airway protection

A

epiglottis folds down to make contact with top of artynoids, mechanical barrier from bolus entering trachea

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7
Q

SWALLOWING MECHANICS

A

need lips to stay closed after liquid, seal off nasal cavity so liquid does not come out nose

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8
Q

NORMAL SWALLOW

A

Innate ability present in-utero Divided into stages
1. Oral preparation stage
2. Oral transit stage
3. Pharyngeal stage
4. Esophageal stage
variability in ‘typical’

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9
Q

ORAL PREPARATION PHASE

A

Theme: bolus formation (PREPARING FOR BOLUS LOSS)
Includes
+ Sealing lips to contain food
+ Lowering of velum Mastication – saliva increases
- needs to stay in a lower position for breathing through nose
+ More rapid for liquids than solids
+ Normal nasal breathing pattern

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10
Q

ORAL TRANSIT PHASE

A

+ still breathing through nose in this phase
+ Theme: bolus movement (oral cavityàpharynx)
+ Includes
- tongue presses upward against hard palate
- Buccal muscles keep bolus in central groove
- Normal nasal breathing pattern

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11
Q

masseter muscle

A

important for chewing

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12
Q

PHARYNGEAL PHASE

A
  • only phase where we have to stop breathing
    during air way protection
  • Theme: bolus movement (pharynx à esophagus)
    Includes:
  • Swallow reflex is triggered when bolus reaches anterior faucial pillars
  • Airway protection happens
  • Bolus is propelled inferiorly through muscle contraction and gravity
  • Breathing stops (apneic period, only lasts for a sec)
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13
Q

AIRWAY PROTECTION RESPONSE

A

CRITICAL – first phase where bolus can enter airway or nasal cavity
Protective mechanisms prevent this:
- velum meets posterior pharyngeal wall (closes off nasal cavity from oropharynx)
- Epiglottis inverts to meet arytenoids (covers larynx)
- True vocal folds adduct (seals off trachea)
If all else fails, cough reflex

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14
Q

ESOPHAGEAL PHASE

A

Theme: bolus movement (esophagusàstomach) Includes
Upper esophageal sphincter opens to allow bolus to enter esophagus
Esophagus contracts to move bolus inferiorly (use gravity assist)
Lower esophageal sphincter (LES) opens to allow bolus to enter stomach (muscles need to relax and open)

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15
Q

ATYPICAL & LIFE-THREATENING SWALLOWS: PENETRATION

A

life-threatening occurs during pharyngeal phase

penetration = material falls into the laryngeal vestibule but not below vocal folds (VFs)
can be cleared if sensation & motor ability is sufficient
VFs are the last level of protection from the lungs

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16
Q

ATYPICAL & LIFE-THREATENING SWALLOWS: ASPIRATION

A

aspiration = material falls below the level of the VFs
cannot be cleared
food/liquid in lungsàinfection (pneumonia) can be silent (i.e., ‘silent aspiration’)
can be overt

17
Q

CLASSIFICATION OF DYSPHAGIAS

A

We classify dysphagia by phase(s) impaired
E.g. patient presents with severe oropharyngeal dysphagia…
E.g. patient presents with mild pharyngeal dysphagia…

18
Q

SLPs mostly screen and assess

A

oral/pharyngeal dysphagias

19
Q

SLPS Screen ONLY for

A

esophageal issues and refer to GI

20
Q

SYMPTOMS OF A SWALLOWING DISORDER

A
  • things other healthcare professionals may notice wet- or gurgly-sounding voice after drinking coughing during eating
  • trouble keeping food & liquid in mouth unintended
  • weight-loss or dehydration pneumonia
  • needing extra time at meals, esp. to chew or swallow
21
Q

ASSESSMENT OF SWALLOW FUNCTION

A
  • bedside evaluation and screeners cognition
    language
  • oral-motor
  • chart and medical history review etiology
  • nutritional assessment
    formal testing
  • a few different choices…
  • ordered by a physician
  • trial of variety of textures & thicknesses
22
Q

SWALLOW SCREENING: Bedside swallowing screening

A
  • A minimally invasive procedure that provides quick determination of the likelihood that dysphagia exists
  • Determine whether it is safe to feed the patient orally (for the purposes of nutrition, hydration, and administration of medication)
  • Identify overt signs of aspiration
  • Determine whether the patient requires referral for further swallowing assessment
23
Q

ASSESSMENT: MBSS

A

Modified Barium Swallow Study a.k.a. video fluoroscopic swallow study (VFSS)

  • most common in hospitals supervised by a radiologist
    pt ‘x-ray-ed’ while consuming barium dyed food/drink
  • barium is white but presents as black on x-ray
  • barium considered a medication – ordered by M.D.
    pt positioned laterally
  • Anterior-posterior (A-P) view possible, not standard
    viewed on-line and recorded for future viewing
24
Q

ASSESSMENT: MBSS pros and cons

A

pros
- can see where the swallowing difficulty is occurring.
- can determine if the person is penetrating or aspirating.

cons
- radiation
- cannot be done bedside less ecological validity

25
Q

ASSESSMENT: FEES

A

Fiberoptic endoscopic evaluation of swallowing (FEES)
a.k.a. nasoendoscopy
- small camera inserted via nasopharynx
- any type of food/liquid usually dyed for clarity
- May also include sensory testing viewed on-line and recorded for future viewing

26
Q

SWALLOWING DIAGNOSTICS

A

Pros
- Cost effective
- Portability to bedside - immobile and medically fragile patients
- No radiation
- No barium which is distasteful to the patient
- Functional - it simulates natural every day eating
- Can clearly see laryngeal anatomy

Cons
- Can’t view what happens ‘during’ the swallow trigger
- Can’t screen esophagus

27
Q

TREATMENT

A

requires multi-disciplinary team approach the SLP focuses on:
compensatory strategies diet modifications swallowing exercises
- swallowing exercises: improve underlying
psychiological mechanism
strengthen muscle of tongue, lips, etc

28
Q

TREATMENT: COMPENSATORY STRATEGIES

A

A. Headflexion(chintuck)
B. Headturn(movingbolusto strong side of mechanism)
C. Headextension

29
Q

TREATMENT: DIET MODIFICATIONS

A

choosing food textures & thicknesses that are safe to swallow
remember nutrition considerations dietitian, physician consults
least restrictive diet

30
Q

TREATMENT: SWALLOWING EXERCISES

A
  • to rehabilitate musculature & practice safe swallowing
  • many options
  • effortful swallow
  • mendelsohn maneuver
  • supraglottic swallow
  • masako maneuver (never trial with food)
  • shaker exercise (aka head lift exercise)
  • electrical stimulation (vitalstim)
31
Q

Which of the following is an example of a non-instrumental assessment of voice?

A

Auditory perceptual judgments

32
Q

Which voice assessment tool involves inserting a camera through the nasal passage?

A

Flexible laryngoscope

33
Q

Which voice assessment tool involves inserting a camera into the mouth?

A

Rigid largyngoscope

COMDIS415 EXAM 2 (7 decks)

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