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NESPA Studying Guides > Dysphagia and Swallowing > Flashcards

Dysphagia and Swallowing Flashcards

including physiology, disorders, screening and assessment, and treatment

1
Q

swallowing physiology

A
  • oral phase (voluntary)
  • pharyngeal phase (involuntary)
  • esophageal phase (involuntary)
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2
Q

oral phase (voluntary)

A
  • oral preparation
  • oral transport
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3
Q

oral preparation

A
  • manipulation and mastication of food into a bolus
  • structures/muscles involved: lips, jaw, tongue, soft palate, buccal and mastication muscles
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4
Q

oral transport

A
  • tongue tip and sides in contact with alveolar ridge
  • anterior to posterior movement
  • bolus and tongue motion near faucial pillars + tongue base: pharyngeal swallow triggered
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5
Q

pharyngeal phase (involuntary)

A
  • pharyngeal phase initiated
  • bolus near tongue base
  • bolus nears upper esophageal sphincter (UES)
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6
Q

pharyngeal phase initiated

A
  • laryngeal and hyoid elevation
  • velopharyngeal closure
  • epiglottis closes airway
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7
Q

pharyngeal phase: bolus near tongue base

A

walls of pharynx contract

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8
Q

pharyngeal phase: bolus nears UES

A

walls of pharynx contract

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9
Q

esophageal phase (involuntary)

A

food transports from pharynx to stomach

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10
Q

labial

A

lips

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11
Q

dental

A

teeth

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12
Q

lingual

A

tongue

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13
Q

buccal

A

cheeks

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14
Q

palatal

A

hard and soft palate

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15
Q

palatal arches

A

palatopharyngeal/palatoglossal arch

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16
Q

tongue muscles: intrinsic

A

originate and extend within tongue
- superior longitudinal
- inferior longitudinal
- transverse
- vertical

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17
Q

tongue muscles: external

A

originate outside tongue and extend within
- genioglossus
- hyoglossus
- styloglossus
- palatoglossus

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18
Q

oral preparation swallow disorder: reduced lip closure

A

cannot hold food in mouth anteriorly

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19
Q

oral preparation swallow disorder: reduced tongue ROM, coordination

A

cannot form cohesive bolus

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20
Q

oral preparation swallow disorder: reduced tongue shaping, velar movement

A

premature loss of bolus

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21
Q

oral preparation swallow disorder: aspiration

A

aspiration before the swallow

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22
Q

oral preparation swallow disorder: labial labial tension, tone

A

food falls into anterior sulcus

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23
Q

oral preparation swallow disorder: reduced buccal tension, tone

A

food falls into lateral sulcus

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24
Q

oral preparation swallow disorder: tongue thrust, reduced control

A

bolus abnormally held in front of tongue

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25
Q

oral phase swallow disorder: apraxia of swallow, reduced sensation

A

delayed oral onset of swallow

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26
Q

oral phase swallow disorder: apraxia of swallow

A

searching tongue movements

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27
Q

oral phase swallow disorder: tongue thrust

A

tongue moves forward to start swallow

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28
Q

oral phase swallow disorder: reduced tongue movement, strength

A

food/residue remains on the tongue

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29
Q

oral phase swallow disorder: reduced tongue elevation

A

incomplete tongue to palate contact

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30
Q

oral phase swallow disorder: oral onset time (OTT)

A

normal is 1-1.5 seconds in duration

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31
Q

triggering pharyngeal phase swallow disorder: delayed pharyngeal swallow

A

duration of delay in seconds

32
Q

triggering pharyngeal phase swallow disorder: pharyngeal swallow not triggered

A

bolus head enters pharynx before trigger

33
Q

pharyngeal phase swallow disorder: reduced velopharyngeal closure

A

nasal penetration

34
Q

pharyngeal phase swallow disorder: reduced pharyngeal contraction

A

residue on pharyngeal walls

35
Q

pharyngeal phase swallow disorder: reduced posterior tongue base movement

A

vallecular residue after swaallow

36
Q

pharyngeal phase swallow disorder: reduced laryngeal elevation

A

residue at top of airway

37
Q

pharyngeal phase swallow disorder: reduced closure of airway

A

penetration/aspiration may occur

38
Q

pharyngeal phase swallow disorder: reduced anterior laryngeal motion

A

residue (stasis) in both pyriform sinuses

39
Q

esophageal phase swallow disorder: tracheoesophageal fistula

A

abnormal hole between trachea and esophagus

40
Q

esophageal phase swallow disorder: Zenker’s Diverticulum

A

pharynx herniation, food collects in pouch

41
Q

esophageal phase swallow disorder: reflux (GERD)

A

back flow of food, stomach to esophagus

42
Q

dysphagia screening and assessment: prior to initiation

A

assess if patient is alert and can follow simple directions

43
Q

OFSME: facial symmetry

A

at rest and during movements

44
Q

OFSME: velar symmetry

A

open mouth wide, prolonged “ah”

45
Q

OFSME: dentition, oral

A

open mouth wide, examine teeth + hygiene

46
Q

OFSME: lingual symmetry

A

stick out tongue

47
Q

OFSME: lingual ROM

A

movement of tongue left/right, up/down

48
Q

OFSME: lingual strength

A

tongue against resistance (e.g. IOPI)

49
Q

OFSME: lingual coordination

A

observe coordination during movements

50
Q

OFSME: labial symmetry

A

at rest, during smile + pucker

51
Q

OFSME: labial ROM

A

protrude (pucker) and retract (smile)

52
Q

OFSME: labial strength

A

resistance against tongue blade

53
Q

OFSME: labial closure

A

puff cheeks, hold air inside cheeks against resistance

54
Q

OFSME: jaw ROM

A

open + close jaw, move side to side

55
Q

OFSME: diadochokinetic rate (DDK)

A
  • repetition of “puh”, “tuh”, and “kuh”
  • repetition of “puhtuhkuh”
56
Q

OFSME: soft palate movement

A

production of “ah”

57
Q

OFSME: voicing

A

sustained phonation “ahhh” (for as long as possible)

58
Q

bedside clinical swallowing examination

A

assess and identify signs/symptoms of dysphagia, refer for instrumental testing

59
Q

disorders/conditions that may have a higher risk of developing dysphagia

A
  • stroke (CVA)
  • mechanical ventilation
  • oral cancer
  • ALS and MS
  • GI ulcers
  • dementia
  • head injury/TBI
  • tracheostomies
  • motor neuron diseases
  • myasthenia gravis
  • dystonia
  • diabetes
  • cervical fusion/surgery
  • laryngectomies
  • Parkinson’s disease
  • hiatal hernia
  • Huntington’s disease
  • sepsis, renal disease
60
Q

instrumental examination

A
  • Videofluoroscopic Swallowing Study (VFSS)
  • Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
61
Q

compensatory or postural strategies

A
  • swallowing maneuvers (motor with swallow)
  • focus on eliminating symptoms of dysphagia (e.g. altering food flow), not on eliminating the condition
62
Q

examples of compensatory strategies

A
  • positioning strategies: chin tuck, head turn
  • food/liquid modification: texture/consistency diet changes, volume/rate, etc.
63
Q

sensory stimulation

A
  • muscle strengthening exercises (motor without swallow)
  • goal is to increase sensory stimulation
64
Q

examples of direct therapeutic sensory techniques

A
  • thermal-tactile stimulation to anterior faucial pillars to stimulate swallow trigger
  • increased downward pressure of spoon, changes to bolus (sour/sweet), electrical stimulation
65
Q

swallowing maneuvers - motor with swallow

A

patient must be alert and able to follow directions to complete
- breath-holding techniques
- Mendelson maneuver
- effortful swallow

66
Q

breath-holding techniques

A
  • supraglottic swallow
  • super-supraglottic swallow
67
Q

breath-holding techniques: supraglottic swallow

A
  • airway protection at level of true vocal folds
  • instructions: take a deep breath (inhale) and hold, keep holding your breath as you swallow, cough immediately after swallow
68
Q

breath-holding techniques: super-supraglottic swallow

A
  • airway protection at level of laryngeal vestibule
  • instructions: take a deep breath and hold (while bearing down), keep holding breath + bearing down as you swallow, cough immediately after
69
Q

Mendelson maneuver

A
  • aimed to improve upper esophageal sphincter (UES) opening and bolus flow
  • instruct patient to place fingers on Adam’s apple + feel swallow (up/down movement)
  • instructions: swallow and try to hold the larynx in the elevated (up) position for as long as possible (1-3 seconds), then complete the swallow
70
Q

effortful swallow

A
  • aimed to improve base of tongue retraction + pressure, bolus clearance
  • instructions: push + squeeze muscles to swallow as “hard” as you can, may be done with or without food/liquid
71
Q

muscle strengthening exercises - motor without swallow

A
  • lingual resistance
  • CTAR
  • shaker head lift
  • EMST
72
Q

lingual resistance

A
  • strengthening tongue muscles
  • may use tongue depressor, device such as IOPI, etc.
73
Q

chin tuck against resistance (CTAR)

A
  • designed to improve UES opening
  • squeezing of rubber ball and tucking chin in using maximum pressure
74
Q

shaker head lift

A
  • designed to improve UES opening
  • patient lays flat, raises their head (looks to toes), + holds that position for about 1 minute x 3 reps
75
Q

expiratory muscle strength training (EMST)

A

designed to improve maximal expiratory pressure, strengthen expiratory muscles

NESPA Studying Guides (18 decks)

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