Dysphagia Flashcards
If pt has aspirated following a p.o. trial with a regular solid (e.g. a cracker or cookie)
a. they will cough in an attempt to clear the airway in almost 95% of cases assessed bedside
b. the pt is not safe for any p.o. substance and should be NPO at that point
c. the clinician should evaluate a pt’s overall ability to successfully tolerate p.o. intake before making diet recommendations
d. they should automatically be limited to thin liquids and mechanical chopped diet
c. the clinician should evaluate a pt’s overall ability to successfully tolerate p.o. intake before making diet recommendations
if a pt has aspirated they can’t handle solids such as cracker and cookies, however they should be evaluated to assess their ability to tolerate thin liquids, mech soft and puree foods to make sure that those consistencies would be safe for oral consumption
A tracheostomy impacts speech production and swallowing by :
a. improving hyolaryngeal excursion
b. impairing oropharyngeal pressure
c. improving ability to manage secretions in the oral cavity and pharynx
d. improving ability to tolerate p.o intake
b. impairing oropharyngeal pressure
The coordination of breathing and intake of fluid in newborns is called:
a. suck and breathe
b. suck and swallow
c. suckle, breathe, wait
d. suck, swallow, breathe
d. suck, swallow, breathe
What CNs are involved in oral prep?
VII, XII
What CNs are involved in oral transit?
XII
What CNs are involved in pharyngeal stage?
IX, X, XI, and V, VII, XII
What are the four doors to airway closure?
true vocal cords
false vc
arytenoids
epiglottis flipping over like a lid to a teapot
What opens the UES?
the UES relaxes during the swallow
elevation of the larynx pulls the UES open
duration of opening increases as bolus volume increases
If the larynx moves, the UES moves
forming a lip seal
VII
Mastication
V and XII
bolus transit
XII
velopharyngeal closure, airway closure, and pharyngeal contraction (contraction of the velopharyngeal muscles
X
What can a chin tuck help with?
weak BOT
poor oral control
improves airway protection
residue in vallecula
who is a head turn good for?
good for pt with unilateral weaknesses and poor hyolaryngeal elevation bc opens the UES a little bit
supraglottic swallow
involves voluntarily holding one’s breath prior to and during swallowing ,then coughing immediately after the swallow, then dry swallowing
super supraglottic swallow
= effortful swallow + supraglottic swallow
pediatric anatomy differences
their oral cavities are proportionally smaller compared to their tongue. There is much less space bc the oral cavity is full of tongue which is helpful to suck on nipple
whole larynx is much higher in the neck, and as a consequence, there are 2 other salient findings:
1. body of tongue is wholly in the oral cavity (adults have oral and pharyngeal portion of the tongue)
What is suckling?
0-6 months
loose lips, reduced lip seal, tongue seals around nipple
not lips making the seal
wide mandibular excursions
tongue moves in and out
possible after more control of head posture occurs and some facial growth (increased intra-oral space)
what is sucking?
6-9+ months
tight lip seal, reduced tongue seal
reduced mandibular excursions bc tongue is involved more in contributing more to the feeding
tongue moves up/ down
a product of restricted intra-oral space, reduced tongue movements, and sensorimotor development
penetration
when food or liquid enters the vestibule of the larynx, but it’s above the true vocal folds
aspiration
anything that goes beneath the true vocal folds
FEES
can see BEFORE and AFTER the swallow → can NOT see the moment of the swallow (different than MBSS where you can see every part of the swallow) That is a downside to FEES. Can’t see aspiration during the swallow
what can you observe in a FEES?
VP closure, structural integrity of the larynx/pharynx, excess secretions, sensation (via touching epiglottis or arytenoid cartilage), and TVE abb/adduction
