DYSPHAGIA Flashcards
which phase includes base of tongue retraction and laryngeal vestibule closure?
pharyngeal
what would pyriform sinus residue indicate?
reduced laryngeal elevation
reduced UES opening
what would valleculae residue indicate?
reduced base of tongue retraction
what do posterior cricoarytenoid muscles do?
ABduct the VFs
which branch of the vagus nerve (CN X) supplies the TAs, IAs, LCAs, PCAs?
recurrent laryngeal
this test requires the individual to drink 3 oz of water. it also requires a brief cognitive screen. what test is this?
Yale Swallow Protocol
T/F: a clinical sign is something observed by the SLP during physical examination.
TRUE
which one is true regarding FEES?
A. can assess sensory function
B. can view the swallow as it happens
C. can view oral and oral prep phase
D. exposure to radiation
A. can assess sensory function
which of the following muscles is involved in mastication?
A. hyoglossus
B. superior longitudinal muscle
C. lateral pterygoid
D. levator veli palatini
C. lateral pterygoid
T/F: chin tuck would be most beneficial for reduced pharyngeal contraction, reduced tongue control/strength, and pyriform sinus residue.
FALSE
what would chin tuck be beneficial for?
delayed pharyngeal swallow, reduced airway closure, and for reduced TBR
head extension
compensatory strategy
super-supraglottic swallow
compensatory AND rehabilitative strategy
effortful swallow
compensatory AND rehabilitative swallow
mendelson maneuver
compensatory AND rehabilitative
which strategy is the following: Breathin, let some air out and hold your breath, put a small amount of food or liquid in your mouth, swallow, cough or clear your throat while exhaling, swallow again?
supraglottic swallow
do NOT perform with a bolus?
masako maneuver
at what age is it recommended to terminate nipple feeding?
12 months
which reflux is test by poking the bottom of a baby’s foot, causing the baby’s leg to withdraw and toes extend?
flexor withdrawal
at what age does transitional feeding occur?
4-7 months
which muscles ADduct the true vocal folds and help approximation of the ventricular folds?
LCA, IA, and TA
how do we know the pharyngeal swallow has been triggered?
first brisk hyoid movement
what moves the epiglottis into the horizontal position?
laryngeal elevation and tongue base retraction
which area is created by the BOT and epiglottis?
valleculae
muscle relaxes to open UES/PES
cricopharyngeus
which phase includes BOT retraction and LV closure
pharyngeal phase
which phase includes posterior bolus propulsion
oral phase
which structure moves posteriorly to meet the PPW?
base of tongue
which structures moves horizontally, then fully inverts over the LV?
epiglottis
which area goes around the laryngeal vestibule and ends above the UES/PES
pyriform sinuses
what events facilitates opening the UES/PES
laryngeal elevation
initiation of the pharyngeal swallow
pharyngeal MOTOR response to sensory input
what moves the epiglottis into the fully inverted position?
-laryngeal elevation
-pharyngeal contraction/ squeeze
which two structures come together at the top of the pharynx to push the bolus through the pharynx?
TB & PPW
muscles of the lips
orbicularis oris
zygomaticus
what structures close the LV laterally to medially?
true and false VF
what structures close the laryngeal vestibule posteriorly to anteriorly?
arytenoids tilt forward
residue in valleculae
d/t reduced BTR
residue in pyriform sinuses
d/t reduced laryngeal elevation or reduced UES opening
residue in valleculae
d/t reduced BTR
residue in pyriform sinuses
d/t reduced laryngeal elevation or reduced UES opening
when muscle contracts
structure at point of insertion moves closer to the structure at point of origin
orbicularis oris
opens, closes, protrudes inverts, and twist lips
zygomaticus
draw lip upward and outward
buccinator
flattens cheeks
uvulae
shortens and raises the uvula
cricopharyngeus
relaxes to allow food to pass through UES/PES
recurrent laryngeal nerve (branch of vagus)
TA
LCA
IA
PCA
superior laryngeal nerve (branch of vagus)
CT
can assess anatomy and physiology of upper aerodigestive mechanism used in swallowing
VFSS & FEES
can vary amount and textures
VFSS & FEES
able to view the pharyngeal swallow as it happen
VFSS
can view esophageal phase
VFSS
image lost during the actual swallow
FEES
can crudely assess sensory functions
FEES
can view management of secretions and reaction to them
FEES
can document penetration and aspiration
FEES
can document penetration and aspiration
VFSS & FEES
can EASILY view airway closure
FEES
can evaluate compensatory strategies
VFSS & FEES
readily accessible
VFSS (only if in the hospital)
FEES
portable
VFSS
FEES
exposure to radiation
VFSS
can view repeated swallows
VFSS & FEES
super-supraglottic swallow
compensatory AND rehabilitative
mendelson maneuver
compensatory AND rehabilitative
effortful swallow
compensatory AND rehabilitative
suckling
0-4 months
A-P tongue movements, loose lips, wide mandible excursion -> jaw opens and tongue moves back and forth
sucking
4-6+ months
superior to inferior tongue movements, lip closure, tongue grooving
NICU full term in weeks
37-40
late pre term
34-36 weeks
pre term
28-34 weeks
extremely premature
below 28 weeks
avg birth weight
over 2500 grams
overall neurologically immature; immature oral sensorineural skills; poor endurance; frequent state changes; hypotonia
preterm infants
NICU handling
cluster care
one stimulus at a time
read infant cues
positive touch
NICU major stress cue
apnea and bradycardia
SSB
suck, swallow, breathe coordination
swallowing begins in utero at how many weeks?
12-13
more stabilized pattern of rhythmic sucking and swallowing in utero at how many weeks?
34-36
coordination of suck swallow breathe process occurs when?
after birth
bottle and breast feeding milestone
4-6 monthst
transitional feeding age
4-7 months
spoon feeding age
5-7 months
cup drinking age
1 month after development of spoon feeding
termination of nipple feeding age
12 months
straw drinking age
variable (1-3 years)
chewing (normal rotary) age
24-36 months
biting
more advanced skill
do not start until child can move food from midline to lateral chewing
not spoon feeding by 9 months
criteria for referral
not able to chew or self-feed finger foods or a spoon by 18 months
criteria for referral
not drinking from a cup by 24 months
criteria for referral
excessive drooling past 5 years
criteria for referral
operant conditioning
using rewards and consequences to shape feeding behaviors
classical conditioning
associating new foods with positive experiences to reduce aversion
hypersensitive
lower threshold for sensory info
hyposensitive
not processing enough sensory info
stability
muscle tone and coordination contraction of the muscles
by what age can most infants control saliva?
6 months
sialorrhea
excess saliva
nonmaleficence
above all, do no harm
beneficence
avoid harm, but provide positive benefits as well
justice
fairness
what muscles adduct the true vocal folds and help approximation of the ventricular folds?
LCA
IA
TA
T/F: during FEES, the esophagus/ esophageal phase can be seen?
false
what is the distinction between supraglottic swallow and super-supraglottic swallow?
super supraglottic swallow requires you to hold you breath WITH EFFORT
T/F: pediatric VFs have a downward slant from posterior to anterior which is not found in adults
TRUE
how do we know the pharyngeal swallow has been triggered?
first brisk hyoid movement
when is instrumental swallow examinations warranted?
done after CSE, when clinical evaluation fails to answer relevant questions
what moves the epiglottis into the horizontal position?
laryngeal elevation and tongue base attraction
what is the main goal for instrumental swallow eval?
identify conditions under which patients CAN eat rather than keeping patients from eating orally
which area is created by the BOT and epiglottis?
valleculae
this muscle relaxes to allow the UES/PES to open?
cricopharyngeus
which phase includes bolus formation and manipulation?
oral prep phase
which phase includes BOT retraction and LV closure
pharyngeal phase
which phase includes posterior bolus propulsion
oral phase
which portion of the bolus enters the pharynx last?
bolus tail
which structure moves posteriorly to meet the PPW?
base of tongue
which structure moves horizontally, then fully inverts over the laryngeal vestibule/
epiglottis
which area goes around the laryngeal vestibule and ends above the UES/PES
laryngeal elevation
initiation of the pharyngeal swallow
the pharyngeal MOTOR response to sensory inputs
along with laryngeal elevation, what moves the epiglottis to the fully inverted position?
pharyngeal contraction/ squeeze
what two structures come together at the top of the pharynx to push the bolus through the pharynx?
TB and PPW
which muscles are we assessing, when we examine the pharyngeal stripping wave?
constrictor muscles
in this phase, the bolus passes through the UES, then through the LES?
esophageal phase
what are the two muscles of the lips?
orbicularis oris
zygomaticus
if the larynx doesn’t elevate fully, it will affect the UES in these ways
distance and duration
muscles of mastication
masseter, pterygoids, temporalis
which muscles elevate, tense, and retract the soft palate?
LVP, TVP, musculus uvulae
which muscles stabilize the floor of the mouth
geniohyoid, mylohyoid, digastricus, stylohyoid
extrinsic muscles of the tongue
genioglossus
hyoglossus
styloglossus
palatoglossus
which muscle facilitates posterior oral containment by raising the back of the oral tongue and drawing down the palate?
palatoglossus
intrinsic muscles of the tongue
longitudinal
transverse
vertical
other than laryngeal elevation, what do the long pharyngeal muscles do?
shorten and widen the pharynx
what are the long pharyngeal muscles?
stylopharyngeus
salpingopharyngeus
palatopharyngeus
what structures close the laryngeal vestibule laterally to medially
true and false VFs
what structures close the laryngeal vestibule posteriorly to anteriorly?
arytenoids tilt forward
