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Organic Disorders > Dysphasia > Flashcards

Dysphasia Flashcards

1
Q

Disorder of swallowing

A

SLP’s who treat dysphagia are part of a team  Swallowing disorders increase risk of choking  **May lead to aspiration and pneumonia
 GASTROESOPHAGEAL REFLUX

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2
Q

Lifespan perspective

A

Problems occur in children and adults
 Newborns, may be unable to such/ingest
nutriment
 May refuse food, develop unhealthy habits
 Outcomes of swallowing disorders include
 *Malnutrition and ill health
 *Weight loss
 *Fatigue
 *Frustration
 *Respiratory Infection
 *Aspiration
 *Death

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3
Q

Swallowing process

A

Anticipatory Phase
Oral phase
Pharyngeal phase
Esophageal phase

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4
Q

Anticipatory Phase

A

Anticipatory Phase
*Salivating, positioning, response to aroma, personal rituals

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5
Q

Oral phase

A

Oral Phase
*Oral Preparatory
*Preparedliquid/solidboluspositioned *Oral transport
*Moved to back of mouth *Swallow reflex triggered

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6
Q

Oral phase

A

Oral Phase
*Oral Preparatory
*Preparedliquid/solidboluspositioned *Oral transport
*Moved to back of mouth *Swallow reflex triggered

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7
Q

Pharyngeal phase

A

 Pharyngeal Phase
 *Velum stops bolus from entering nasal cavity  *Creation of pressure
 *Pharynx contracts and squeezes
 *Hyoid bone rises, larynx up and forward
 *Vocal folds close, epiglottis lowered
 *Cricopharyngeal sphincter opens

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8
Q

Esophageal phase

A

Esophageal Phase
 *Muscles of esophagus move bolus down in peristaltic contractions

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9
Q

Disorder of swallowing
Anticipatory phase

A

Anticipatory Phase
 *Lack of interest in food
 *Sensory Impairment
 *Poor positioning

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10
Q

Disorder of swallowing
Oral phase

A

Oral Phase
 *Poor Lip Seal
 *Difficulty Chewing
 *Insufficient saliva production  *Reduced tongue function

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11
Q

Disorder of swallowing
Pharyngeal phase

A

Pharyngeal Phase
 *If swallow delayed or not triggered,
aspiration can occur
 *Open velopharyngeal port allow food into the nasal cavity.
 *Insufficient pharyngeal pressure

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12
Q

Disorder of swallowing
Esophageal phase

A

Esophageal Phase
 *Incomplete bolus movement
 *Residue can cause infection and nutritional problems.

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13
Q

Pediátric dysphasia

A

 *Inadequate growth, ill health, difficulty learning, poor parent-child relationships
 Can be due to:
 *Cerebral Palsy
 *Spinal Bifidia
 *Mental Retardation/Developmental Delay
 *Autism spectrum disorders
 *HIV/AIDS
 *Structural/Physiological abnormalities

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14
Q

Cerebral palsy and swallowing

A

Cerebral Palsy
 *Most common cause
 *Muscle tone, coordination, posture, discoordination, gag
 *May require gastrostomy tube feedings

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15
Q

Spina Bífida and swallowing

A

Spina Bifida
 *limited sensation and motor difficulties
 *Can affect all phases of swallow

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16
Q

Mental Retardation/Developmental Delay

A

Mental Retardation/Developmental Delay
 *Delayed motor coordination
 *Inability to express food preferences.

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17
Q

Adult dysphasia

A

 Dysphagia in Adults
 *Over 6 million Americans over age 60  DUE TO:
 *Stroke
 *Cancer of the mouth, throat, larynx
 *HIV/AIDS
 *Multiple Sclerosis
 *Amyotrophic Lateral Sclerosis
 *Parkinson’s Disease
 *Spinal Cord Injury
 *Medication and nonfood substances
 *Dementia
 *Depression and Social Isolation

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18
Q

Stroke

A

Stroke
 *All phases likely to be slow, impaired
 *Poor coordination of swallowing/breathing

19
Q

Cancer

A

Cancer of the mouth, throat, larynx
 *Likely after cancer treatment, depends on treatment type

20
Q

HIV and AIDS

A

HIV/AIDS
 *Esophageal ulcers, esophagitis

21
Q

 *Multiple Sclerosis

A

 *Multiple Sclerosis
 *Delayed swallow reflex, reduced pharyngeal peristalsis

22
Q

 Amyotrophic Lateral Sclerosis (ALS)

A

 Amyotrophic Lateral Sclerosis (ALS)
 *Reduced tongue mobility, laryngeal elevation, pharyngeal peristalsis

23
Q

Parkinson’s Disease

A

Parkinson’s Disease
 *Rolling tongue pattern, Pharyngeal swallow delayed, poor
laryngeal closure, esophageal abnormalities.

24
Q

Spinal cord injury

A

Spinal Cord Injury
 *Esophageal dysphagia, sometimes oral phase/pharyngeal
weakness

25
Q

 Medications and Nonfood Substances

A

 Medications and Nonfood Substances
 *Medication side effects, tardive dyskinesia
 *Smoking, excessive caffeine

26
Q

Dementia

A

Dementia
 *Attention/orientation to food, oral prep/transport impaired, delayed pharyngeal swallow, reduced laryngeal elevation

27
Q

Depression and Social Isolation

A

Depression and Social Isolation
 *Diminished interest in food, cooking for self, restlessness, fatique

28
Q

Evaluation of swallowing

A

 Silent Aspiration
 Screening for Dysphagia
 *Failure to Thrive
 *Non-Instrumental Clinical Evaluation
 *Checklist for older adults are available  *3-ounce water swallow test
 *Inappropriate weight

Case History and Background Information
 Three areas of concern:
 *Observe difficulties during eating and drinking
 *Client appears to be at risk for aspiration
 *Client appears not to be receiving adequate nourishment
 OBTAIN INFORMATION ABOUT:
 *Location of swallowing problem
 *Consistencies that are easiest/hardest to swallow
 *Nature and Severity of Disorder

29
Q

Evaluation of swallowing g cont

A

Clinical Assessment
 *Caregiver and environmental factors
 *Cognitive and communicative functioning  *Head and body posture
 *Oral mechanisms
 *Laryngeal functioning
 *Bedside Swallow evaluations
 *Managing a tracheostomy tube

Caregiver and Environmental Factors
 *Caregiver attentiveness, distractions,
position, expressing food preferences
 Cognitive and Communicative Functioning
 *Alertness/wakefulness, ability to follow directions, general functioning
 Head and Body Posture
 *Note position and whether patient can change position as directed.

30
Q

Evaluation
Oral mechanism

A

Oral Mechanism
 Note Abnormalities, asymmetry, sagging, motor difficulties, oral reflexes, sensation, drooling, infection, upper airway obstruction

31
Q

Evaluation
Pharyngeal function

A

Laryngeal Function
 Hoarse, gurgly, breathy voice
 If voice problems, may need to refer to otolaryngologist

32
Q

Bedside evaluation

A

 Reaction to food/drink
 Oral mechanisms throughout swallow
 Inability to cough/poor airway protection
 Nasal regurgitation
 Observe movement of hyoid bone/thyroid cartilage
 Record number of swallows
 Vocal quality changes
 Difficult and safe consistencies
 Preferred Placement

33
Q

 Managing a Tracheostomy Tube

A

 Managing a Tracheostomy Tube
 *Swallowing evaluation may still be
completed
 *Physician approval
 Procedure
 *Cuff is deflated
 *Secretions are suctioned
 *Patient covers tube before each swallow to normalize tracheal pressure

34
Q

Modified Barium Swallow Study
 *Videofluoroscopy

A

Modified Barium Swallow Study
 *Videofluoroscopy
 *Barium on food or in liquid
 *X-Ray recorded for later analysis  Used for determining
 *Oral vs. Nonoral feeding  *Safest food textures
 *Appropriate therapy

35
Q

Fiberoptic Endoscopic Evaluation of Swallowing

A

Fiberoptic Endoscopic Evaluation of Swallowing
 *For adults too ill for MBSS
 *Flexible-laryngoscope through nose into
pharynx
 *Swallow dyed food
 *May reveal premature spillage, airway closure
 *Provides information about desirable posture, preferred food types.

36
Q

Scintigraphy

A

Scintigraphy
Computerized technique
Measures amount of aspiration
Radioactive tracer mixed with food
 SLP positions, suggests swallow procedures, interprets results

37
Q

Ultrasound/Ultrasonography

A

Ultrasound/Ultrasonography
 *Transducer placed externally
 **Generatesandreceivessoundwaves  *Acoustic Images are taped
 *Assesses
 *Oralphaseduration
 *Structure/movementofhyoidboneand tongue

38
Q

Feeding Environment

A

Feeding Environment
Minimize Distraction
Relaxed and Unhurried
Develop self-feeding skills if possible
Appropriate utensils

39
Q

Body and Positioning

A

Body and Positioning
 *Upright, 90 degree hip angle, symmetrical
 *Reduce extraneous movement
 *Chin Tuck
 *Head back
 *Head tilt and head rotation
 May lie on one side if pharyngeal residue is present

40
Q

Modification of Foods and Beverages

A

Modification of Foods and Beverages
 *Textures, Quantities, and Temperatures
 *May only tolerate certain consistencies
 *Straws usually not recommended
 *Swallow twice
 *Vary temperatures
 Placement
 *Place where intact sensation and adequate muscle strength

41
Q

Behavioral Swallowing Treatment

A

Behavioral Swallowing Treatments Strengthening Exercises Effortful and double swallows Supraglottic swallow Mendelsohn Maneuver

42
Q

Medical and Pharmacological Approaches

A

Medical and Pharmacological Approaches
 *Drug Treatments
 **Medications can either help or cause/contribute to swallowing disorders
 Prostheses and Surgical Procedures
 *Prosthetic devices if swallowing mechanism not
intact
 *Remove cervical growths, increase vocal fold dimension, elevate larynx, suture vocal folds closed
 Nonoral Feeding
 *Nasogastric tube, Pharyngotomy, Esophagostomy, Gastrostomy

43
Q

Nonoral Feeding

A

Nonoral Feeding
 *Nasogastric tube, Pharyngotomy,  Esophagostomy, Gastrostomy

44
Q

Objective

A

Objectives
 *Improve food and drink intake
 *Prevent Aspiration
 * Success determined by cause, severity, onset of treatment
 *Treatment beneficial at least 80% of the time
 *Sometime preventable
 *Can be related to poor dentition
 *Avoid certain substances

Organic Disorders (6 decks)

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