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Dysphagia Flashcards

1
Q

Stage 1 of Swallow
Oral Prep

A
  • Voluntary (except salivary response)
  • Food is masticated and mixed with saliva (bolus is formed)
  • Posterior of tongue and soft palate are elevated
  • Labial seal with buccal tension
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2
Q

Stage 2 of Swallow
Oral Transport

A
  • Breathing cessation (stops)
  • Posterior propulsion of bolus via anterior-posterior lingual rolling pattern
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3
Q

Transition Point 1 of Swallow

A

Base of tongue retraction to posterior pharyngeal wall

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4
Q

Stage 3 of Swallow
Pharyngeal

A
  • Involuntary
  • Sensory info relayed to swallowing center in medulla (CN IX)
  • Palatopharyngeal folds adduct, bolus passes through this slit
  • Velum is raised
  • Upper pharynx narrows and crosses cricopharyngeal muscle
  • Tongue is still retracted (prevents food from coming back up)
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5
Q

Stage 4 of Swallow
Laryngeal

A
  • Larynx and hyoid bone are pulled superiorly and anteriorly
  • Enlarges pharynx
  • Creates a vacuum (pulls bolus downward)
  • Opens cricopharyngeal muscle (closed at rest)
  • True and false vocal folds adduct
  • Epiglottis covers larynx protecting the airway; diverts bolus into pyriform sinuses
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6
Q

Transition Point 2 of Swallow

A

Opening of cricopharynx

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7
Q

Stage 5 of Swallow
Esophageal

A
  • Involuntary
  • Bolus is moved down the esophagus via peristalsis (wave like motion) and gravity
  • Larynx lowers and returns to rest position
  • Cricopharyngeal muscle closes to prevent reflux
  • Respiration resumes
  • 8-20 seconds in duration
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8
Q

Cricopharyngeal muscles

A
  • UES, closed at rest to prevent the reflux of food from the esophagus into the throat
  • Opens when a person swallows and allows food to pass
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9
Q

Sign of aspiration

A

Infiltration in right mid lobe-

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10
Q

Esophageal stricture

A

A muscular tube whose primary function is to transport food from oropharynx to stomach via peristalsis (UES and LES)

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11
Q

Zenker’s diverticulum

A

Pouch at lower throat, cricopharyngeal muscle fails to relax during the swallow

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12
Q

Palpation

A
  • Feel the swallow
  • 3 contact points for palpation
    1. Base of tongue/ hyoid
    2. Thyroid notch/ laryngeal prominence/ Adam’s apple
    3. Cricoid cartilage
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13
Q

Frazier Free Water Protocol

A

Encourages patients to take small sips of water or have ice chips 30 minutes after their meal

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14
Q

When INFLATED, the cuff of a tracheostomy tube is designed to

A

Prevent air leakage and seal off the upper airway (needed for ventilator use or to reduce work of breathing)

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15
Q

The Penetration Aspiration scale

A

8 point scoring system to determine how much residue enters the airway

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16
Q

Lack of Laryngeal Closure

A

Penetration- above vocal folds (VF)
Aspiration- below vocal folds (VF)
Decreased ability to generate adequate hypopharyngeal pressures to propel the bolus through the pharyngoesophageal segment and into the esophagus

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17
Q

Passy Muir Valve

A

Small, one-way valve that helps people with tracheostomies (trach tubes) speak and breathe more naturally. It attaches to the opening of the trach tube

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18
Q

How Passy Muir Valve works
Step 1

A

Inhaling
- Air enters through the tracheostomy tube into the lungs
- The valve stays open to allow easy inhalation

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19
Q

How Passy Muir Valve works
Step 2

A

Exhaling
- The valve automatically closes when the person exhales
- This forces air up through the vocal cords instead of exiting through the trach tube
- The air passes out through the mouth and nose, allowing speech, coughing, and smelling

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20
Q

Cuff of the trach must be _______ when used with Passy Muir in order to allow air to be exhaled

A

Deflated (Pt will not be able to breathe if not)

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21
Q

What does “No Leak” design of the Passy Muir Valve mean

A

the valve is always in a closed position until the patient inhales

22
Q

Flexible Endoscopic Evaluation of Swallowing (FEES)

A
  • Evaluates the swallow before and after the pharyngeal swallow
  • Observe quiet and forced respiration, coughing, speaking, and dry swallows
23
Q

One downfall of FEES

A
  • Whiteout phase: During swallow and airway closure, the pharyngeal walls contract and blocks the view of the endoscope
24
Q

Modified Barium Swallow (MBS)/ Also called Videofluoroscopic swallow study (VFSS)

A
  • Dynamic assessment of the oral, pharyngeal, and esophageal phases of swallowing
  • Requires a fluoroscopic unit, video recorder, and foods and liquids coated or mixed with barium
  • Frontal and lateral dynamic x-rays are obtained with the fluoroscope
25
Masako Maneuver (Tongue Hold)
- Protrude tongue slightly from mouth and stick tongue out between your teeth to hold it in place - Hold this position with your tongue and swallow (makes tongue base work harder)
26
Effortful Swallow
- Swallow normally but squeeze very hard with your tongue and throat muscles throughout the swallow. - Increases tongue base retraction and pressure during the pharyngeal phase of the swallow and reduces the amount of food residue in the valleculae of the throat
27
Mendelsohn Maneuver
- Swallow normally and feel the larynx lift during the swallow. - On the next swallow, feel your larynx elevating and hold it up with your neck muscles. - Do not try to lift the larynx early and let the larynx lift normally and then hold it up so that it does not drop - Then, complete the swallow - Increases laryngeal elevation and increases the extent and duration of cricopharyngeal opening
28
Supraglottic Swallow
- Take a deep breath and hold breath while swallowing bolus - Cough immediately after the swallow and then swallow again - Closes the vocal folds to protect the upper airway well in advance of the bolus arriving
29
Super-Supraglottic Swallow
- Hold your breath very tightly and continue to hold your breath tightly while swallowing - Clear your throat/cough immediately after swallowing and then swallow again. - Helps to close the airway at the vocal fold level before and during swallow - Patients with uncontrolled high blood pressure should not use this
30
Shaker Exercise (Head Lift) Part One
Lie flat, keeping shoulders on the bed/mat and raise your head to look at the toes. Maintain position for 60 seconds and repeat 2 more times.
31
Part Two (repetitive movement)
- In the same starting position, raise the head to look at the chin, then lower the head back to the bed (repeat 30 times) - Helps those who exhibit reduced superior and anterior movement of the hyolaryngeal complex
32
Valsalva Maneuver
Exhale with the nostrils and mouth, or the glottis, closed to help achieve better closure of the larynx
33
Head Turn
- Turn the head/neck to either the left or right side prior to swallowing the bolus - Turning the head toward the weaker side has been shown to direct the bolus through the pharynx via the stronger side and seals off pyriform sinus
34
Head Tilt
- Tilt the head to the stronger side to direct the bolus down the most intact side - Used for unilateral oral or pharyngeal weakness or if patient is pocketing their food
35
Head tilt vs. head turn
* Strong side: head tilt * Weak side: head turn
36
Chin Tuck
- Direct the chin toward the chest prior and during the swallow - Gives more time for VF's to close and reduces risk of aspiration
37
Head Back
- Helps with posterior propulsion of the bolus by using gravity to assist - For someone with a tough time propelling the bolus back because of poor tongue control - Used only in patients with adequate laryngeal closure
38
Orotracheal
Entrance to trachea via oral cavity
39
Nasotracheal
Entrance to trachea via nasal cavity
40
Tracheostomy
- Surgical opening of the trachea - Tube placement to maintain airway opening
41
Cricothyrotomy
Trauma emergency exception
42
42
STARSS Acronym
MUSCLE STRENGTH MUSCLE TONE ACCURACY OF MOVEMENT RANGE OF MOVEMENT SPEED OF MOVEMENT STEADINESS OF MOVEMENT
43
Schatzki's Ring
- Ring of tissue that forms inside the esophagus - Makes the esophagus narrow in one area, close to where it meets the stomach (bottom) - Can make it hard to swallow - May feel like food gets stuck in your esophagus
44
Barrett’s esophagus
Esophagus becomes damaged by acid reflux, which causes the lining to thicken and become red
45
Cranial Nerves Involved in Swallowing
1. Vagus Nerve (CN X) 2. Trigeminal Nerve (CN V) 3. Glossopharyngeal Nerve (CN IX)
46
2 parts of vagus nerve involved in the swallow
1. Recurrent Laryngeal Nerve (RLN) - Innervates all laryngeal muscles, except the cricothyroid - Responsible for glottic closure during swallowing 2. Superior Laryngeal Nerve (SLN) - Internal and external divisions
47
Esophageal stricture
A muscular tube whose primary function is to transport food from oropharynx to stomach via peristalsis (UES and LES)
48
Cervical Auscultation
- Stethoscope is placed at the lamina of the thyroid cartilage (bilaterally or medially) - Swallow is assessed auditorily during three stages
49
3 stages swallow is assessed during cervical auscultation
1. Pre-Swallow (range = 20-30 seconds) 2. Moment of Swallow (0.4-1 second) 3. Post-Swallow(range = 20-30 seconds)
50
First step during dysphagia assessment
Bedside Swallow Exam Then video exam

Speech Pathology Comps (7 decks)

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