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med speech > exam 2 > Flashcards

exam 2 Flashcards

1
Q

seatbelt + airbag

prevention of TBI

A

81%

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2
Q

wearing a motorcycle helmet

prevention of TBI

A

67%

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3
Q

what % of motorcyclists who dies were speeding

A

40%

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4
Q

TBI

A
  • caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain
  • either closed or open head injury
  • neurological injury can occur due to TBI -> focal brain damage at the site of injury widespread brain damage due to diffuse axonal injury, ischemia, or other secondary effects
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5
Q

ABI

A
  • brain damage caused by other etiologies
    • those like near-drowning, brain infections, congenital heart defects, chemotherapy and radiation, and drug overdose
      • associated with loss of oxygen & widespread disruption of cell functioning
    • brain tumors, ruptured arteriovenous malformations, and strokes
      • more focal lesions
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6
Q

TBI demographics

A
  • below 5 years
  • 15-24 years
  • 75+ years (or 65+)
    • survival rate and age have an inverse relationship.
  • males higher incidence
    • about 1/2 of all pediatric TBI are from falls
    • motor vehicle accidents are a large %
    • shaken baby syndrome
    • sports/recreational activities
  • those with previous tbi are 3x as likely to have another tbi
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7
Q

blast injury

A

- cavitation effect: negative pressure at the point opposite impact drops below vapor pressure level, causing intra and extracellular fluid to convert to a gaseous form

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8
Q

penetrating injury

A
  • an object (eg bullet) penetrates the skull, possibly carrying debris into the brain
    • if brainstem: high mortality rate
    • KEY: if patient survives initial injury, prognosis is surprisingly good
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9
Q

closed head

A

acceleration/decceleration
nonacceleration
impression trauma

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10
Q

acceleration/deceleration: linear velocity

A
  • brain moves along linear path
  • KEY: coup, contrecoup
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11
Q

acceleration/deceleration: angular acceleration

A
  • brain rotates at an angle
    • lacerations, shearing of axonal connections
    • KEY: diffuse axonal injury
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12
Q

non-acceleration: ellipsoidal deformation

A
  • caused by a slow-moving object which deforms skull from oval to circular
  • KEY: brain tissue moves outward from center
    • stretching, tearing of central structures
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13
Q

impression trauma

A

damage going in and damage coming out (carrying debris)

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14
Q

personal orientation spheres that may be disturbed by TBI:

A
  1. person
  2. time
  3. place
  4. circumstance
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15
Q

cognitive stall

A
  • common for TBI patients to improve after injury at a slower rate than typically developing peers
    • particularly executive functioning can recover more slowly
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16
Q

diff between restorative and compensatory approaches to treatment

A
  • restorative: based on notion that neuronal growth (which results from improvement in function) is associated with repetitive exercise of neuronal circuits
    • ‘muscle building approach’—repetitive exercises and drilling
  • compensatory: concedes that certain functions can’t be recovered, so the goal is to develop strategies to circumvent the impaired functions

  • this view of cognitive rehabilitation implies that restoration and compensatory strategies are distinct phases of the rehabilitation continuum. First we do restorative treatment and then we implement compensatory strategies where needed.
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17
Q

pediatric TBI: aspects of cognition negatively affected by TBI

A
  • working memory
  • attention
  • declarative memory
  • social cognition
  • executive functioning
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18
Q

pediatric tbi recovery

A
  1. occurs in context of development
  2. influenced by the child’s environment
  3. nature and extent depends on the age at the injury (due to plasticity)
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19
Q

tbi in adolescents vs pediatric

A

adolescents:
- respond more like adults do
- diffuse axonal injury
- focal contusions

pediatric
- more likely to have diffuse cerebral edema
- does not affect syntax or morphology

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20
Q

primary and secondary TBI damage

A

primary:
- focal and diffuse lesions

secondary:
- the changes that evolve over a period of hours to days after the primary brain injury

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21
Q

secondary TBI damage

A
  • hemorrhage
  • intracranial pressure
    • might restrict cerebral blood flow
  • hypoxic & ischemic
    • hypoxia: lack of oxygen to brain tissue
  • seizures:
    • many patients have seizures within 24 hrs of TBI
  • neurochemical alteration:
    • injured neurons due to the TBI might secrete damaging cytokines
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22
Q

simple partial

seizure

A
  • remain conscious.
    • weakness, numbness, unusual smells/tastes
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23
Q

complex partial

A
  • alters their ability to interact with environment
    • eg. walking in circle, smacking lips, fear, uncontrollable laughter, etc
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24
Q

petit mal

A
  • lapses of awareness, staring, brief jerking of the eyelids or facial muscles
    • usually begin and end abruptly, lasting only a few seconds
      • often so brief they escape detection
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25
Q

atonic

A

individual has an abrupt loss of muscle tone producing head drops, loss of posture or sudden collapse

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26
Q

grand mal

A
  • stiffening of the limbs (tonic phase), followed by jerking of the limbs (clonic phase)
    • during the tonic phase, breathing may decrease producing cyanosis (blueing) of the lips, nail beds, and face
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27
Q

glasgow coma scale

A

measures eye opening, verbal response, and motor response

  • severe: 3-8
  • moderate: 9-12
  • mild: 13-15

-if it is more severe it will be a lower number
-if it is less it will be higher

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28
Q

rancho los amigos scale

no general is loco enough to be confused 3x he is automatic and purposeful-appropriate 3x

A
  • I: no response — total assistance
  • II: generalized response — total assistance
  • III: localized response — total assistance
  • IV: confused-agitated — maximal assistance
  • V: confused, inappropriate, non-agitated — maximal assistance
  • VI: confused-appropriate — moderate assistance
  • VII: automatic-appropriate — minimal assistance for daily living skills
  • VIII: purposeful-appropriate — stand by assistance
  • IX: purposeful-appropriate — stand by assistance on request
  • X: purposeful-appropriate — modified independent
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29
Q

FIM scale (functional independence measure)

A
  1. total assist (performs less than 25% of task)
  2. maximal assist (performs 25%-49% of task)
  3. moderate assist (performs 50%-74% of task)
  4. minimal assist (performs 75% or more of task)
  5. supervision (cuing, coaxing, prompting)
  6. modified independence (extra time, devices)
  7. complete independence (timely, safeley)
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30
Q

grasp

primitive reflexes

A
  1. press object on the palm of the hand
  2. closure of the hand around object
31
Q

babinski

primitive reflexes

A
  1. scratch the lateral margin of the foot from the heel to the toe
  2. extension and flaring of the toes
32
Q

moro (startle)

primitive reflexes

A
  1. loud noise
  2. symmetrical spread of the arms with the fingers extended
33
Q

tongue thrust

primitive reflexes

A
  1. present liquid
  2. movement of the tongue between/against the upper teeth during swallow
34
Q

tonic bite

primitive reflexes

A
  1. pressure to the gums
  2. closure of the jaws in a biting motion
35
Q

RHD characterized by

A
  1. perceptual deficits
  2. attentional deficits
  3. affective (emotional) deficits
  4. communication deficits
36
Q

perceptual deficits

A
  • capgras syndrome
  • prosopagnosia
  • left neglect
37
Q

capgras syndrome

A

belief that family and friends are not real selves, but imposters or doubles

38
Q

prosopagnosia

A

inability to recognize familiar faces

39
Q

left neglect

A
  • copying/pointing to/reading from only the right side
    • not a visual problem
40
Q

makisack-myers edgeness task

A
  • Tx of left neglect
  • find specified number of cubes on a board with quadrants
    • can increase difficulty by including colors
41
Q

tompkins & flowers Tx

A
  • Tx of prosodic features
  • 3-sentence story, last sentence is a quote by a character
    • patient has to read and generate appropriate prosody
42
Q

oral phase

A
  1. food chewed into paste texture
  2. bolus formed positioned for transport into pharynx
  3. voluntary
43
Q

oral transit or transport phase

A
  1. begins with the posterior propulsion fo the bolus by the tongue
  2. bolus is propelled posteriorly in the pharynx
  3. bolus arrives at the base of the tongue and triggers swallow reflex
  4. voluntary
44
Q

pharyngeal phase

A
  1. bolus moves through larynx
  2. larynx rises and laryngeal vestibule closes
  3. epiglottis inverts to cover airway
  4. pharynx constricts, esophageal sphincter opens
  5. involuntary
45
Q

esophageal phase

A
  1. bolus enters the esophagus through the UES and travels to the stomach
  2. gravity and peristalsis
  3. involuntary
46
Q

difference between aspiration and penetration

A

aspiration:
- food, fluid, or secretions pass the fold and enter the trachea

penetration:
- material enters the larynx but does not pass below the folds

47
Q

outward symptoms of dysphagia

A
  • self-report of difficulty swallowing
  • slowness in eating
  • coughing/choking at mealtimes
  • gurgly/wet voice
  • drooling/leakage at the lips
  • residue in the mouth after swallowing
  • watery eyes
  • history of recurrent pneumonia
  • unexplained weight loss
  • silent aspiration
48
Q

clinical swallow assessment (bedside swallow)

A

steps:
1. observe patient in room (alertness, posture, O2 saturation, ability to follow directions)
2. oral motor exam (labial, lingual, velopharyngeal)
3. graduated food trials (ice chips, thin liquids, thick liquids, pureed food, solids
- advantages: easily accessible materials, more timely, view oral-prep phase
- disadvantages: can’t see the pharyngeal phase*
- or esophageal
- can’t see silent aspiration

49
Q

fiberoptic endoscopic examination of swallow (FEES)

A
  • video naseoendoscopy
  • disadvantage: “white out period” where the image is blocked
50
Q

modified barium swallow examination:

A
  • videofluoroscopy (moving x-ray)
  • radio-opaque barium is used to visualize food movements during swallow
  • different types of food and liquid can be visualized
  • most in depth
51
Q

after evaluation: modifying diet

A
  • modifying food textures may be used to:
    • help avoid aspiration risk
    • improve ease of chewing and managing the bolus
    • help improve safety if the patient has cognitive impairments
  • solid foods may be pureed, minced, or chopped
  • liquids may be thickened
    • thing liquids can be hardest to control
    • think: would you drink this?
  • altering texture and thickness does NOT guarantee swallow safety
52
Q

after evaluation: nasogastric tube

A
  • nurse usually insertis tube via nose, pharynx, into the esophagus
  • delivers liquified nutrients
  • usually short-term option
  • increased reflux risk
53
Q

indirect treatment:

A

indirect treatment:

  • exercising muscle groups used in swallowing or by practicing neuromuscular elements in swallow without using food
    • ex. shaker exercise:
      • client lies on back, elevates head to see their feed for 1 minute, then 1 minute of rest
54
Q

direct treatment:

A
  • actually change swallow physiology as food or liquid is utilized
    • generally not provided if patient is aspirating

-shaker exercise don’t know unless he talked about it in class

55
Q

what is mechanical dysphagia?

A

structural change caused by surgery to remove tumor (such as laryngectomy, hemilaryngectomy etc.); may involve the tongue or larynx

56
Q

what is triggered to protect the airway form the intrusion of food, liquid, or secretions?

A

cough reflex

57
Q

ICP (intracranial pressure)

A
  • hemorrhage, edema, or CSF can cause increased ICP
  • increased ICP can restrict cerebral blood flow
  • | severity | ICP in mmHg |
    | typical | 5-15 |
    | mild | 16-20 |
    | moderate | 21-30 |
    | severe | 31-40 |
    | very severe (often fatal) | 40+ |
58
Q

minimally conscious state

A

a condition in which there is minimal but definitive evidence of self- or environmental awareness

59
Q

why treat dysphagia?

A

🍎 maintain adequate nutrition

📈 increase recovery

🫁 decrease risk of aspiration pneumonia, which may

       🏥 lengthen hospital stay

       😷 weaken an already sick patient

       ⚰️result in death
60
Q

swallow reflex

A
  • a sequential series of actions to:
    1. protect the airway and
    2. propel food into the esophagus
  • hyoid bone moves anteriorly, epiglottis inverts, larynx elevates, the laryngeal vestibule collapses and breathing temporarily stops
  • constrictor muscles move the food through the pharynx as the upper esophageal sphincter relaxes and allows the food to enter the esophagus
61
Q

gag reflex

A
  • triggered by touching pharyngeal wall
  • often also based of tongue, velum
  • not predictive of swallowing function
62
Q

cough reflex

A
  • triggered by material in the larynx
  • forceful exhalation, vocal fold approximation
  • protects the airway against intrusion
  • neuro damage can prevent this reflex
63
Q

neurological dysphagia

A
  • brain damage impacts control of movements
    • stroke, tbi, or degenerative disease
  • could cause weakness, slowed contraction, or discoordination
  • impaired sensory feedback
64
Q

neurologic dysphagia phases

A

oral and oral transit phases
- poor chewing, bolus formation
- weakness prevents bolus propulsion
- residue in the mouth
- premature spilling of liquids into pharynx
- thin liquids are most difficult for them

pharyngeal phase
- difficulty triggering swallow
- insufficient laryngeal elevation, closure
- weakened pharyngeal peristalsis
- pooling of residue — subsequent aspiration

esophageal phase
- seldom seriously affected

65
Q

esophageal diverticulum

A

bulging or pouch caused by weakness in the esophageal wall

66
Q

mechanical dysphagia phases

A

oral and oral transit phases
- difficulty forming, moving bolus
- may need to change food textures

pharyngeal phase
- airway protection may be compromised
- scarring may reduce mobility

esophageal phase
- physical constriction or blockage
- unlike neurological which doesn’t have issues

67
Q

how do we treat dysphagia

A

diet, postural changes, exercise, and alternative feeding options

68
Q

behavioral treatments — postural adjustments

A

chin down — helps protect airway
chin up — uses gravity to move bolus
head tilt — tips bolus toward stronger side
head turn — can close off weaker side of pharynx

69
Q

npo

A
  • some patients must be npo
    • aspiration of all texture types
    • minimally responsive
    • recent oral/pharyngeal surgery
70
Q

nasogastric tube (NG tube)

A
  • nurse usually inserts tube via nose, pharynx, into the esophagus
  • delivers liquified nutrients to stomach
  • usually short-term option
    • causes irritation, ulcerations
  • increased reflux risk
71
Q

PEG feeding (percutaneous endoscopic gastrostomy)

A
  • attachment remains on abdominal wall
  • allows long term feeding
    -be REALLY clean around them
72
Q

non-enteral feeding

A
  • bypasses digestive tract
  • nutrients delivered to bloodstream
73
Q
A

med speech (10 decks)

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