dysphagia

Question 1

dysphagia in stroke is located in what 3 areas of brain

Answer 1

In cases of stroke, dysphagia is traditionally associated with brainstem lesions or bilateral cortical damage, unilateral hemispheric lesions

Question 2

swallowing occurs in what two phases? - unlateral hemispheric lesions

Answer 2

Swallowing occurs in voluntary (oral) and involuntary (pharyngeal) phases, hence, damage to voluntary and involuntary components of neurological function can affect dysphagia after a stroke

Question 3

how does swallowing use bi-hemispheric components of neurological function?

Answer 3

left hemisphere was more associated with the voluntary oral phase of swallowing, whereas the right hemisphere was more associated with the reflexive (involuntary) pharyngeal phase and aspiration as a complication.

Question 4

oral phase swallowing dysfunction has difficulty with doing what? and what brain track lesions?

Answer 4

-interrupt voluntary control of mastication and bolus transport
-corticospinal and corticobulbar tracts

Question 5

Pharyngeal dysfunction involves relatively large brain areas called?

Answer 5

corona radiate

Question 6

neural pathways involved in activation of the motor system are asymmetrically organized in humans. The right hemisphere plays a dominant role in activating? The left hemisphere mainly activates?

Answer 6

right- both ipsilateral and contralateral motor neurons
L- ipsilateral motor neurons.

https://www.youtube.com/watch?v=MhI4ZHLA7xg

Question 7

define dysphagia

Answer 7

“dysfunction in any stage or process of eating. It includes any
difficulty in the passage of food, liquid, or medicine, during any stage of
swallowing that impairs the client’s ability to swallow independently or safely.”

Question 8

how is Swallowing is an essential activity of daily
living:

Answer 8

the inability to swallow negatively affects nutrition, overall health, and quality of life.

Question 9

diagnosis with dysphagia

Answer 9

cva- cebrebovasuclar accident, parkinson’s, elderly institutionalized patients

Question 10

EAT-10 eating assessment tool questions is used as what kind of tool and it’s purpose, what score means more assessment needed?

Answer 10

quick screening tool for subjective symptoms
initial dysphagia severity and monitor the treatment response
3 or more areas an issue to undergo further assessment

Question 11

MISA McGill- 4 areas it assesses?

Answer 11

positioning, self feeding skills, oral motor skills, texture management

Question 12

What are the therapy treatment options (3)

Answer 12

management / compensation
rehabilitation
or both

Question 13

reasons for Compensatory treatment? why is it commonly used by clinicians? What should be considered?

Answer 13

• Accommodates or compensates for underlying
  swallowing disorder
• “Works” when used – disorder still exists when not
  used
• Commonly used by clinicians:
  – Can improve safety/nutrition to allow intake
  – In populations where rehabilitation may not be
  feasible
• Consider if this is the only approach

Question 14

reasons for Rehabilitation approach?

Answer 14

• Used to improve swallowing function
• Improve skill, alter underlying
  pathophysiology
• Principles of plasticity:
  – Muscle
  – Behavioural
  – Neural

Question 15

10 principals of nuro plasticity

Answer 15

-use it or loose it
-Use It and Improve It
-plasticity is experience specific
-repetition matters
-intensity matters
-time matters (pairing compensatory strategies with
those that access neural adaptation early in recovery)
-transference
-interference
-age
-salience matters (movement is purposeful and related to the behavior being trained)

Question 16

define the use it or lose it neuro plasticity prinicpal and how does it relate to dysphagia?

Answer 16

-if a neural substrate is not biologically active, its function can degrade
-Following brain injury further cortical loss can occur without training, as the movements formerly represented in the lesioned zone do not reappear in adjacent cortical regions
-Failure to drive specific brain function through training can lead to further degradation of a function
-disuse of the swallowing mechanism may diminish its cortical representation and poses a threat to functional recovery in the long term

Question 17

is asperation alleviated by tube feeding? (aspiration pneumonia)

Answer 17

it is now recognized that aspiration is not alleviated by tube feeding

Question 18

Use it or Lose it - nero plasticity - rehabilitation goal and method for oropharyngeal dysphagia life threatening aspirations and reasoning?

Answer 18

hypothesized that they should be offered systematic swallowing drills but without using a bolus.
The goal would be to improve their swallowing skill, albeit only on dry or saliva swallows. Intuitively, such activity — if it emphasizes multiple repetitions of more immediate, stronger swallows — will help preserve cortical and subcortical representations and make the patient’s return to oral nutrition easier and faster.

Question 19

define behavioural plasticity

Answer 19

behavioral plasticity, operationally defined as apparent change in task performance without clear evidence of associated neural systems alteration(s)

Question 20

Use it and Improve it extends the Use it and lose it prinicpal, define the theory. What two systems are we trying to connect ultimately?

Answer 20

-with increased biological activity, future functioning is enhanced, especially if that activity involves skill training or what could be called target practice
-important: use a function with increasing competence, whether that competence is measured as efficiency or accuracy.
-simply swallowing will not necessarily improve swallowing by a person with dysphagia

trying to connect: discover which of these methods, in which patients, has maximum effects on both behavioral and neural plasticity.

Question 21

give example/ explain how connecting a trained motor gain can trigger a nero response?

Answer 21

training with strenthening of oral motor accuracy seems to trigger the pharyngeal swallow which is a different pathway - neuro

training in other abilities can lead to an enhancement of function and the underlying neural mechanisms involved in that behavior
A testable hypothesis is when a normalized motor pattern accompanies a stronger oral phase; the volitional oral events are recognized more readily and therefore trigger the pharyngeal swallow response more efficiently. Such events may be a function of neural plastic adaptation.

Question 22

repetition matters (neuro plasticity)- consistent practice allows 2 improvements
intensity has two affects?

Answer 22

-From a clinical perspective, findings suggest a source of evidence to support the need for consistent practice to acquire and maintain an improved swallow.
-there is a threshold of intensity required to elicit neural changes and also the possibility of excitotoxicity with too great a level of stimulation: training long does not necessarily imply training hard.
evidence suggests: that low-intensity treatment is unlikely to support maximum behavioral or neural plasticity.

Question 23

Salience - nero plasticity
how does this apply to learning?

Answer 23

To be aware of things that are more important or striking to that person

neural plasticity is best induced when the movement is purposeful and related to the behavior being trained

Learning has been shown to be as related to the behavioral importance of the stimulus as it is to the frequency of occurrence, so a stimulus that is relevant to the organism

Question 24

Age matters - neural plasticity

Answer 24

Younger nervous systems are more responsive to training and adaptive neural plasticity than older ones - neural plasticity does occur over the lifespan, although outcomes are demonstrated to decrease with age

Question 25

define interference in neuro plasticity, the result, and an example.

Answer 25

Interference refers to “the ability of plasticity within a given neural circuitry to
impede the induction of new, or expression of existing, plasticity within that same circuitry”
The result is that learning or skill acquisition or reacquisition may be hampered.

example: literature suggesting that compensatory activities such as using the unimpaired limb following damage to a limb on the other side of the body may cause nervous system changes; in fact, such changes impede recovery in the affected limb and may impact subsequent rehabilitation of the impaired function

Question 26

The oropharyngeal swallow has been represented as a complex function comprised of how many physiologic components?

Answer 26

14 physiologic components

Question 27

The primary role of swallowing rehabilitation is?
swallowing requires coordinated activity of both?

Answer 27

-to effect change (improved strength, duration, and timing of movement)
-requires the coordinated activity of neural mechanisms distributed across both cranial and spinal nerve systems

Question 28

The neural networks are referred to as central pattern generators (CPGs) in relation to dysphagia? how is the network organized and what does it allow?

Answer 28

-Similar to breathing, chewing, and walking, interneurons have been identified in the brain stem that can generate a basic swallowing pattern in the absence of ascending (sensory) or descending (cortical) inputs.
-flexibly organized neural networks
-allows coordinated activity within the swallowing system but also the cross-system coordination with respiratory and laryngeal systems

Question 29

Interventions - Sensory: what aspects can be modified? two areas change sensory imput?

Answer 29

All aspects of oropharyngeal swallowing have been found to be modifiable with varying sensory input.
-Bolus characteristics
-stimulation of structures with thermal, tactile, gustatory, and electrical stimulation

Question 30

Interventions- Bolus: name 5 sensory changes regarding bolus

Answer 30

volume, viscosity, thermal, taste, tactile

Question 31

Several aspects of oral and pharyngeal swallowing are altered with bolus volume, including: (6)

Answer 31

-timing and extent of structural movement,
-duration of laryngeal vestibule closure,
-anterior and superior hyo-laryngeal movement,
-upper esophageal sphincter(UES)opening,
-base of tongue to posterior pharyngeal wall approximation,
-respiration cessation during swallowing

Question 32

Compensatory interventions are used in the treatment of dysphagia to compensate for? .They include? These treatment techniques exploit? The majority of these techniques seek to? in this way compensatory interventions are ______ with anticipated ______ effect.
When used alone what is not expected to occur?

Answer 32

-structural and physiologic deficits
-alterations in diet consistency or positioning
-retained abilities
-alter the circumstances of the swallow instead of the swallow patterns themselves
-behavioral / temporary
-not believed to modify neural plastic underpinnings as a treatment outcome

Question 33

Motor exercises accomplished during swallows are used to?
Their use is predicated on the assumption that changes in what 3 things?
In response to specific exercises that increase: what 3 things?
What pathway are motor exercises using?

Answer 33

-reduce the deficiencies within the swallow pattern itself
-muscle strength, range of motion, and coordination
-the effort, duration, and force of muscle patterns.
-musculo-spinal pathways

Question 34

This “motor with swallow” category of techniques centers on the principles of _______________ neural plasticity
what 3 areas of neuro plasticity support this?
what is the goal?
this may result in the preservation of ______ and the maintenance of allocated ________ representation

Answer 34

-experience-dependent neural plasticity
-Use It or Lose It, Use It and Improve It, and Repetition Matters.
-goal of increasing the success of the swallow itself

synapses
cortical

Question 35

The “motor without swallow” includes exercises to?
Non-swallowing exercising of the oral, pharyngeal, laryngeal, and re-spiratory (i.e., swallowing) musculature holds a great deal of promise in treating individuals with severe dysphagia, why?

Answer 35

-improve range of motion and strengthening (lingual, velar, pharyngeal, laryngeal [non-speech and speech], and respiratory)
-allows patients to progress through a training regimen safely without limitations that may be imposed if the swallowing of boluses is necessary for functional gain
-

Question 36

“motor without swallow”
evidence exists that some of the swallowing musculature has a propensity for increasing?
and this translates into?
Behavioral plasticity of swallowing has been demonstrated from three different non-swallowing exercising techniques:

Answer 36

muscle strength/tone with non-swallow exercising
improved function (behavioural plasticity)
lingual exercising, head lifting, and LSVT ( LVST = Lee Silverman Voice Treatment)

Question 37

Lingual Exercise showed an increase in what? it is a _____strengthening exercise.
as a result, improvement in swallowing pressures of what occured? some showed improvement in _______ aswell.

Answer 37

non-swallowing
lingual strength increased
on liquid boluses occurred
speech

Question 38

head lifting exercise

head-lifting exercises and experienced increased what physically? (Shaker et al., 1997). In addition
improved swallowing function was reported, with de-creased? and an ability to return to?

Answer 38

laryngeal anterior excursion and cross-sectional opening of the UES
post swallow aspiration
various levels of oral intake

Question 39

InParkinson’s patients observed that 3 things decreased following completion of 1 month of LSVT?
what does LSVT stand for?

Answer 39

oral transit time, pharyngeal transit time, and vallecular residue
LVST = Lee Silverman Voice Treatment

Question 40

motor exercises without swallow have been shown to increase? 3 things

Answer 40

range of motion and strength in those muscles used for swallowing, to improve the swallow itself, and to demonstrate associated behavioral plasticity.

Question 41

compensatory treatment is a quick-fix, these immediately executable interventions have 3 notable negative things?

(e.g., postural adjustment)

Answer 41

ex postural adjustment
appear to have no long-lasting effects,
must be implemented for each swallow,
and may diminish the pleasure associated with dining

Question 42

nero plasticity - what questions should the clinician ask to improve the clinician’s ability to effect significant and long-lasting improvement?

Answer 42

who to treat,
at what intensity,
how many repetitions,
when to initiate interventions in the course of the disease