dysphagia Flashcards
except for voluntary manipulation and preparation of food, swallowing is primary ____
involuntary (pg.364)
______ is difficulty or abnormality in moving food from the mouth to the stomach
dysphagia (pg.364)
what muscle composes the upper esophageal sphincter?
cricopharyngeal muscles (pg. 364)
the ______ contains the epiglottis, valleculae, pyriform sinuses and laryngeal aditus
laryngeopharynx (pg.364)
a. trigeminal V
b. facial VII
c. glossopharyngeal (IX)
d. vagus (X)
e. spinal accessory (XI)
f. hypoglossal (XII)
- sensation in anterior 2/3 of tongue (hot, cold, oral pain)
- 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
a. trigeminal V (pg.364)
a. trigeminal V
b. facial VII
c. glossopharyngeal (IX)
d. vagus (X)
e. spinal accessory (XI)
f. hypoglossal (XII)
- taste in anterior 2/3 of the tongue
- sensation to soft palate
- salivation from all salivary glands except parotid glad
- motor control of lip motion and bilabial seal
- motor control for the facial muscles, FOM muscles and cheeks
- assists in elevation of hyoid and larynx to protect airway
b facial VII (pg.364)
a. trigeminal V
b. facial VII
c. glossopharyngeal (IX)
d. vagus (X)
e. spinal accessory (XI)
f. hypoglossal (XII)
- taste in posterior 1/3 of tongue
- sensation to faucial pillars and soft palate
- salivation from the parotid gland
- sensation to the pharynx and larynx
- motor velopharyngeal closure
- motor control of the upper pharyngeal constrictor muscles
c. glossopharyngeal IX (pg.365 )
a. trigeminal V
b. facial VII
c. glossopharyngeal (IX)
d. vagus (X)
e. spinal accessory (XI)
f. hypoglossal (XII)
- controls sensory information for pharyngeal and esophageal phases
- motor innervation to the base of the tongue and all pharyngeal muscles
- major innervation to the larynx, diaphragm and lungs
- pharyngeal contraction and esophageal peristalsis
d. vagus X (pg. 365)
a. trigeminal V
b. facial VII
c. glossopharyngeal (IX)
d. vagus (X)
e. spinal accessory (XI)
f. hypoglossal (XII)
- partial innervation of soft palate and uvula
- partial innervation of muscles of upper pharynx
- primary function is to provide stability of shoulder and neck muscles during swallowing and allow rotation of head and neck
e. spinal accessory XI (pg.365)
a. trigeminal V
b. facial VII
c. glossopharyngeal (IX)
d. vagus (X)
e. spinal accessory (XI)
f. hypoglossal (XII)
- primary motor for all tongue muscles
- motor innervation of the pharynx (aids in hyolaryngeal elevation and airway protection
f. hypoglossal XII (pg. 366)
the swallowing center is located in the ____ and _____
medulla and pons (pg. 366)
a. oral prep
b. oral phase
c. pharyngeal phase
d. esophageal phase
- entirely voluntary
- manipulate bolus to swallow-ready state
a. oral prep (pg.366)
a. oral prep
b. oral phase
c. pharyngeal phase
d. esophageal phase
- partially voluntary, because it requires some cortical control
- bolus is transferred to pharynx
b. oral phase (pg.366)
a. oral prep
b. oral phase
c. pharyngeal phase
d. esophageal phase
- the bolus flows vertically through the pharynx to the esophagus while the airway is protected from bolus entry
- this stage is involuntary
c. pharyngeal phase (pg. 367)
how long does the pharyngeal phase last?
1.5 seconds (pg.367)
a. oral prep
b. oral phase
c. pharyngeal phase
d. esophageal phase
- totally involuntary
- lasting 8-10 seconds
- the bolus is moved into the stomach
d. esophageal phase (pg.367)
what cranial nerve innervates the esophagus?
CN X (pg.367)
what is sarcopenia?
what is affected?
muscle wasting (pg.367)
affects tongue muscle and swallow function in older people
what are the most common neurological conditions that result in dysphasia?
- stroke
- parkinson’s disease
(pg. 371)
true/false: bilateral damage to the pons and medulla may cause total dysphagia with poor prognosis
true (pg. 372)
true/false: subcortical stokes will have mild symptoms including mild oral and pharyngeal transit delays
true (pg.372)
a. right
b. left
______ hemisphere damage is more susceptible to pharyngeal problems such as delayed pharyngeal stripping wave motion
- mild oral delays, longer pharyngeal delays
- aspiration before or during swallow due to incomplete laryngeal elevation
a. right (pg.373)
a. right
b. left
____ hemisphere damage results in the oral phase of the swallow being impaired
- may have difficulty initiating a swallow
- mild delay in triggering pharyngeal phase which may result in aspiration or laryngeal penetration before the swallow is triggered
- better recovery of swallow function
b. left (pg.373)
a. parkinsons
b. progressive supra nuclear palsy
c. amyotrophic lateral sclerosis
d. myasthenia gravis
- dysphasia is found in 50% of patients
- a movement disorder caused by dopamine depletion in the substantia nigra in the subcortical region
- symptoms include resting tremor, rigidity, impaired postural reflexes and paucity of movement
a. parkinsons (pg. 373)
a. parkinsons
b. progressive supra nuclear palsy
c. amyotrophic lateral sclerosis
d. myasthenia gravis
- a severe and rapid progressive degeneration of UMN and LMN tracts, causing severe motor dysfunction, dysarthria and dysphagia affecting all stages of swallow
- cognition is not impaired
c. ALS (pg. 373)
a. parkinsons
b. progressive supra nuclear palsy
c. amyotrophic lateral sclerosis
d. myasthenia gravis
- a LMN disorder in which conduction is impaired at the myoneural junction, due to a defect of acetylcholine release
- weakness that exacerbates with repeated effort is the primary symptom
- dysphasia occurs due to fatigue of the muscles of mastication
d. myasthenia gravis (pg.373)
treatment
a. parkinsons
b. progressive supra nuclear palsy
c. amyotrophic lateral sclerosis
d. myasthenia gravis
- focuses on sensory awareness and control of the oral swallow
- expiratory muscle strength training
- lee silverman voice treatment
a. parkinsons (pg.373)
treatment
a. parkinsons
b. progressive supra nuclear palsy
c. amyotrophic lateral sclerosis
d. myasthenia gravis
- there is no cure
- dysphagia treatment is temporary and minimally successful
- family and patient counseling is essential in early stages
c. ALS (pg.373)
treatment
a. parkinsons
b. progressive supra nuclear palsy
c. amyotrophic lateral sclerosis
d. myasthenia gravis
- medical treatments include removal of the thymus glad and use medication to help facilitate muscle movement
- behavioral treatment includes energy conversation
- small meals, increased frequency
- modify texture so less chewing effort needed for oral preparation
d.myashenia gravis (pg.373)
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
- an immune-mediated demyelination of nerve fibers in the brain and spinal cord
- dysphagia occurs if corticobulbar tracts or brain stem pathways affected
a. multiple sclerosis (pg.374)
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
- an autosomal-dominant, neurodegenerative disease that can be detected with blood tests
- progressive psychiatric disturbance
- choreatic movements
- oropharyngeal dysphagia
b. huntington’s disease (pg. 374)
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
- viral induced degeneration of the LMN and brain stem
- degeneration decades after polio exposure
- dysphagia occurs in almost all cases and is found in all phases of the swallow
c. postpolio syndrome (pg.374)
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
- autoimmune disorder affecting the peripheral nervous system, resulting in demyelination of cranial nerves
- causes weakness and sensory loss of the oral cavity, pharynx and larynx during the acute phase of the disease
d. guillain-barre syndrome (pg. 374)
treatment
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
-medical treatment by high-dose intravenous corticosteroids and beta-interferon has been proven effective
a. multiple sclerosis (pg.374)
treatment
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
-treatment involves feeding them in an uncluttered space, with seating that provides head and trunk support
b. huntington’s disease (pg.374)
treatment
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
-oral exercises are minimally effective, while postural and dietary treatments appear helpful
c. postpolio syndrome (pg.374)
treatment
a. multiple sclerosis
b. huntington’s disease
c. postpolio syndrome
d. guillain-barre syndrome
-plasmapheresis or intravenous immunoglobulin are highly effective cures
d. guillain-barre syndrome (pg.374)
a. dystonia
b. dermatomyositis
c. TBI
d. dementia
-difficulty coordinating respiration and swallowing
-different types
neck=delayed swallow initiation and vallecular residue
laryngeal/spasmodic= swallwoing presrved
oromandibular=premature spillage of bolus into pharynx with vallecualr reside, difficulty in oral preparation stage
lingual= biting tongue, expel food from mouth
a. dystonia (pg. 374)
a. dystonia
b. dermatomyositis
c. TBI
d. dementia
- the leading cause of death and disability in the US for persons 40 and under
- usually causes memory and other cognitive impairments
c. TBI (pg.374)
a. dystonia
b. dermatomyositis
c. TBI
d. dementia
- a cognitive impairment where dysphagia is not typical
- if there is dysphagia it will appear in volitional eating, transporting food to the mouth, lack of awareness of food placed in the oral cavity and an inability to determine when to swallow
d. dementia (pg. 375)
treatment
a. dystonia
b. dermatomyositis
c. TBI
d. dementia
-treatment may include Botox injections or lesion surgery but effects remain inconclusive
a. dystonia (pg.374)
treatment
a. dystonia
b. dermatomyositis
c. TBI
d. dementia
- directed feeding and individual assistance during meals is often required
- as cognition become more impaired, treatment may no longer be beneficial for swallowing or feeding
c. dementia (pg. 375)
when there is surgical removal of a tumor when should treatment for dysphagia begin?
-after major healing (pg.376)
treatment for FOM, tonsils and pharyngeal tumors includes…
mendelsohn maneuver
sensory stimulation
prothesis (pg.377)
if treatment for tumors includes radiation therapy____ and ______ will result
xerostomia
reduced range of motion (pg.377)
_______ is often constructed with a tissue fold at the BOT that can cause a problem and obstruct the pharynx or collect residue
pseudo epiglottis (pg.377)
any of the surgical procedure where tissue is removed and a flap is constructed from distal tissue may cause ____ and _____ changes to the swallow
sensory
motor (pg. 377)
_____ is a placement of a small, flexible prosthesis into a tracheal stoma to prevent back flow and aspiration
tracheoesophageal puncture (pg. 377)
_____ has benefits for swallowing as it helps restore sensation, take and laryngeal closure
passy-muri speaking valve (pg. 377)
a. aspiration
b. penetration
_______ is the entry of food or liquid into the airway below the true vocal folds
aspiration (pg. 378)
true/false: aspiration pneumonia will always occur if the material enters the lungs
false: only if the material continues a respiratory pathogen (pg. 378)
________ is the most import predictor of aspiration pneumonia
oral hygiene (pg. 378)
a. aspiration pneumonia
b. aspiration pneumonitis
chemical injury caused by inhalation of sterile gastric contents
b. aspiration pneumonitis (pg.378)
it differs from aspiration pneumonia, which is caused by inhalation of oropharyngeal secretions colonized by pathogenic bacteria
a. aspiration
b. penetration
occurs when material enters the laryngal adieus by does not pass into the airway
b. penetration (pg. 378)
true/false: penetration is considered a sign of dysphagia
false (pg.378)
a. GERD
b. LPR (laryngeopharyngeal reflux)
-heartbun that occurs after a meal
a. GERD (pg. 379)
a. GERD
b. LPR (laryngeopharyngeal reflux)
-occurs when back flow rises to the level of the larynx, which can then accumulate in the pyriform sinuses and spill over into the larynx, causing aspiration and hoarseness
b. LPR (pg. 379)
a. zenker’s diverticulum
b. ill induced esophagitis
c. achalasia
d. scleroderma
-pocket or pouch that forms when the pharyngeal or esophageal muscles herniate
a. zenker’s diverticulum (pg. 380)
a. zenker’s diverticulum
b. pill induced esophagitis
c. achalasia
d. scleroderma
-an inflammation of the wall of the esophagus produced by a pill or capsule that has lodged in the mucosa
b. pill induced esophagitis (pg. 380)
a. zenker’s diverticulum
b. pill induced esophagitis
c. achalasia
d. scleroderma
-a motility disorder of the connective tissue that affects the smooth muscle region of the esophagus
d. scleroderma (pg. 380)
true/false: it is not important to collect a complete drug history when treating an individual with dysphagia
false (pg. 380)
what is the most commonly used instrumental procedure for swallowing evals?
- modified barium swallow followed by fiberoptic nasoenoscopy, EMG, ultrasound, manometry
(pg. 381)
what is the purpose of instrumental evaluation for dysphagia?
- provide objective, visualized, dynamic, real-time documentation of anatomical and functional causes of swallowing impairment
- visualize bolus flow and control, swallowing timing, pharyngeal residue, response to bolus misdirection and airway protection
- determine aspiration risk, effect of modifications in body position, posture, treatment strategies and changes in bolus consistency on ability to swallow
(pg. 381)
signs that require instrumental assessment include…
- fever
- pain
- excessive effort
- coughing
- choking
- difficulty breathing
during or after swallowing
(pg. 381)
lack of cough or throat clearing with fever, pain, or difficult breathing may indicate what?
silent aspiration (pg. 381)
true/false: when selecting a instrumental evaluation, you want to select the most accurate, least invasive and safest technique
true (pg. 381)
MBS is not advisable for who?
- infants
- someone with limited mobility
- persons who have allergies to barium
- persons with high doses of radiation exposure
(pg. 381)
a. MBS
b. FEES (fiberoptic endoscopic)
c. FEEST (fiberoptic endoscopic with sensory testing)
d. US (ultrasound)
- the most complete method to assess oropharyngeal swallowing behavior for treatment planning purposes and follow-up
- major flaw is radiation
- best procedure to detect aspiration, penetration, swallow duration and pharyngeal and esophageal function
a. MBS (pg. 382)
a. MBS
b. FEES (fiberoptic endoscopic)
c. FEEST (fiberoptic endoscopic with sensory testing)
d. US (ultrasound)
- known as nasoendoscopy
- uses a reliable nano-pharyngo-laryngoscope to observe the pharynx and larynx and vocal folds before and after a swallow
- no radiation
- used for bedridden or immobile patients and for a bedside evaluation or follow-up assessment
b. FEES (pg. 382)
what swallowing disturbance would you expect with the following MBS observation…
-laryngeal penetration and aspiration
- impaired epiglottic function (pg. 382)
what swallowing disturbance would you expect with the following MBS observation…
-coughing, choking, wet/gurgly voice, harsh vocal quality related to meals
-laryngeal penetration or aspiration (pg. 382)
what swallowing disturbance would you expect with the following MBS observation…
-none on clinical exams but signs are seen on instrumental study
silent aspiration (pg. 382)
what swallowing disturbance would you expect with the following MBS observation…
-penetration, aspiration, residue, effortful or incomplete swallows
reduced laryngeal elevation (pg. 382)
what swallowing disturbance would you expect with the following MBS observation…
-penetration due to reduced vocal fold closure, may cause aspiration
impairment in vocal fold adduction (pg. 382)
what swallowing disturbance would you expect with the following MBS observation…
-pain when swallowing, bolus feels stuck in throat
mass or obstruction in pharynx (pg. 382)
a. MBS
b. FEES (fiberoptic endoscopic)
c. FEEST (fiberoptic endoscopic with sensory testing)
d. US (ultrasound)
- adds sensory testing of the larynx using pugs to the laryngeal ventricle as a test of ability to swallow
- it is postulated that persons with stroke of CN X problems may be silent aspirators without a cough and this test may be able to predict that event
c. FEEST (pg. 383)
a. MBS
b. FEES (fiberoptic endoscopic)
c. FEEST (fiberoptic endoscopic with sensory testing)
d. US (ultrasound)
- a safe noninvasice technique to view the oral and pharyngeal muscles and soft tissues
- can visualize real-time movements of the tongue, floor of mouth, hyoid and larynx during swallowing using normal food
- safe to use repeatedly and is advantageous for infants and children who are high risk or poor feeders
- it does not show bones and has limited filed of view depending on the scope of the transducer that is being used
d. US (pg. 383)
true/false: cautions and considerations in reviewing results include understand that a MBS study is not a replica of a real meal and barium may cause a unique swallow pattern
true (pg. 382)
based on what is seen on VFS/MBS, what posture should be used?
-reduced posterior propulsion of bolus over the tongue
-slightly tilt head back and then move head forward quickly
( gravity and oral pressure change helps clear oral cavity)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-delay in triggering the pharyngeal swallow
-tuck chin down in midline
( widens valleculae and narrows laryngeal audits; may present bolus entry into airway)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-reduced movement of the base of tongue
-chin down in midline or hawking and throat clearing
( pushes base of tongue closer to posterior pharyngeal wall)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-aspiration during the wallow due to unilateral vocal fold impairment
-chin down with head rotated to closed off the weakened side
(forces vocal folds closure on weaker side )
(pg.383)
based on what is seen on VFS/MBS, what posture should be used?
-aspiration from oropharynx during swallow
chin lowered with a forceful swallow or throat clearing
(may narrow laryngeal adieus and clear airway; may aid in cola fold adduction and hyoid elevation)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-residue in the valleculae or pyriform due to paresis on one side of the pharynx
rotate head toward the weaker side
(closes off the weaker side and permits bolus to flow down the stronger side)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-slowed pharyngeal contractions
side lying or forceful swallow
(may help force bolus through the pharynx)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-combination of unilateral oral and pharyngeal stasis
head tilt and forceful swallow
(permits bolus to flow down the stronger side)
(pg. 383)
based on what is seen on VFS/MBS, what posture should be used?
-impaired laryngeal elevation and impaired UES opening
mendelsoh maneuver (manual manipulation raises the thyroid cartilage and may relax the UES) (pg. 383)
a. manometry
b. scintigraphy
c. fMRI
d. SEMG
-sophisticated radiographic technique using alternating magnetic folds to delineate soft tissues and blood vessels
-rapid movement, such as swallowing, impends the image
-
c. fMRI (pg. 384)
a. manometry
b. scintigraphy
c. fMRI
d. SEMG
- use of electrodes placed on the submittal or neck region
- signal begins at the onset of the swallow, with a peak rise and descending pattern at the end of the swallow
- used as biofeedback technique for swallowing
d. SEMG (pg. 384)
surface electromyography
a. direct
b. indirect
- treatments that use food, dietary modifications or postural changes and maneuvers during swallowing
- purpose is to modify the swallow by modifying food or feeding methods
a. direct (pg. 384)
a. direct
b. indirect
- treatments that do not use food during the actual exercises
- purpose is to modify the swallowing mechanism and modify the patient without the use of food or liquids
b. indirect (pg. 384)
a. direct
b. indirect
- supraglottic swallow
- mendelsohn maneruver
- shaker exercises
a. direct (pg. 384)
true/false: swallowing is the most effective exercise to retain the swallow
true (pg. 384)
a. supraglottic swallow
b. mendelsohn maneuver
c. masako maneuver
d. thermal tactile stimulation
- hold breath, take sip, swallow, cough and clear the airway, swallow again
- to protect the airway before the swallow and to clear the airway of penetrated material that has accumulated during or after the swallow
- may increase anterior laryngeal motion and tongue base movement while adding in UES opening
a. supraglottic swallow (pg. 384)
true/false: super supraglottic swallow is different only in the amount of effort used before the swallow in breath holding
true (pg. 384)
should supraglottic swallow be used for someone with coronary artery disease or recent stroke?
no (pg. 384)
a. supraglottic swallow
b. mendelsohn maneuver
c. masako maneuver
d. thermal tactile stimulation
- manually lifts the larynx and sustains laryngeal height during swallow of food
- used for those with reduced opening of the UES and cricopharyngeal muscle dysfunction
b. mendelsohn (pg. 385)
a. supraglottic swallow
b. mendelsohn maneuver
c. masako maneuver
d. thermal tactile stimulation
- tongue-holding maneuver where tongue is held outside the mouth
- assists bolus flow through the pharynx
c. masako maneuver (pg. 385)
a. supraglottic swallow
b. mendelsohn maneuver
c. mask maneuver
d. thermal tactile stimulation
- purpose is to trigger a pharyngeal swallow with use of sensory stimulation to anterior faucial arches and surrounding tongue and posterior pharyngeal area
- useful for stoke and in persons with delay in triggering of the pharyngeal swallow
- used without food
- used a cold laryngeal mirror dipped in ice
d. thermal tactile stimulation (pg. 385)
_____ is a factor in treating elderly, so rigorous exercises often are not feasible
fatigue (pg. 385 )
use of specific _______ exercises that use resistance to retain lingual muscles has had positive effects on swallowing in the elderly
isometric (pg. 385)
______ is the term for reduced muscle mass common in the elderly
sarcopenia (pg. 385)
a. shaker exercise
b. effortful swallow
c. postural changes
- isometric neck exercise that has improved anterior laryngeal excursion and the anterior-posterior diameter of UES opening
- consists of repetitions of sustained head-raising in supine position
a. shaker exercise (pg. 385)
a. shaker exercise
b. effortful swallow
c. postural changes
- hard swallow
- increases oral lingual pressure and increased duration of max hyoid elevation then used
b. effortful swallow (pg. 385)
a. shaker exercise
b. effortful swallow
c. postural changes
-compensatory techniques that are used to improve patient’s safety and ability to transfer a bolus safely into the pharynx
c. postural changes (pg. 385)
a. fundamental posture
b. tilt chin downward
c. turn or tilt head
d. turn head to damaged side and tuck chin
e. tilt head back
f. side lying
-seated upright or close to 45 degrees with hips flexed to 90 degrees to achieve best bolus flow and benefit of gravity on bolus transit to the esophagus
a. fundamental posture (pg. 385)
a. fundamental posture
b. tilt chin downward
c. turn or tilt head
d. turn head to damaged side and tuck chin
e. tilt head back
f. side lying
- if there is residue in valleculae or delayed triggering of swallow
- widen valleculae and narrows entry into larynx
b. tilt chin downward (pg. 386)
a. fundamental posture
b. tilt chin downward
c. turn or tilt head
d. turn head to damaged side and tuck chin
e. tilt head back
f. side lying
- rotate head to damaged side if there is unilateral paralysis or paresis
- this allows bolus to flow down stronger side
- reduced pharyngeal residue and aspiration risk
c. turn or tilt head (pg. 386)
a. fundamental posture
b. tilt chin downward
c. turn or tilt head
d. turn head to damaged side and tuck chin
e. tilt head back
f. side lying
- useful if there is unilateral paralysis or paresis and slowed triggering of the swallow
- allows bolus to flow down the undamaged or stronger side
- may be the most effective posture
d. turn head to damaged side and tuck chin (pg. 386)
a. fundamental posture
b. tilt chin downward
c. turn or tilt head
d. turn head to damaged side and tuck chin
e. tilt head back
f. side lying
- lingual transit insufficient to move bolus
- will allow gravity to assist in bolus motion
- may be useful in early ALS
e. tilt head back
a. fundamental posture
b. tilt chin downward
c. turn or tilt head
d. turn head to damaged side and tuck chin
e. tilt head back
f. side lying
- for oral cancer or if risk of aspiration is not severe.
- head of bed should be tilted upward at least 30 degrees and pillows used for back support
f. side lying (pg. 386)
when should diet modification be instituted?
after an objective swallow study to determine which bolus types are safe (pg. 386)
a. thicker liquids
b. moist food
c. purees
- may help provide sensory input needed to trigger a swallow
- appropriate for those with poor tongue or lip control
a. thicker liquids (pg. 386)
a. thicker liquids
b. moist food
c. purees
-more cohesive and easier to transfer into the pharynx
b. most food (pg. 386)
a. thicker liquids
b. moist food
c. purees
-may decrease choking risk or aspiration in neurologically impaired who have most difficulty with liquids due to inability to contain a bolus on the lingual surface
c. purees (pg. 386)
NPO for those who are critically ill, comatose, unable to swallow, aspirate over _____ % of all food consistencies or shoes swallow is delayed for more than ____ seconds
10, 10 (pg. 386)
_____ is one of the most important treatments for patients who are in hospitals or nursing facilities or who are infirm elderly and unable to take proper care of themselves
oral hygiene (pg. 386)
what is a controversial technique that requires the use of electrodes placed submentally to provide electrical stimulation to the muscles of the neck
neuromuscular electrical stimulation (pg. 387)
what is a systematic exercised based program combined with traditional swallowing therapy and surface electromyography biofeedback
McNeill dysphagia therapy program (pg. 387)
what are some mealtime strategies that can be useful for nursing home residents and patens with dementia?
- visual cues, improved lighting, minimal distractions, written reminders, one-step directions, food placement, increasing visual contracts on plate, modified cups and utensils
- direct feeding supervision, soft foods, small bites, one items at a time, easily chewable food, added smell and tastes enhancement
(pg. 387)
The cardiologist mentioned to the patient that this vascular anomaly in the
thorax, particularly in the aortic arch, was compressing the trachea and esophagus and
resulted in the patient experiencing significant respiratory distress and feeding difficulties.
This condition is called ________
dysphagia lusoria
A 92-year-old patient with dementia is experiencing severe oral-and-pharyngeal-stage
dysphagia including aspiration. The clinician would like to teach the patient a swallowing
therapy technique, as the family is concerned that he is losing weight. The patient is
currently being tube fed and is monitored closely by the hospital staff and dietitian.
Ethically, which is the only appropriate technique that the clinician should consider?
A. Introduce the supraglottic swallow procedure to the patient.
Continue with the tube feeding.
A 58-year-old patient who had undergone a total laryngectomy came to an outpatient
clinic complaining of coughing when swallowing. The patient was puzzled because he had
been told that he would not run the risk of aspiration because there was a physical
separation of the gastrointestinal tract and the respiratory tract. The patient had a
prosthetic valve in his tracheoesophageal segment to facilitate speaking. The patient said he
had understood that the duckbill prosthesis would prevent backflow from the esophagus to
the trachea and eliminate aspiration. After completing trial feedings, the speech–languagepathologist informed the client that he was coughing because
there was leakage around the prosthesis.
This muscle is located under the jaw and extends from the mastoid process to the
symphysis menti. It is part of the suprahyoid group of muscles. When this muscle contracts,
it elevates the hyoid bone. This muscle is known as the
digastric.
An 84-year-old woman with dementia who recently suffered a stroke was admitted to a
nursing home, as she had difficulty swallowing. The results of a videofluoroscopic study
indicated that she had severe pooling in the vallecula and pyriform sinuses. She also was at
risk for aspiration. The speech–language pathologist decided to administer syringe feedings.
Ethically, the clinician
should have a rationale for using syringe feedings.
A patient with end-stage cancer was experiencing loss of weight, fatigue, weakness, and
a significant reduction in appetite. The oncologist mentioned to the speech–language
pathologist that even though the patient was not actively trying to lose weight, his loss of
body mass would be difficult to reverse nutritionally because he had aggressive cancer. This
condition of weight loss that is a common complication associated with cancer is called
cachexia
A 45-year-old woman was complaining of difficulty masticating. She had tonic spasms
after irradiation. The physician explained to the speech–language pathologist that this
condition is believed to exist secondary to fibrosis of the muscles involved in mastication.
trismus.
A professor is teaching a class anatomy and physiology and mentions that closure of the airway occurs at anatomically different locations and functionally separate levels in the larynx. A student in the class answers that the appropriate choice would be
the supraglottic portion of the laryngeal vestibule.
You are consulting with the nursing staff about a patient who is being tube fed. During
the evaluation, you notice that the patient is experiencing aspiration. The nurse says that
the most appropriate method to reduce aspiration would be to
elevate the head of the bed at least 30 degrees before and during continuous feeding.
A 32-year-old patient was involved in a motor vehicle accident. He is a ventilatordependent patient with a tracheostomy tube in place. Because the ventilator controls the
respiratory cycle, the patient cannot lengthen exhalations; however, the physician
recommends trial therapy for tolerance for swallowing. In preparing for feeding and
swallowing, which of the following is recommended?
It is preferable to present food to the patient at the beginning of the exhalation phase of the
respiratory cycle
An attending physician refers a patient for swallowing therapy. The patient has a
tracheostomy tube in place. Which of the following is recommended while conducting
therapy?
Do not feed when the cuff is inflated
Specific swallow maneuvers
supraglottic swallow
super-supra gottic swallow
effortful swallow
mendelsohn maneuver
How do you do the Super-supraglottic swallow?
EFFORTFUL hold breath before and during swallow and cough after.
How do you do theEffortful swallow?
squeeze hard with all muscles during swallow,
How do you do the Mendelsohn maneuver?
sustain peak laryngeal prominence elevation during swallow for a few seconds,
How do you do the Supraglottic swallow?
hold your breath (at true VFs) before and during swallow and cough after
Postural techniques for tretment
chin down/chin tuck/head flexion
chun-up/head extension
head rotation/head turn
How do you do the Chin-down/chin-tuck/
head flexion?
touching chin to neck
How do you do the Chin-up/
head extension?
raising chin
How do you do the Head rotation/
head turn?
rotation to damaged side
How should patients head be positioned for trials in case of tongue weakness and bolus manipulation problems?
downward as food is placed then backward
in the case of hemilaryngectomy, delayed trigger ing of swallowing reflex, and inadequate laryngeal closure, how should patient hold head?
tilt downward until food in vallecula is triggered.
What does a MBSS evaluate? (aka videoflourographic assessment)
oropharyngeal swallow involving lateral ad anterior-posterior plan examinations
What does FEES evaluate?
laryngeal penetration of food, aspiration, food residue, and completeness of swallow
what does a manometric assessment do?
Measures pressure of lower and upper esophgus
How does the supersupraglottic swallow help?
enhances airway closure by closing: - false VFs -arytenoids -epiglottis, -true VFs (*closes airway at 3 points)
How does the effortful swallow help?
improved:
- tongue base movement,
- posterior movement
- lingual pressure
How does the Mendelson Maneuvar help?
improves coordination of swallow, increases extent
Who does the supraglottic swallow help?
delayed pharyngeal swallow, reduced or delayed initiation of laryngeal closure (*closes airway)
How does the Chin-down/chin-tuck/
head flexion help?
- pushes anterior pharyngeal wall posteriorly
- tongue base and epiglottis pushed closer to posterior pharyngeal wall
- airway entrance narrowed, valleculae widened
Who does the chin down/chin tuck help?
- delayed pharyngeal swallow
- reduced tongue base retraction
- reduced airway closure
How does the chin up help?
- drains food from oral cavity using gravity
- narrows valleculae
Who does the chin up help?
- reduced tongue control,
- oral/lingual deficits
- *only used when the pharyngeal swallow is intact
How does the head turn help?
twists pharynx, closes damaged side, food floods down normal side.
Who does the head turn help?
- unilateral pharyngeal wall -unilateral vocal fold impairments
- associated with increased UES opening (allowing for a drop in pressure)
Disorders or Swallowing:
Which phase has difficulty with….
Anterior instead of posterior tongue movement, weak tongue movement and elevation, reduced labial, buccal and tongue tension and strength.
Oral Phase
Disorders or Swallowing:
Which phase has difficulty with….
Difficulty chewing due to reduced range of lateral and vertical tongue movement, reduced range of lateral mandibular movement, reduce buccal tension and poor alignment of the mandible
Oral Preparatory
Disorders or Swallowing:
Which phase has difficulty with….
Formation of diverticulum, development of tracheoesophageal fistula, esophageal obstruction.
Esophageal
Disorders or Swallowing:
Which phase has difficulty with….
Reduced movement of the base of tongue, reduced laryngeal movement, cricopharyngeal dysfunction.
Pharyngeal Phase
Disorders or Swallowing:
Which phase has difficulty with….
Difficulty forming and holding the bolus, abnormal holding, slippage of food into anterior and lateral sulcus, aspiration before swallow, weak lip closure, reduced tongue
Oral Preparatory
Disorders or Swallowing:
Which phase has difficulty with….
Residue in various places suggesting incomplete swallow
Oral Phase
Disorders or Swallowing:
Which phase has difficulty with….
Premature swallow of solid and liquid food and aspiration before swallow, called by apraxia of swallow
Oral Phase
Disorders or Swallowing:
Which phase has difficulty with….
Inadequate closure of the airway
Pharyngeal Phase
Disorders or Swallowing:
Which phase has difficulty with….
Piecemeal swallow (multiple attempts to swallow)
Oral Phase
Disorders or Swallowing:
Which phase has difficulty with….
Backflow from esophagus, reduced esophageal contractions
Esophageal
Disorders or Swallowing:
Which phase has difficulty with….
Food coating pharyngeal walls; residue in valleculae, on tip or airway, in pyriform sinuses and throughout pharynx; delayed pharyngeal transit; reduced pharyngeal peristalsis or constricting and relaxing movements of the pharynx; pharyngeal paralysis
Pharyngeal Phase
Disorders or Swallowing:
Which phase has difficulty with….
Difficulty passing bolus through the cricopharyngeus muscles and past the seventh cervical vertebra
Esophageal
Disorders or Swallowing:
Which phase has difficulty with….
Difficulties propelling bolus through the pharynx and into the PE segment; delayed or absent swallowing reflex; nasal and airway penetration of food
Pharyngeal Phase
Patients with xerostomia may need ________ prior to eating.
synthetic saliva
