dysphagia

Question 1

Disorders or Swallowing:

Which phase has difficulty with….

Formation of diverticulum, development of tracheoesophageal fistula, esophageal obstruction.

Answer 1

Esophageal

Question 2

Disorders or Swallowing:

Which phase has difficulty with….

Residue in various places suggesting incomplete swallow

Answer 2

Oral Phase

Question 3

Disorders or Swallowing:

Which phase has difficulty with….

Piecemeal swallow (multiple attempts to swallow)

Answer 3

Oral Phase

Question 4

If patient has limited oral control, what types of consistency should be used?

Answer 4

liquid foods

thin consistency foods

Question 5

Indirect laryngescopy or endoscopy do what?

Answer 5

movement of bolus until it triggers pharyngeal swallow and any food residue after swallow.

Views and inspects funtioning of:

• base of tongue
• vallecula
• epiglottis
• pyriform sinuses
• vf
• ventricular folds

Question 6

Disorders or Swallowing:

Which phase has difficulty with….

Premature swallow of solid and liquid food and aspiration before swallow, called by apraxia of swallow

Answer 6

Oral Phase

Question 7

FEEST

Answer 7

• adds sensory testing of the larynx
• test of ability to swallow
• may predict silent aspiration

Question 8

How do you do the Mendelsohn maneuver?

Answer 8

sustain peak laryngeal prominence elevation during swallow for a few seconds,

Question 9

What does a manometric assessment measure?

Answer 9

pressure in upper and lower esophagus

Question 10

How to increase tongue resistance?

Answer 10

pushing the tongue against a depressure

Question 11

Pharyngeal phase

Answer 11

• swallowing reflex trigger by contact with faucial arches
• velopharyngeal closure
• pharyngeal closure by elevated larynx
• relaxation of cricopharyngeal muscles
• reflexive contraction of pharyngeal contractors to move bolus down

-

Question 12

MBS

Answer 12

• most complete method to assess oropharyngeal for tx planning purposes and follow-up
• best to detect aspiration, penetration, swallow duration and pharyngeal and esophageal function
• -flaw is radiation

Question 13

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

Answer 13

Pharyngeal Phase

Question 14

How to increase range of lateral movements of the jaw?

Answer 14

wide opening and sideways movement of the jaw

Question 15

Cons of rigid scope?

Answer 15

Can only producce vowels

-likely to promote gag reflex

Question 16

How should patients head be positioned for trials in case of tongue weakness and bolus manipulation problems?

Answer 16

downward as food is placed then backward

Question 17

Disorders or Swallowing:

Which phase has difficulty with….

Inadequate closure of the airway

Answer 17

Pharyngeal Phase

Question 18

Specific swallow maneuvers

Answer 18

supraglottic swallow
super-supra gottic swallow
effortful swallow
mendelsohn maneuver
shaker and jaw opening

Question 19

How does the head turn help?

Answer 19

twists pharynx, closes damaged side, food floods down normal side.

Question 20

What does FEES evaluate?

Answer 20

• laryngeal penetration
• aspiration
• residue
• completeness of swallow

Question 21

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.

Answer 21

Oral Phase

Question 22

Studies about the chin down eliminates ____________________________ but ____________________

Answer 22

1. aspiration in 50% of patients who aspirated due to a pharyngeal onset delay.
2. empties the pyriform sinuses into the airway.

Question 23

digastric.

Answer 23

• muscle located under the jaw.
• suprahyoid group of muscles
• elevates the hyoid bone.

Question 24

If patient has delayed swallowing reflex, what types of consistency should be used?

Answer 24

thicker

Question 25

Disorders or Swallowing: Which phase has difficulty with.... Backflow from esophagus, reduced esophageal contractions

Answer 25

Esophageal

Question 26

ultrasound -

Answer 26

- noninvasice technique - view the oral and pharyngeal muscles and soft tissues - real-time movements of the tongue, floor of mouth, hyoid and larynx during swallowing using normal food - safe to use repeatedly - does not show bones and has limited filed of view depending on the scope of the transducer that is being used

Question 27

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

Answer 27

Oral Preparatory

Question 28

oral phase

Answer 28

- -anterior-posterior tongue action that moves bolus posteriorly - ends as food passes through anterior faucial arches

Question 29

Swallowing deficiencies seen with a a lateral medullary stroke damaging the right nucleus ambiguus and other centers shows what deficits?

Answer 29

- Impaired or absent opening of UES - nasopharyngeal regurgitation during the pharyngeal stage - unilateral pharyngeal paralysis

Question 30

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

Answer 30

Oral Preparatory

Question 31

How does the supersupraglottic swallow help?

Answer 31

``` enhances airway closure by closing: - false VFs -arytenoids -epiglottis, -true VFs (*closes airway at 3 points) ```

Question 32

what are the most common neurological conditions that result in dysphasia?

Answer 32

- stroke - parkinson's disease (pg. 371)

Question 33

what muscle composes the upper esophageal sphincter?

Answer 33

cricopharyngeal muscles (pg. 364)

Question 34

MBS is not advisable for who?

Answer 34

1. infants 2. someone with limited mobility 3. persons who have allergies to barium 4. persons with high doses of radiation exposure (pg. 381)

Question 35

How many aduts are affected by dysphagia?

Answer 35

1 in 25

Question 36

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

Answer 36

Pharyngeal Phase

Question 37

subcortical stokes will have what kind of symptoms?

Answer 37

mild oral and pharyngeal transit delays

Question 38

When is edoscope viewing superior to other views?

Answer 38

when the primary goal is to evaluate the volume of and the patient’s response to pharyngeal secretions.

Question 39

Steps of progressive resistive exercise component of treatment.....

Answer 39

1. calcualte exercise target below maximum ressure generation 2. increase target and continue 3. obtain measures 4. perform VFSS to evaluate efficacy

Question 40

Disorders or Swallowing: Which phase has difficulty with.... Difficulty passing bolus through the cricopharyngeus muscles and past the seventh cervical vertebra

Answer 40

Esophageal

Question 41

How to increase range of tongue movements?

Answer 41

- raising tongue - holding tongue as high as possible - alternating raaising and lowering tongue

Question 42

What does a MBSS evaluate? (aka videoflourographic assessment)

Answer 42

oropharyngeal swallow involving lateral and anterior-posterior plan examinations

Question 43

Oral prep phase

Answer 43

-food is masticated, mixed with saliva and prepared to be swallowed

Question 44

What muscle controls the lips?

Answer 44

obiculis oris

Question 45

in the case of hemilaryngectomy, delayed triggering of swallowing reflex, and inadequate laryngeal closure, how should patient hold head?

Answer 45

tilt downward until food in vallecula is triggered.

Question 46

_____ is a placement of a small, flexible prosthesis into a tracheal stoma to prevent back flow and aspiration

Answer 46

tracheoesophageal puncture (pg. 377)

Question 47

There are numerous studies indicating the increased dysphagia/aspiration likelihood in people with what?

Answer 47

- hx of ead-neck radiation - any neurological disease or stroke - nexplained weight loss.

Question 48

trismus.

Answer 48

- difficulty masticating - tonic spasms after irradiation - exists secondary to fibrosis

Question 49

Patients with xerostomia may need ________ prior to eating.

Answer 49

synthetic saliva

Question 50

Esophageal phase

Answer 50

- begins when food arives at orfice of esophagus | - food is propelled through peristalic action

Question 51

How to increase buccal tension?

Answer 51

- stretching lips as tightly as possible and saying "eee" - rounding lips tightly and saying "oh" - rapidly alternating

Question 52

How do you do the Supraglottic swallow?

Answer 52

hold your breath (at true VFs) before and during swallow and cough after

Question 53

cachexia

Answer 53

- weight loss - fatigue - weakness - reduction in appetite - accompanied by cancer

Question 54

How do you do the Super-supraglottic swallow?

Answer 54

EFFORTFUL hold breath before and during swallow and cough after.

Question 55

Disorders or Swallowing: Which phase has difficulty with.... Reduced movement of the base of tongue, reduced laryngeal movement, cricopharyngeal dysfunction.

Answer 55

Pharyngeal Phase

Question 56

How to increase lip strength?

Answer 56

- strething lips to produce /i/ - puckering tightly - tighltly closing lips

Question 57

Postural techniques for tretment

Answer 57

chin down/chin tuck/head flexion chun-up/head extension head rotation/head turn

Question 58

How to improve laryngeal adduction?

Answer 58

push down

Question 59

How does the chin up help?

Answer 59

- drains food from oral cavity using gravity | - narrows valleculae

Question 60

How do you do theEffortful swallow?

Answer 60

squeeze hard with all muscles during swallow,

Question 61

_____ has benefits for swallowing as it helps restore sensation, take and laryngeal closure

Answer 61

passy-muri speaking valve (pg. 377)

Question 62

what does a manometric assessment do?

Answer 62

Measures pressure of lower and upper esophgus

Question 63

What is important to remember about exercises?

Answer 63

Mass practice and task specificity are important principles of exercise therapy.

Question 64

VFSS evlautes what planes?

Answer 64

A-P | lateral