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dysphagia > Comps review > Flashcards

Comps review Flashcards

1
Q

5 Stages of Pediatric Swallow

A
  1. Pre-Oral
    - Delivering food to oral cavity
  2. Oral
    - Sucking or chewing once food is received
  3. Pharyngeal
    - involuntary phase begins at tonsillar pillars
  4. Esophageal
    - Food enters esophagus
  5. Gastrointestinal
    - Food processed and delivered to stomach
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2
Q

4 Stages of Adult Swallow

A
  1. Oral prep
    - Mastication and bolus prep
  2. Oral Transit
    - bolus transported via action of tongue
  3. Pharyngeal
    - Begins when bolus reaches faucial arches
  4. Esophageal
    - Bolus propelled through esophagus by contraction above and relaxation below bolus
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3
Q

Muscles of Mastication

A
  • Masseter
  • Temporalis
  • Lateral pterygoid
  • Medial pterygoid
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4
Q

Laryngeal Inlet

A
  • Lateral borders > aryepiglottic folds > cuneiform cartilage contained within aryepiglottic folds
  • Anterior wall > thyroid cartilage
  • Vocal folds > below laryngeal inlet
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5
Q

Cranial Nerves Involved in Swallowing

A
  • Trigeminal
  • Facial
  • Glossopharyngeal
  • Vagus
  • Hypoglossal
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6
Q

Sphincters of the Swallow and Location - Adult Swallow

A
  • Lips
  • Velopharyngeal sphincter
  • Laryngeal sphincter
  • Upper esophageal sphincter
  • Lower esophageal sphincter
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7
Q

Penetration

A

Bolus contents pass into the larynx to a level ABOVE the level of the true vocal folds

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8
Q

Aspiration

A

Food, liquids, pills, secretions pass into airway BELOW the level of the true vocal folds

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9
Q

Silent Aspiration Possibilities

A
  • Hx of pneumonia combined with:
    – Weak or absent cough
    – Changes in body temp after eating
    – Wet vocal quality
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10
Q

Aspiration Pneumonia

A

Results from the entrance of foreign materials, usually foods, liquids, or vomit into the bronchi of the lungs with resultant infection

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11
Q

Negative Results of Aspiration

A
  • Aspiration pneumonia
  • Lung infections
  • Degydration
  • Malnutrition
  • Reduced enjoyment of eating
  • Reduced quality of life
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12
Q

Silent Aspiration

A
  • Penetration of food, liquid, or saliva to the subglottic area without the elicitation of a cough
  • 40% of dysphagia clients silently aspirate
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13
Q

Zenker’s Diverticulum

A
  • Typically results from increased pressure within the pharynx during swallowing
  • Often due to dysfunction in the mechanics of the UES
  • Cricopharyngeus muscle is a key component of the UES
    – Primary function is to relax and open to allow food to pass from the pharynx to the esophagus
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14
Q

Identification of Penetration on MBS/FEES

A
  • Material is below the epiglottis but above the vocal folds
  • Airway remains clear
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15
Q

GERD

A
  • Retrograde movement of gastric contents from stomach through the LES and into the esophagus
  • Most common symptom is heartburn
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16
Q

Symptoms of GERD

A
  • Noncardiac chest pain
  • Regurgitation of gastric contents
  • Water brash
  • Dysphagia
  • Odynophagia
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17
Q

Water Brash

A
  • Stimulated salivary secretion by esophageal acid
  • Excessive amount of saliva occurs and mixes with stomach acids that have risen to the throat
  • Causes bad taste in mouth and can lead to heartburn
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18
Q

Odynophagia

A
  • Pain upon swallowing
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19
Q

Globus

A
  • Sensation of a lump in the throat
  • May be caused by GERD
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20
Q

Esophagitis

A

Inflammation of the esophagus

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21
Q

Laryngopharyngeal Reflux Disease

A
  • Inflammatory disease of the larynx that originates in the stomach like other reflux disorders
  • Acid from stomach rises up to the level of the larynx and targets laryngeal tissues
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22
Q

LPRD Symptoms

A
  • Hoarseness
  • Vocal process granulomas
  • Coughing
  • Excessive phlegm in throat
  • Throat clearing
  • Severe cases
    – Excessive coughing
    – Occasional choking of liquids or foods
    – Globus
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23
Q

Barrett’s Esophagus

A
  • Lining of esophagus irritated and damaged from acid reflux
  • LES won’t close as tightly
  • Nonspecific complaints of heartburn and dyspepsia
  • Precursor to cancer
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24
Q

Dyspepsia

A

Indigestion

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25
Q

Trigeminal (V) Sensory

A
  • Tongue
  • Inferior alveolus
  • Buccal mucosa
  • Lower lip
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26
Q

Trigeminal (V) Motor

A
  • Mastication muscles
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27
Q

Facial (VII) Sensory

A
  • Anterior 2/3 of tongue (taste)F
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28
Q

Facial (VII) Motor

A
  • Muscles of facial expression
  • Lip closure
  • Cheek tension
  • Lip movements
  • Grasping
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29
Q

Glossopharyngeal (IX) Sensory

A
  • Oropharynx
  • Base of tongue
    – Supports taste fibers at base of tongue
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30
Q

Glossopharyngeal (IX) Motor

A
  • Stylopharyngeus muscle
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31
Q

Stylopharyngeus Muscle

A

Elevates pharynx

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32
Q

Vagus (X) - Recurrent Laryngeal Nerve

A
  • Innervates all laryngeal muscles except cricothyroid
  • Responsible for glottic closure during swallow
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33
Q

Vagus (X) - Superior Laryngeal Nerve

A
  • External division
    – Tenses vocal folds
  • Internal division
    – Sensation to larynx
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34
Q

Hypoglossal (XII) Motor

A
  • Tongue
    – Bolus control
    – Lingual strength
    – Lingual coordination
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35
Q

Pharyngeal Plexus

A
  • Main motor and sensory nerve supply to muscles of soft palate and pharynx
  • Acts to coordinate swallowing and speech
  • Has both motor and sensory fibers
  • Important for muscles of soft palate and pharynxP
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36
Q

Pharyngeal Plexus - Bundle of Intersecting Nerves

A
  • Pharyngeal branch of Vagus (X)
  • Accessory (XI)
  • Glossopharyngeal (IX)
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37
Q

Trigeminal (V) Motor - Result of Injury

A

Slight weakness in mastication

38
Q

Facial (VII) - Result of Injury

A
  • Slight weakness in bolus control
  • Weak lip closure
39
Q

Glossopharyngeal (IX) Sensory - Result of Injury

A
  • Failure to trigger pharyngeal stage of swallow
  • Premature spillage from mouth into airway
40
Q

Glossopharyngeal (IX) Motor - Result of Injury

A

Deficit from loss of function of stylopharyngeus secondary to intact function of other elevators of the larynx

41
Q

Hypoglossal (XII) - Result of Injury

A
  • Bolus control problems
  • Crippled swallow if bilateral
42
Q

Vagus (X) Superior Laryngeal Nerve - Result of Injury

A

Loss of protective glottic closure and cough reflex that protects airway from material on the supraglottic larynx

43
Q

Vagus (X) Motor - Result of Injury

A
  • Inadequate velopharyngeal closure, nasal regurgitation
  • Incomplete residue clearance in hypopharynx
  • Pooling above VF
  • Aspiration when VF open
  • Inadequate glottic closure during pharyngeal transit
44
Q

Oral Cavity

A

Responsible for bolus containment and preparation

45
Q

Oral Cavity Containment

A
  • Lips
    – Closure after bolus intake
  • Cheeks
    – Adequate tension to assist in lip closure
46
Q

Oropharynx

A
  • Oropharyngeal Propulsion Pump
  • Velopharyngeal Function
47
Q

Oropharyngeal Propulsion Pump

A
  • Soft palate
  • Lateral pharyngeal walls
  • Base of tongue
48
Q

Velopharyngeal Function

A
  • Soft palate
    – Elevates as tongue propels
  • Tongue elevation
    – Necessary for propulsion
49
Q

Hypopharynx

A
  • Muscular propulsion
  • Larynx
50
Q

Muscular Propulsion

A
  • Pharyngeal constriction
  • Piriform sinuses
  • Cricopharyngeal function
51
Q

Larynx

A
  • Closure
    – Glottis
    – Ventricular folds
    – Epiglottis
  • Pharyngeal squeeze
  • Hyoid elevation
52
Q

Esophagus

A
  • 1 UES opening
  • 2 primary peristaltic wave
  • 3 secondary peristaltic wave
53
Q

Oral Cavity

A
  • Buccinator
  • Orbicularis Oris
  • Soft palate
  • Tongue
54
Q

Buccinator

A
  • Seals lips
  • Keeps food on tongue
55
Q

Orbicularis Oris

A
  • Seals lips
  • Keeps food on tongue
56
Q

Soft Palate

A

Lowers and creates seal to prevent early leaking or spillage into oropharynx

57
Q

Tongue

A
  • Oral portion innervated by hypoglossal nerve (XII)
  • Base portion innervated by vagus nerve (X)
58
Q

Orbicularis Otis Muscle

A
  • Tenses cheeks
  • Lateral movement of corners of mouth
59
Q

Pharyngeal Constrictors

A
  • Superior pharyngeal constrictor
  • Medial pharyngeal constrictor
  • Inferior pharyngeal constrictor
60
Q

Masseter

A
  • Powerful jaw closure
  • Sling muscle with pterygoid
  • Jaw closing
61
Q

Temporalis

A
  • Biting and tearing food
  • Lateral movements of jaw
  • Jaw closing
62
Q

Medial Pterygoid

A
  • Powerful jaw closure
    – Sling muscle with masseter
  • Jaw protrusion
    – With lateral pterygoid
  • Jaw closing
63
Q

Lateral Pterygoid

A
  • Protrusion of jaw
    – with internal pterygoid
  • Mandibular lateralization
  • Oral cavity opening
  • Jaw opening/jaw retraction
64
Q

Digastric, anterior belly

A
  • Depress and retract the mandible when the hyoid bone is fixed
  • Jaw opening/retraction
65
Q

Digastric, posterior belly

A
  • Elevates hyoid bones and moves it forward
  • Jaw opening/retraction
66
Q

Mylohyoid

A
  • Depress and retracts the mandible when the hyoid bone is fixed
  • Jaw opening/retraction
67
Q

Geniohyoid

A
  • Depresses and retracts the mandible when the hyoid bone is fixed
  • Jaw opening/retraction
68
Q

Oral Prep - Adult

A

Mastication and bolus preparation

69
Q

Oral Transit - Adult

A

Bolus transported via action of tongue

70
Q

Pharyngeal - Adult

A
  • Bolus is transferred from oral cavity to pharynx
  • Begins when bolus reaches faucial arches
71
Q

Esophageal - Adult

A

Bolus propelled through esophagus by contraction above bolus and relaxation below bolus

72
Q

Oral Prep - Poor Lip Closure

A
  • Anterior spillage
  • Poor bolus control
  • Poor anterior/posterior propulsion
  • Lack of cohesive bolus
  • Premature spillage into pharynx
  • Stasis in pharynx
  • Possible decreased speech of moevement through esophagus
73
Q

Oral Prep - Poor Lip Closure Intervention (Oral Motor Exercises)

A
  • Lip closure tasks
  • Pucker swing
  • Puffing cheeks
  • Sucking and blowing exercises
74
Q

Oral Prep - Decreased Buccinator Strength

A
  • Pocketing on the affected side
  • Possible anterior spillage
75
Q

Oral Prep - Decreased Buccinator Strength Intervention (Oral Motor Exercises)

A
  • Lingual sweep
  • Finger sweep
  • Use of mirror
  • Digital assistance
  • NMES
76
Q

Oral Prep - Poor Lingual Lateralization

A
  • Decreased ability to move bolus from molars to tongue
  • Decreased ability to break down consistency of bolus
  • Inability to clear pocketed material
  • Poor bolus control
77
Q

Oral Prep - Poor Lingual Lateralization intervention (Oral Motor Exercises)

A
  • Lateral tongue exercises
    – Alternate puffed cheeks and suck in on cheeks
    – Tongue in cheek
    – Circles in cheek with tongue
  • Lingual sweep
  • Finger sweep
  • Use of mirror
78
Q

Oral Prep - Premature Spillage into Pharynx Intervention (Oral Motor Exercises)

A
  • Chin tuck
  • Thermal stim
  • Hard fast swallow
  • Masako
  • Velar exercise
79
Q

Oral Transit - Decreased Anterior/Posterior Lingual Movement

A
  • Poor tongue propulsion of bolus
  • Potential stasis in pharynx
80
Q

Oral Transit - Decreased Anterior/Posterior Lingual Movement Intervention (Oral Motor Exercises)

A
  • Alternating protrusion/retraction of tongue
  • Masako
  • Hard /k/ productions
81
Q

Oral Transit - Head/Neck Cancer

A
  • Poor population of the bolus
82
Q

Oral Transit - Head/Neck Cancer Intervention

A
  • Head position backward
  • Glossectomy
  • Spoon
  • Oral motor exercises
83
Q

Pharyngeal - Decreased Pharyngeal Peristalsis Intervention

A
  • Masako
  • Effortful swallow
  • Hard/fast swallow
84
Q

Pharyngeal - Stasis in Pyriform Sinus Intervention

A
  • Multiple swallows
  • Alternate liquids/solids
  • Effortful swallow
  • Masako
  • Hard fast swallow
  • Head turn to affected side
  • Head tilt to strong side
85
Q

Pharyngeal - Stasis Just Above UES Intervention

A
  • Mendelsohn maneuver
  • Multiple swallows
  • Shaker exercise
86
Q

Pharyngeal - Penetration Intervention

A
  • Masako
  • Hard fast swallow
  • Chin tuck
    – If due to premature spillage
  • Supraglottic swallow
  • Mendelsohn maneuver
  • Modify diet
    – Thickened liquids
87
Q

Pharyngeal - Delayed Initiation of Swallow Intervention

A
  • Chin tuck
  • Thermal stim
  • Hard fast swallow
  • Masako
88
Q

Esophageal - Poor Opening of UES Intervention

A
  • Mendelsohn maneuver
  • Multiple swallows
  • Shaker exercises
89
Q

Esophageal - Dysmotility of Esophagus Intervention

A
  • Alternate consistencies
  • Diet modifications
  • GI referral
90
Q

Pharyngeal - Stenosis of Esophagus Intervention

A
  • Alternate consistencies
  • GI referral
91
Q

Pharyngeal - Zenker’s Diverticulum Intervention

A
  • Diet modificaitons
  • ENT and/or GI consult
92
Q

Pharyngeal - Refl

A

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