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Dysphagia > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Most neurogenic disorders have an effect on…

A

Sensory Feedback

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2
Q

It is important to determine the etiology to determine the appropriate

A

treatment plan

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3
Q

When might a clinical bedside assessment not completely identify dysphagia

A

In cases on silent aspiration

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4
Q

A clinical bedside assessment is approximately sensitive to __ to __% of identification of dysphagia

A

40-80%

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5
Q

Provides objective or quantitative data on all phases of swallowing
Known as the “gold standard”

A

Videofluoroscopic Swallow Study (VFSS)

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6
Q

This is a 2D assessment
Requires exposure to radiation
Not always available

A

Videofluoroscopic Swallow Study (VFSS)

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7
Q 
can identify the presence of aspiration
Provides distinct information
Can be performed at bedside
Avoids radiation risk
Able to see smaller instances of aspiration
A

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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8
Q

Cortical impairments can be determined by

A

Lobe function

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9
Q

Cortical impairments may also be implied dependent on

A

Hemisphere

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10
Q

Diseases of cortical impact include

A

CVA, dementia, TBI

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11
Q

For CVA, Sensory deficits, especially in the pharynx lead to

A

dysphagia

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12
Q

CVA commonly results

A

oropharyngeal dysphagia

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13
Q

Locations of CVA —

A
  1. Medulla
  2. Pontine
    — Cerebellum & cortex
    — Depends on severity and location
  3. Subcortical
  4. Cortical
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14
Q

What might a CVA in the lower brainstem (medulla) exhibit in the oral phase?

A

normal oral processing but significantly impaired triggering of pharyngeal swallow

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15
Q

In relation to dysphagia, What might be absent with a CVA in the lower brainstem (medulla)?

A

Absent pharyngeal swallow

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16
Q

Allows for viewing of before or after the swallow

A

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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17
Q

In relation to dysphagia, what might be reduced in a lower brainstem (medulla) CVA?

A

Reduced laryngeal elevation and anterior motion with reduced CP opening

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18
Q

What swallowing difficulties might be present in a lower brainstem (medulla) CVA?

A

Difficulty with oral processing or pharyngeal swallow

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19
Q

Lower brainstem (medulla) CVAs generally result in significant oropharyngeal dysphagia because of the location of what?

A

Central pattern generator

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20
Q

Reduced laryngeal elevation and anterior motion with reduced CP opening may cause…

A

A lot of residue in pharynx or bolus can’t get through pharyngeous

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21
Q

A lower brainstem (medulla) CVA may cause _____ ______ weakness.

A

unilateral pharyngeal weakness

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22
Q

A higher brainstem (pontine) CVA may cause severe…

A

hypertonicity.

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23
Q

What 5 things might a person with a higher brainstem (pontine) CVA exhibit in relation to dysphagia?

A
  1. Delay in triggering the pharyngeal swallow
  2. Absent pharyngeal swallow
  3. Unilateral spastic pharyngeal wall paresis/paralysis
  4. Reduced laryngeal elevation
  5. CP dysfunction
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24
Q

Subcortical involves the _____ and _____ pathways

A

motor and sensory pathways

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25
This location CVA is usually not as significant of an impairment as other patients
Subcortical
26
In relation to dysphagia, A person with a subcortical CVA may exhibit...(4 things)
1. Mild delay in oral transit 2. Mild delay in triggering the pharyngeal swallow 3. Could have 3-5 second delay in pharyngeal swallow 4. Mild-moderate impairment of timing of neural controls
27
Anterior left cortical CVA can result in... including...
Mild to severe apraxia including delay in initiation or oral swallow with no tongue motion
28
In an anterior left cortical CVA, Pharyngeal swallow may present _____ _____. Explain.
motorically normal. Could be that once food makes it to the mandibular line the rest of the swallow is normal
29
An anterior left cortical CVA may result in.... and have delays in.... in relation to dysphagia.
Mild-severe searching motions Delays in noticing something is in the mouth and in tongue movement.
30
In relation to dysphagia, a right hemisphere cortical CVA can result in these delays.
Mild oral transit delay and longer pharyngeal delays (Neglect or hemiparesis)
31
Describe silent aspiration and when you should be more alert to it
Bolus into lungs but nothing to notify that it happened sensory impairment that they cannot feel it is going into their airway If they have sensory impairments you should be more alert
32
What tools are important in finding out if there is silent aspiration
VFSS and FEES are important here
33
What typically follows the clinical bedside assessment with CVA populations?
Instrumental assessment
34
Additional risk factors of aspiration in patients with CVA
1. Site of lesion 2. Co-morbidities 3. Age 4. Pulmonary health (How do their lungs sound? History of pneumonia?) 5. Head/Neck cancer 6. Dementia
35
Instrumental assessment is performed based on...(3 things)
history, risk factors, and clinical bedside swallow evaluation results
36
For CVA timing of evaluation is typically ____ at a hospital they must be seen _____
within the first week within 24 hours
37
What patients change rapidly and often?
CVA
38
the leading cause of oropharyngeal dysphagia and esophageal dysphagia
CVA
39
__% of CVA patients experience ________ after 2 weeks
50% ; dysphagia
40
CVA is a primary risk factor for _____
aspiration pneumonia
41
There is silent aspiration in __/__ of CVA patients
2/3
42
Progressive motor system disease caused by failed dopamine production
Parkinson's disease
43
slowed rate of movement
Hypokinesia
44
What stages of swallowing does dysphagia present in for parkinson's disease?
All stages! oral, pharyngeal and esophageal
45
How can parkinson's effect the oral stage of swallowing? (3)
1. slow oral swallow initiation 2. tremor may impact tongue and lips 3. May not have all the sensory needed to move or create the bolus
46
How can parkinson's effect the pharyngeal stage of swallowing? (4)
1. Delay in swallow initiation 2. Reduced pharyngeal contraction 3. Reduced tongue base movement 4. Aspiration typically after the swallow
47
How can Parkinson's effect the esophageal stage of swallowing?
CP dysfunction
48
Progressive disorder, impact on cells within brain and spinal cord
ALS - Amyotrophic lateral sclerosis
49
ALS may exhibit decreased _____. Also may have ____. Characterized by ________
1. decreased tongue mobility 2. Weight loss 3. Characterized by reduced velar movement and reduced pharyngeal contraction
50
A person with this may not exhibit dysphagia for a number of years
ALS
51
In ALS, Dysphagia begins with patient
avoiding solid consistency items
52
In ALS there is decreased _____ _____ with _______ present
decreased oral control ; fasciculations
53
What might be seen when ALS becomes more global for swallowing
1. Decreased laryngeal elevation 2. Residue, penetration, aspiration 3. May include globus
54
20-70% of people with ___ have dysphagia
TBI
55
What scales are used for TBI?
Ranchos Los Amigos Scale Glasgow Coma Scale
56
3 causes of TBI include:
1. Targeted intervention (Radiation) 2. Trauma 3. Vascular or metabolic disorder
57
3 comorbidities of TBI
— Cognitive deficits — Impulsivity — Reduced sensation
58
4 ways the oral stage is affected by TBIs
— Reduced lip closure — Reduced lingual range of motion (ROM) — Reduced bolus control — Abnormal oral reflexes (Primitive reflexes may return)
59
6 ways the pharyngeal stage is affected by TBIs
``` — Delay in triggering of pharyngeal swallow — Absent pharyngeal swallow — Reduced laryngeal elevation — Reduced airway closure — Reduced tongue base motion — Pharyngeal wall weakness ```
60
Progressive disease | Developing plaques in nerves results in decreased transfer of information and loss of function
Multiple sclerosis
61
In MS, Increased number of _______, increases likelihood of _________
plaques; dysphagia
62
If MS affects the hypoglossal nerve, how does that affect swallowing?
decreased lingual control, decreased mastication, decreased transit
63
If MS affects trigeminal nerve, how does that affect swallowing?
decreased tongue base movement, decreased pharyngeal wall movement, and decreased laryngeal function
64
If MS affects the glossopharyngeal nerve, how does that affect swallowing?
difficulty initiating swallow
65
Non-progressive neurological motor and processing disorder | Follows injury to fetal or infant brain
Cerebral Palsy
66
For cerebral palsy, Dysphagia may be due to...
sensory or motor deficits
67
What are the 3 different ways or categories of dysphagia in patients with cerebral palsy?
— 1: moderate-severe oral dysfunction — 2: oral dysfunction with delay in trigger of pharyngeal swallow — 3: oral and pharyngeal with neuromuscular abnormalities
68
What are different ways oral involvement can be affected in cerebral palsy? (3)
Inappropriate oral reflexes Inability to hold material in a cohesive bolus Disorganized lingual movements
69
Characterized by overall decline in function, including cognitive deficits
Dementia
70
How can dementia affect the motor programming for the oral phase? (4)
Agnosia for food Decreased oral acceptance Feeding and swallowing apraxia (Know what they have to do but can’t do it) Reduced lateral motion for chewing
71
What ways can dementia impact the pharyngeal stage? (4)
Poor vocal fold mobility Weak cough Prolonged swallow gestures 1/3 of patients aspirate
72
Muscles become full of inflammatory cells
Inflammatory myositis
73
explain pharyngeal dysphagia caused by inflammatory myositis (5)
Pharyngeal weakness with prolonged PTT Pyriform pooling Decreased hyolaryngeal elevation Reduced UES opening Aspiration
74
Autoimmune neuromuscular disorder with poor muscular control and easy fatigue
Myasthenia Gravis
75
What is unique cause dysphasia in relation to Myasthenia Gravis
Dysphagia symptoms worsen with use and improve with rest
76
How does Myasthenia Gravis affect the oral stage?
poor oral control, decreased velar function, decreased mastication, oral residue
77
How does Myasthenia Gravis affect the pharyngeal stage?
slow pharyngeal transit, reduced pharyngeal contraction, penetration/aspiration
78
— Disorder involving involuntary, repetitive, tic-like movements with slow onset as a result of long-term or high dose antipsychtropics
— Tardive Dyskinesia
79
How does tardive dyskinesia affect the oral stage?
— Uncontrolled tongue movements — Lip smacking, puckering, pursing — Difficulty with oral opening — Difficulty with bolus formation and transfer
80
How does tardive dyskinesia affect the pharyngeal stage?
— Respiratory irregularity | — Potential for aspiration
81
When does esophogeal phase begin?
When bolus passes ues
82
What is esophageal dysphagia?
Abnormal swallowing during the esophageal phase
83
_____ and _____ are responsible for movement of the bolus through the esophagus
gravity and peristalsis
84
may be present in 60% of dysphagia
esophageal dysphagia
85
Esophageal dysphagia is commonly due to
Gastroesphageal Reflux Disease (GERD)
86
Define esophagitis
Chronic inflammation of esophagus due to reflux
87
Dysphagia in esophagitis is due to ________ ______ ______ due to what 3 symptoms?
diminished esophageal motility inflammation, irritation, and swelling
88
Esophagitis may resolve after...
pharmacological intervention
89
Esophagitis may lead to these two things happening..
esophageal stricture (narrowing of the lumen aka opening) hiatal hernia (portion of stomach comes up through diaphragm)
90
List 7 causes of espohagitis
``` — GERD — Medication — Infection — Radiation — Chemotherapy — Allergies — Caustic injury ```
91
This may lead to trachealization, trachealization is..
— Eosinophillic Esophagitis Hardening of esophagus
92
What are esophageal rings? What can benefit them?
— Narrowing that occurs at the gastroesophageal junction — Can block the esophagus — Benefits from esophageal dilatation
93
What are 5 esophageal dysmotilities?
Ineffective esophageal motility (IEM) ``` Hypertensive LES (HTLES) — Distal esophageal spasm (DES) — Nutcracker Esophagus — Achalasia ```
94
What is achalasia?
Absence of contractions, rely on gravity
95
What is nutcracker esophagus?
Esophagus moves more than normal
96
Laryngopharyngeal Reflux (LPR) is when
Acid from stomach comes up to the level of the larynx
97
— Excessive backflow of stomach contents into the laryngopharynx causing breakdown of mucosal structures
Laryngopharyngeal Reflux (LPR)
98
Compare and contrast GERD and LPR
``` GERD — Primarily nighttime in supine position — Episodes may be prolonged — More obese patients — Result of LES dysfunction — Not tight enough to keep acid from passing through — Result of esophageal dysmotility — LPR — Daytime reflux — Brief episodes — Not related to body mass — Appears unrelated to LES dysfunction — May be related to UES dysfunction ```
99
T/F: the esophagus can handle intermittent exposure to stomach acids
True
100
____ _____ clears the majority of esophageal bolus while____ _____ is a result of repeat swallows to clear
Primary peristalsis; secondary peristalsis
101
Two layers of protection include...
esophageal lining and epithelium
102
poorly protected, highly sensitive
Larynx
103
6 LPR symptoms
``` — Throat clearing — Chronic cough — Globus — Dysphonia — More edema at level of vocal folds — Postnasal drip ```
104
What is nissen fundoplication?
put in structures to tighten LES
105
— Dysphagia can result in head and neck CA patients related to:
Tumor growth changes in tissue due to radiation or chemotherapy can increase dysphagia risk Surgical procedures TMN
106
What functional deficits may result from oral cancer?
— Unable to form cohesive bolus — Unable to transfer bolus — Decrease trigger for pharyngeal swallow — Decreased pressure — Reduced mastication — Anterior loss of the bolus — May not be able to accept a large bolus through oral opening — Reduced sensation and taste — Decreased epiglottic inversion/hyoid elevation — Decreased protection of the airway
107
A swallow requires _____ and ______ function
smooth and coordinated
108
What is a simple resection vs a composite resection?
simple is 1 structure and composite is more than 1 structure
109
Effects are dependent on..
— Location — Age — Size — Severity
110
Best treatment for swallowing is
Swallowing itself
111
— The “mainstay” for small oral and small laryngeal CA
Surgical intervention
112
Typical locations for oral cavity cancer are...
— anterior floor of mouth or lower alveolar ridge — tongue — lateral floor of mouth or lateral alveolar ridge — tonsil — tongue base — hard palate — soft palate
113
Ability to open/close the mouth after surgery oral sphincter surgery depends on
the size of the resection, the nerves involved, and what structural support remains in place
114
— What muscles are on the floor of the mouth?
— Genioglossus — Mylohyoid & Geniohyoid — Stylohyoid
115
Surgery in the anterior floor of the mouth could cause
Decreased hyoid elevation and decreased tongue mobility
116
— Swallowing efficiency is dependent on
ability of tongue base to contact the posterior pharyngeal wall
117
3 types of glossectomy are
total, partial and hemiglossectomy
118
Removal of a portion of the mandible can cause
malocclusion or inability to close the jaw at all
119
Removal of a portion of the mandible can impact
masseter and pterygoid
120
What is oronasal fistula
a hole up to the nasal cavity
121
What is the role of the pharynx?
— To assist in Closure and generate Pressures | — Job of pharyngeal constriction is to move the bolus downward
122
What are the 3 areas of cancer of the larynx?
superglottic (above vocal folds), glottis (between vocal folds), and subglottic (below vocal folds)

Dysphagia (6 decks)

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