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PRAXIS! > Dysphagia > Flashcards

Dysphagia Flashcards

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1
Q

Left CVA lesion

A

deficits in oral phase and initiation of swallow, but better recovery of swallow function than right CVA

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2
Q

Right CVA lesion

A

deficits in pharyngeal phase and aspiration/penetration before swallow is initiated, delayed pharyngeal constriction.

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3
Q

Pons lesion

A

hypertonicity, delayed/absent swallow response, reduced laryngeal elevation, cricopharyngeal dysfunction, and slow recovery

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4
Q

Medulla lesion

A

longer pharyngeal response time, increased duration for velar and laryngeal elevation, delayed opening of UES

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5
Q

Subcortical lesion

A

mild oral and pharyngeal transit delays, aspiration, laryngeal penetration

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6
Q

Dementia clinical findings

A

trouble with bolus prep, self feeding, and food prep, prolonged oral stage

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7
Q

Basal ganglia (parkinson’s) clinical findings

A

repetitive tongue pumping, difficulty in all stages, progressive in nature

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8
Q

CN V

A

normal function: sensation in anterior ⅔ of tongue, sensation to teeth, gums, and oral mucosa, salivary flow to major and minor glands, motor control of mouth opening, mandible motion and mastication, motor innervation to floor of mouth muscles to elevate larynx and hyoid
Abnormal function: difficulty chewing, forming a bolus (oral stage deficits), inability to initiate swallow response, deficits in hyoid elevation, insufficient epiglottic tilt

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9
Q

CN VII

A

Normal function: taste in anterior ⅔ of tongue, sensation to soft palate, salivation from all salivary glands (except parotid), motor control of lip motion and bilabial seal, motor control for the facial muscles, floor of mouth, and cheeks, assists in elevation of hyoid and larynx to protect airway.
Abnormal function: loss of bolus through front of mouth, drooling, over or under salivating (oral stage deficits), pocketing of food, insufficient epiglottic tilt,

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10
Q

CN IX

A

Normal function: taste in posterior ⅓ of tongue, sensation to faucial pillars and soft palate, salivation from parotid, sensation to the pharynx and larynx, motor velopharyngeal closure, motor control of the upper pharyngeal constrictor muscle
Abnormal function: residue in the pharynx, nasopharyngeal regurgitation (incomplete seal due to decreased pharyngeal constriction), weakness in pharyngeal constriction, impaired opening of UES, impaired laryngeal elevation, inability to initiate swallow response

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11
Q

CN X

A

Normal function: controls sensory information for pharyngeal and esophageal phases, sensation for pharynx, larynx, and trachea, visceral sensory for mucosa of the valleculae, pharynx, larynx, lungs, stomach, and abdomen, motor innervation to the base of tongue and pharyngeal muscles, major innervation to the larynx, diaphragm, and lungs, pharyngeal contraction and esophageal peristalsis
Abnormal function: nasopharyngeal regurgitation (decreased pharyngeal constriction), decreased pharyngeal constriction (residue in the pharynx), aspiration due to incomplete closure of the v.f., silent aspiration due to decreased sensation in the larynx, residue in the pyriform sinuses, residue in valleculae, inability to propel the bolus, absence of peristalsis in esophagus

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12
Q

CN XI

A

Normal function: partial innervation of soft palate and uvula, assists with velopharyngeal elevation, partial innervation of muscles of upper pharynx, provides stability of shoulder and neck muscles during swallow and allow rotation of the head and neck
Abnormal function: nasopharyngeal regurgitation, residue in pharynx

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13
Q

CN XII

A

Normal function: motor for all tongue muscles, seal oral cavity and prepare bolus, motor innervation of the pharynx, aids in hyolaryngeal elevation and airway protection
Abnormal function: residue in the oral cavity, inability to form bolus, premature loss of bolus, residue in the vallecula, aspiration, penetration, insufficient epiglottic tilt

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14
Q

Temporalis

A

mandibular branch of CN V. raise/brace mandible, chewing, closing oral cavity

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15
Q

Masseter

A

mandibular branch of CN V. raise/brace mandible, chewing, closing oral cavity

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16
Q

Medial pterygoid

A

mandibular branch of CN V. raise/brace mandible, chewing, closing oral cavity

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17
Q

Lateral pterygoid

A

mandibular branch of CN V. lower/protrude/rock mandible, chewing

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18
Q

Obicularis oris

A

CN VII. seal lips/mouth

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19
Q

Buccinator

A

CN VII. push food toward teeth during mastication, help close mouth

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20
Q

Superior longitudinal

A

intrinsic tongue muscle, CN XII. shorten tip/deflect (up lateral)/concave bow tongue, bolus prep/formation/positioning/transport

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21
Q

Inferior longitudinal

A

intrinsic tongue muscle, CN XII. shorten tip/deflect (up lateral)/concave bow tongue, bolus prep/formation/positioning/transport

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22
Q

Transverse

A

Intrinsic tongue muscle, CN XII. narrow/lengthen tongue, bolus prep/formation/positioning/transport

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23
Q

Verticalis

A

Intrinsic tongue muscle, CN XII. broaden/flatten tongue, bolus prep/formation/positioning/transport

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24
Q

Hyoglossus

A

extrinsic tongue muscle, CN XII. lower/retract tongue, bolus prep/formation/positioning/transport

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25
Q

Genioglossus

A

extrinsic tongue muscle, CN XII. protrude/retract tongue, bolus prep/formation/positioning/transport

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26
Q

Styloglossus

A

extrinsic tongue muscle, CN XII. raise/retract tongue, bolus prep/formation/positioning/transport, seal oral cavity

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27
Q

Mylohyoid

A

suprahyoid, CN III. raise/stabilize hyoid. stabilize tongue, FOM

28
Q

Geniohyoid

A

suprahyiod, CN XII. raise/protract/stabilize hyoid bone

29
Q

Stylohyoid

A

suprahyoid, CN VII. raise/retract/stabilize hyoid, elongate mouth floor

30
Q

Anterior belly of diagastric

A

suprahyoid, CN III. raise/stabilize hyoid, lower mandible

31
Q

Posterior belly of diagastric

A

suprahyoid, CN VII. raise/retract/stabilize hyoid, lower mandible

32
Q

Omohyoid

A

Infrahyoid. Lower/stabilize hyoid

33
Q

Sternohyoid

A

Infrahyoid. Lower/stabilize hyoid.

34
Q

Thyrohyoid

A

Infrahyoid. Lower/stabilize hyoid, raise larynx to hyoid

35
Q

Sternothyroid

A

Infrahyoid. Lower/stabilize larynx

36
Q

Tensor veli palatini

A

CN V. Tense soft palate

37
Q

Levator veli palatini

A

CN XI and X. Raise/retract soft palate, widen entrance to oropharynx, seal nasopharynx

38
Q

Palatoglossus

A

CN XI and X. Raise uvula, brace soft palate

39
Q

Stylopharyngeus

A

CN IX. Raise/shorten pharynx, raise larynx

40
Q

Palatopharyngeus

A

CN XI and X. Lower palate, raise/shorten pharynx, raise larynx, seal oral cavity

41
Q

Salpingopharyngeus

A

CN XI and X. Raise/shorten pharynx, raise larynx

42
Q

Superior pharyngeal constrictor

A

CN XI and X. Narrow pharyngeal lumen, seal nasopharynx, bolus transport

43
Q

Middle pharyngeal constrictor

A

CN X. Narrow pharyngeal lumen, bolus transport

44
Q

Inferior pharyngeal constrictor

A

CN XI and X. Narrow pharyngeal lumen, bolus transport, most distal component of upper esophageal sphincter

45
Q

Lips/face/teeth OME

A

Nonspeech: Symmetry at rest; labial retraction, pucker, labial seal, raise eyebrows, wrinkle forehead, smile, frown
Speech: DDKs

46
Q

Jaw OME

A

Nonspeech: Symmetry, open, close, resistance, lateralization, tactile sensations, range of motion
Speech: bite block (not used normally)

47
Q

Velum/pharynx OME

A

Nonspeech: Position at rest, breathing nasality, gag reflex (no longer used to determine problems)
Speech: oral/nasal minimal pairs (note vs. dote), no nasal assimilation to oral consonant (bambi; pamper)

48
Q

Tongue OME

A

Nonspeech: Protrusion, lateralization, elevation, strength against resistance
Speech: DDKs, speech articulation

49
Q

Respiratory mechanism OME

A

Nonspeech: breathing at rest, rate, depth, quiet/noisy
Speech: MPT, habitual loudness, loudness range, syllables per breath

50
Q

Larynx OME

A

Nonspeech: cough, throat clear, larynx rise during swallow
Speech: sustain voice sounds; alternate voice/voiceless; voice quality (CAPE-V)

51
Q

Benefits of clinical examination

A

locus of the patient’s dysphagia, that is, whether it is oral or pharyngeal
patient’s readiness for a radiographic study
patient’s ability to accept food into the mouth
oral reaction to placement of various tastes, temperatures, and textures in oral cavity
presence of any oral apraxia, abnormal oral reflexes such as tonic bite
any particular postural and behavioral needs of the patient that must be addressed during the radiographic study.
Laryngeal Function as it may affect airway protection and aspiration during the swallow.
Coughing status
Decision on Best Posture
Best Position of Food in Mouth
Oral Sensitivity
Best Food Consistency
Selection of Optimum Swallowing Instructions (Posture or sequence of postures)

52
Q

Limitations of clinical examination

A

38 - 40% of patients who aspirate are not identified on clinical examination
Pharyngeal events are not observable
Basis for aspiration cannot be determined

53
Q

Benefits of VFSS (MBS)

A

Dynamic
Thorough
Unlimited review capacity
Readily available in hospital setting

54
Q

Limitations of VFSS (MBS)

A 
Exposure to radiation
“Snapshot” of swallow function
Abnormal environment
Transport to radiology may be problematic
Not easily accessible outside hospital
55
Q

Benefits of FEES

A

No radiation exposure
equipment is portable,
The clinician can assess VPI (velopharyngeal incompetence) and vocal cord issues
Gives immediate results

56
Q

Limitations of FEES

A

Invasive - Difficulty maintaining cooperation in 12 mos - 4 yrs olds
doesn’t give info on interaction of oral, pharyngeal and esophageal phases of swallowing

57
Q

How is the modified evans blue dye test performed?

A

EBDT -Described by Cameron et al 1973
–Place 4 drops of aqueous solution of Evans blue dye on patient’s tongue q 4 hours
–Monitor tracheal secretions for bluish discoloration for 48 hours
–Any evidence of blue dye in tracheal secretions indicates aspiration
–Perform routine tracheostomy care
Components of MEBDT:
•Color liquids and solids with blue dye
•Deflate cuff
•Present boluses in order of difficulty
•Suction after each bolus consistency
•Examine tracheal secretions for evidence of blue tint
•Recommend diet; specify compensations and conditions of PO intake

58
Q

What are the limitations of MEBDT?

A

Not sensitive enough to detect trace aspiration, increased risk for sepsis, burns, shock, surgical intervention, renal failure, celiac sprue, IBD

59
Q

Oral stage deficits

A

Lips don’t seal, no teeth, flaccid cheeks, drooling, poor bolus formation, prolonged oral stage, unable to propel bolus, reduced/weak lingual movement, kinking of the soft palate, loss of bolus over base of tongue, premature leakage

60
Q

Pharyngeal phase deficits

A

poor soft palate seal, nasopharyngeal regurgitation, sluggish elevation of the soft palate, constrictors don’t contract, unilateral asymmetry, retention in vallecula/pyriforms, absent hyoid elevation, incomplete/absent epiglottic tilt, vocal folds open during swallow, aspiration/penetration, problem with cricopharyngeus opening late/closing early

61
Q

Esophageal stage deficits

A

dysmotility, reflux, spasms, stenosis, diverticulum, GERD, fistula

62
Q

How can a tracheostomy affect swallowing?

A

Restriction of laryngeal elevation, decreased laryngeal sensitivity, decreased glottal pressure, interrupts the cricopharyngeus, causes difficulty in expelling air

63
Q

Be able to state factors which increase risk of aspiration pneumonia in individuals with dysphagia

A

Impaired consciousness, poor mobility, COPD, medication, age, poor oral hygeine

64
Q

State the main limitations of electrical stimulation as a therapeutic intervention.

A

Many limitations to existing research (ie., unequal treatment, dosage of stim unreported, multiple
threats to internal/external validity)
Unanswered questions (which muscles stimulated?, where place electrodes, effects LT/ST?)
Potential for harm - anecdotal reports worsen swallow & ES resulted in decreased hyoid elevation
Surface ES stimulates superficial, not deep muscles
Lost time (family & clinician)
Slowed progress
Lost hope and misplaced trust
Loss of credibility

65
Q

Know the steps of a clinical/bedside swallow evaluation from referral through recommendations

A
  • Interview patient and caregivers
  • Examine speech/swallow components
  • Observe what happens when patient is fed
  • Teach compensations
  • Tailor instrumental exam
66
Q

Assessment of functional components

A

Respiratory- breathing rate, sustained phonation, loudness
Laryngeal- laryngeal elevation, sustained phonation, voice quality (rough, strained), voiced/voiceless contrasts
Velum/pharynx- mirror under nose, nasal sounds (look for nasal assimilation or stuffiness)
Tongue- protrusion, DDK
Lips/face/teeth- pucker, raise eyebrows, DDK
Jaw- open against resistance, range

67
Q

Understand how a tracheostomy cannula may preclude some swallowing strategies

A 
Restriction of laryngeal elevation
Decreased laryngeal sensitivity
Decreased glottal pressure
Interrupts the cricopharyngeus
Causes difficulty in expelling air

PRAXIS! (7 decks)

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