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Praxis Focus > dysphagia > Flashcards

dysphagia Flashcards

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1
Q

Disorders or Swallowing:

Which phase has difficulty with….

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

A

Esophageal

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2
Q

Disorders or Swallowing:

Which phase has difficulty with….

Residue in various places suggesting incomplete swallow

A

Oral Phase

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3
Q

Disorders or Swallowing:

Which phase has difficulty with….

Piecemeal swallow (multiple attempts to swallow)

A

Oral Phase

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4
Q

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

A

liquid foods

thin consistency foods

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5
Q

Indirect laryngescopy or endoscopy do what?

A

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
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6
Q

Disorders or Swallowing:

Which phase has difficulty with….

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

A

Oral Phase

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7
Q

FEEST

A
  • adds sensory testing of the larynx
  • test of ability to swallow
  • may predict silent aspiration
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8
Q

How do you do the Mendelsohn maneuver?

A

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

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9
Q

What does a manometric assessment measure?

A

pressure in upper and lower esophagus

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10
Q

How to increase tongue resistance?

A

pushing the tongue against a depressure

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11
Q

Pharyngeal phase

A
  • 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

-

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12
Q

MBS

A
  • 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
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13
Q

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

A

Pharyngeal Phase

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14
Q

How to increase range of lateral movements of the jaw?

A

wide opening and sideways movement of the jaw

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15
Q

Cons of rigid scope?

A

Can only producce vowels

-likely to promote gag reflex

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16
Q

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

A

downward as food is placed then backward

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17
Q

Disorders or Swallowing:

Which phase has difficulty with….

Inadequate closure of the airway

A

Pharyngeal Phase

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18
Q

Specific swallow maneuvers

A 
supraglottic swallow
super-supra gottic swallow
effortful swallow
mendelsohn maneuver
shaker and jaw opening
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19
Q

How does the head turn help?

A

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

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20
Q

What does FEES evaluate?

A
  • laryngeal penetration
  • aspiration
  • residue
  • completeness of swallow
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21
Q

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.

A

Oral Phase

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22
Q

Studies about the chin down eliminates ____________________________ but ____________________

A
  1. aspiration in 50% of patients who aspirated due to a pharyngeal onset delay.
  2. empties the pyriform sinuses into the airway.
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23
Q

digastric.

A
  • muscle located under the jaw.
  • suprahyoid group of muscles
  • elevates the hyoid bone.
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24
Q

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

A

thicker

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25
Q

Disorders or Swallowing:

Which phase has difficulty with….

Backflow from esophagus, reduced esophageal contractions

A

Esophageal

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26
Q

ultrasound

-

A
  • 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
27
Q

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

A

Oral Preparatory

28
Q

oral phase

A
  • -anterior-posterior tongue action that moves bolus posteriorly
  • ends as food passes through anterior faucial arches
29
Q

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

A
  • Impaired or absent opening of UES
  • nasopharyngeal regurgitation during the pharyngeal stage
  • unilateral pharyngeal paralysis
30
Q

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

A

Oral Preparatory

31
Q

How does the supersupraglottic swallow help?

A 
enhances airway closure by closing:
- false VFs
-arytenoids
-epiglottis,
-true VFs
 (*closes airway at 3 points)
32
Q

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

A
  • stroke
  • parkinson’s disease
    (pg. 371)
33
Q

what muscle composes the upper esophageal sphincter?

A

cricopharyngeal muscles (pg. 364)

34
Q

MBS is not advisable for who?

A
  1. infants
  2. someone with limited mobility
  3. persons who have allergies to barium
  4. persons with high doses of radiation exposure
    (pg. 381)
35
Q

How many aduts are affected by dysphagia?

A

1 in 25

36
Q

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

A

Pharyngeal Phase

37
Q

subcortical stokes will have what kind of symptoms?

A

mild oral and pharyngeal transit delays

38
Q

When is edoscope viewing superior to other views?

A

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

39
Q

Steps of progressive resistive exercise component of treatment…..

A
  1. calcualte exercise target below maximum ressure generation
  2. increase target and continue
  3. obtain measures
  4. perform VFSS to evaluate efficacy
40
Q

Disorders or Swallowing:

Which phase has difficulty with….

Difficulty passing bolus through the cricopharyngeus muscles and past the seventh cervical vertebra

A

Esophageal

41
Q

How to increase range of tongue movements?

A
  • raising tongue
  • holding tongue as high as possible
  • alternating raaising and lowering tongue
42
Q

What does a MBSS evaluate? (aka videoflourographic assessment)

A

oropharyngeal swallow involving lateral and anterior-posterior plan examinations

43
Q

Oral prep phase

A

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

44
Q

What muscle controls the lips?

A

obiculis oris

45
Q

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

A

tilt downward until food in vallecula is triggered.

46
Q

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

A

tracheoesophageal puncture (pg. 377)

47
Q

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

A
  • hx of ead-neck radiation
  • any neurological disease or stroke
  • nexplained weight loss.
48
Q

trismus.

A
  • difficulty masticating
  • tonic spasms after irradiation
  • exists secondary to fibrosis
49
Q

Patients with xerostomia may need ________ prior to eating.

A

synthetic saliva

50
Q

Esophageal phase

A
  • begins when food arives at orfice of esophagus

- food is propelled through peristalic action

51
Q

How to increase buccal tension?

A
  • stretching lips as tightly as possible and saying “eee”
  • rounding lips tightly and saying “oh”
  • rapidly alternating
52
Q

How do you do the Supraglottic swallow?

A

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

53
Q

cachexia

A
  • weight loss
  • fatigue
  • weakness
  • reduction in appetite
  • accompanied by cancer
54
Q

How do you do the Super-supraglottic swallow?

A

EFFORTFUL hold breath before and during swallow and cough after.

55
Q

Disorders or Swallowing:

Which phase has difficulty with….

Reduced movement of the base of tongue, reduced laryngeal movement, cricopharyngeal dysfunction.

A

Pharyngeal Phase

56
Q

How to increase lip strength?

A
  • strething lips to produce /i/
  • puckering tightly
  • tighltly closing lips
57
Q

Postural techniques for tretment

A

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

58
Q

How to improve laryngeal adduction?

A

push down

59
Q

How does the chin up help?

A
  • drains food from oral cavity using gravity

- narrows valleculae

60
Q

How do you do theEffortful swallow?

A

squeeze hard with all muscles during swallow,

61
Q

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

A

passy-muri speaking valve (pg. 377)

62
Q

what does a manometric assessment do?

A

Measures pressure of lower and upper esophgus

63
Q

What is important to remember about exercises?

A

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

64
Q

VFSS evlautes what planes?

A

A-P

lateral

Praxis Focus (13 decks)

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