Dysphagia

Question 1

best practice

Answer 1

evidence, experience, empathy

Question 2

5 key activities of pharyngeal stage

Answer 2

1. closure of velopharyngeal port
2. elevation of hyoid and larynx
3. closure of larynx
4. relaxation/opening of UES
5. tongue base retraction

Question 3

methods to evaluate swallowing

Answer 3

bedside swallow eval
MBS
manometry
ultrasound

Question 4

4 categories of swallowing treatment (Groher&Crary)

Answer 4

1. Behavioral (chin down, no straws)
2. Dietary (meats chopped, liquids thickened)
3. Medical (pharmacy, NG, botox)
4. Surgical (g-tube, thyroplasty)

Question 5

Why are elderly at risk for swallowing problems?

Answer 5

overall loss of muscle reserve, scoliosis, arthritis of neck, changes in structural anatomy, sarcopenia, sense of smell and taste buds decrease, poor dentition, uncoupled swallow

Question 6

Main neural control of swallowing

Answer 6

nucleus tractus solitari

Question 7

nucleus tractus solitari

Answer 7

located deep in medulla. main sensory processor for swallowing. identifies food/liquid by taste, processed immediately and sent to cortex

Question 8

nutritive sucking

Answer 8

for nutrition. 1 suck/second. apneic period (airway closed)

Question 9

non-nutritive sucking

Answer 9

for pleasure. 2 sucks/second. no apneic period (no not breathing period). Does NOT mean they can master nutritive sucking.

Question 10

Respiratory Distress Syndrome (RDS)

Answer 10

Will protect respiratory system through voluntary refusal to swallow (central inhibition of swallowing reflux). Affects lungs of premies due to lack of surfactant (fluid secreted by lungs to stabilize and prevent from collapsing)

Question 11

suck/swallow reflex

Answer 11

when lips/mouth touched, mouth opens and sucking begins and tongue immediately moves to back of mouth. Facilitates moving from breast to bottle.

Question 12

Failure to Thrive (FTT)

Answer 12

failure to grow based on established growth standards for age and gender. Children who don’t get adequate nutrition may never recover from the effects because CNS and brain still developing.

Question 13

When is a premie ready to eat?

Answer 13

off ventilator, cardiac/respiratory ok, bowel sounds ok, minimal respiratory distress in feedings, tolerance of bolus feedings, minimal risk for aspiration, can they get enough calories, can they do pleasure feeding

Question 14

Degree of cortical impairment depends on:

Answer 14

location of damage
extent of damage
type of damage
unilateral vs. bilateral

Question 15

oral agnosia

Answer 15

inability to recognize food. common in later stages of dementia and alzheimer’s

Question 16

trismus

Answer 16

cannot open mouth very much