Final Flashcards
Swallowing is initiated voluntarily in the oral cavity. This is followed by involuntary control. This involuntary control is regulated by…
Bilateral cortical interhemispheric and brainstem connections
Failure to close this sphincter during swallowing results in leakage of teh bolus or air into the nasopharynx and diminished ability to generate appropriate oropharyngeal pressures to propel the bolus through the oropharynx.
Velopharyngeal sphincter
The tongue is made up of intrinsic muscles and extrinsic muscles. Together these muscles help the tongue to manipulate and collect the bolus. Which lingual muscles lower the tongue, protract it anteriorly, and elevate the tongue?
Extrinsic muscles: genioglossus, hyoglossus, styloglossus, palatoglossus muscles.
At rest this sphincter is in a state of tonic contraction that minimizes the entrance of air into the gastrointestinal tract during respiration. The major component of this sphincter is the cricopharyngeal muscle. Relaxation of this sphincter begins after the onset of swallowing and lasts 0.5 to 1 second.
Upper esophageal sphincter
These pharyngeal structures are involved in deglutition and form the posterior and lateral pharyngeal walls.
The superior, medial, and inferior pharyngeal constrictors.
Swallowing can be visualized as the passage of the bolus through a series of dynamic chambers. These chambers are separated by sphincters (gates) that help to prevent spillage of the material before it enters the next chamber.
True
Normal bolus movement through the oral and pharyngeal cavities is a combination of opening/closing of sphincters, pressure and tongue posture
True
Which muscle is NOT involved in elevation of the hyoid/laryngeal complex?
Omohyoid
The primary sensory (afferent) control of the tongue, lips, and mandible is via cranial nerve…
CN V Trigeminal
Sensory and motor integration of the phases of swallowing suggests that…
Voluntary and involuntary aspects of swallowing may occur in parallel.
If the hyoid elevates and moves forward, the larynx will move ______ and _____ unless it is stabilized or restricted by other muscles.
upward,forward
The suprahyoid muscles are responsible for elevating the hyoid bone. Which of the following are suprahyoids?
Mylohyoid, Stylohyoid, and Digastrics
The teeth are the primary manipulators of the bolus during the oral phase of swallowing.
false
The tongue is made up of intrinsic muscles and extrinsic muscles. Together these muscles help the tongue to manipulate and collect the bolus. Which lingual muscles shape the tongue for management of various types of food and liquid? They also form a pocket to hold the bolus in place and keep it from falling into the cheek or spilling into the oropharynx.
Intrinsic muscles: transverse, vertical and longitudinal fibers
There are four common patterns of respiration coordination in swallowing. Choose the most common (and also the most protective) pattern found in healthy adults during drinking.
EX/EX (expiration, apnea event, expiration)
A clinical swallow screening can be performed and documented by a nurse, speech-language pathologist, or occupational therapist.
True
Respiration has no influence on swallowing function and therefore need not be considered during patient examination.
false
Which of the following is a part of the case history?
Gathering information on a family history of swallowing disorders, Gathering information on medications and their dosages, Gathering information on any recent weight changes, and Exploring reported evidence of trauma in the patient’s medical history and considering how a history of trauma may impact your relationship with the patient
The clinical swallow evaluation…
Should be relied upon to detect silent aspiration.
The presence of facial asymmetry can contribute to oral preparatory and/or oral phase dysphagia.
true
Oral Phase: Lip Seal
Assess by eliciting a cheek puff from the client.
Oral Phase: Tongue range of motion
Assess by eliciting the following movements: “Lateralize, elevate, and depress tip of tongue.”
Oral Phase: Tongue strength
Assess by pressing the tongue against resistance (such as against a tongue depressor or gloved hand).
oral phase: tongue sensation
Assess by lightly touching different parts of the tongue and oral cavity. Clinicans can also use flavored swabs on different parts of the tongue to assess taste.
oropharynx: soft palate motion
Assess by asking the client to open the mouth. Observe movement during /a/ and “ah-ah-ah” phonation.
oropharynx: soft palate sensation
Assess by touching the structure with a tongue blade or cotton swab. Ask the client if they felt the touch and where they felt it.
Larynx: laryngeal elevation
Can’t be fully assessed at the patient bedside. Requires use of a MBSS/VFSS or FEES for full assessment. Can assess broadly or grossly at the bedside by palpating the patient’s thyroid prominence during swallowing.
larynx: pooling of secretion
Cannot be observed at the patient bedside during a clinical swallow evaluation. Requires a VFSS/MBSS to fully assess. Can be assessed broadly or grossly at the bedside by listening to the patient vocal quality. A wet vocal quality is a red flag.
larynx: vocal fold closure
Cannot be observed at the patient bedside during a clinical swallow evaluation. Requires a VFSS/MBSS to fully assess. May assess informally with laryngeal tasks. May be heard as a loud voice.
During the oral examination, the 3 features of each organ that are assess are…
range of motion, strength, and sensory function
During the pharyngeal phases of swallowing the larynx and hyoid bone move
upward and forward
Five basic taste sensations exist: sweet, sour, salty, bitter, and “zest”.
true
When food or liquid penetrates to the level of the vocal folds, voice quality is likely to change. At the clinical bedside the SLP may hear the voice quality become wet or gurgly sounding.
true
The reluctance to eat or fear of eating/drinking due to past swallowing problems, the inability to digest or absorb ingested nutritents, or the inability to swallow safety are all conditions that increase the risk of malnutrition.
true
This validated self-assessment tool was developed specifically to evaluate the impact of dysphagia on the quality of life of patients with head and neck cancer. It takes about 10 to 15 minutes to administer and consists of 20 items divided into 4 subscales (1) global measure on the impact of swallowing ability (2) emotional (3) functional and (4) physical statements related to swallowing.
MD Anderson Dysphagia Inventory
Community-acquired pneumonia is a pulmonary infection resulting from acute or chronic aspiration of fluids, foods or oral secretions from the mouth or from fluids arising in the stomach and flowering into the airway.
true
This patient-reported outcome measure is used to measure dysphagia symptom severity. Each item is rated on a 5-point interval scale from 0=No problem to 4=Severe problem.
Eating Assessment Tool (EAT-10)
The pharyngeal phase of swallow begins when the bolus reaches the level of the pyriform sinuses.
false
Peristalsis is the sequential contraction of the esophagus and relaxation of the lower esophageal sphincter, characterized in the esophageal phase of swallowing. This type of peristalsis occurs when a swallow induces peristaltic activity.
primary peristalsis
Postoperative anterior cervical spine surgery can cause dysphagia. Speech-language pathologists working with patients following ACSS must be aware that certain postural adjustments like the chin-tuck maneuver or turning the head to one side to facilitate a swallow may not be possible.
true
Aspiration pneumonia is…
a condition in which a chemical inflammation or bacterial infection results in entry of foreign materials into the bronchi of the lungs.
Term that indicates that the bolus has entered the airway but has not gone below the vocal folds.
penetration
A tracheotomy is an operation during which the surgeon makes a cut or opening in the trachea. The removal of a tracheotomy tube is known as decannulation.
true
Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) are…
inflammatory disorders of the esophagus that affect structures within and above the esophagus.
The collection of brainstem nuclei that coordinates the swallowing sequence is known as the central pattern generator.
true
Autoimmune diseases may affect swallowing by causing intrinsic obstruction, external compression, abnormal motility, or inadequate lubrication of swallowing structures.
true
Dysphagia after cervical spine surgery is due to…
Disruption of the motor and sensory innervations (pharyngeal plexus), pain, edema, and scarring in the pharynx
Zenker diverticulum forms above the cricopharyngeal sphincter muscle. It is a pouch created by the failure of the upper esophageal sphincter (UES) to open before the propulsive wave, and due to weakness of the laryngeal elevators.
true
The size and distribution of a stroke infarct (infarct = site of injury where brain cell death occurred) define the clinical presentation of the stroke. The size and distribution of the stroke are dependent on the degree and site of interrupted blood supply to the brain.
true
Amyotrophic Lateral Sclerosis
a progressive disease involving degeneration of the upper and lower motor neurons. 73% of patients in this population will have dysphagia before requiring ventilator support. These patients usually have more problems with liquids and large pieces of food.
Cerebrovascular Accident (CVA) (also known as stroke)
Most common cause of neurogenic oral and pharyngeal dysphagia. The trend is that the larger the area of infarction (lesion/damage), the greater the impairment of swallowing.
Parkinson Disease
a progressive degenerative neuromuscular disorder characterized by the loss of striatal dopamine in an area of the brain known as the basal ganglia.Oral and pharyngeal dysphagia in this population is usually multifactorial - meaning caused by combination of cognitive impairment, reduced posture, dysmotility and impulsive feeding behaviors at times.
Myasthenia Gravis
an acquired autoimmune disorder of neuromuscular transmission in which acetylcholine receptor antibodies attack the postsynaptic membrane of the neuromuscular junction. This leads to rapidly fatiguing muscles since the attack reduces the available muscle-activating neurotransmitter. Swallowing problems occurs in 1/3 of patients with this condition.
The most severe swallowing problems in stroke patients are caused by strokes at the
brainstem
CN V - Trigeminal Nerve (Motor)
Clinician may see slight weakness in muscles of mastication.
CN VII - Facial Nerve
Clinician may see slight weakness in bolus control and weak lip closure.
CN IX- Glossopharyngeal nerve (sensory)
Clinician may see failure for patient to trigger the pharyngeal stage of the swallow. May also see premature spill of material from the mouth into the airway (early bolus loss/premature loss of bolus).
CN X - Vagus Nerve - Superior laryngeal nerve injury (sensory)
During instrumental assessment the clinician may see loss of the protective glottic closure and cough reflexes which our bodies involuntary use to protect the airway from material in the supraglottic larynx (upper larynx)
CN X - Vagus Nerve (motor)
Clinician may see inadequate velopharyngeal closure, nasal regurgitation, incomplete clearing of residue in the hypopharynx, pooling of material above the vocal folds, aspiration once the vocal folds open
CN XII - Hypoglossal Nerve
Clinician may see bolus control problems due to reduced tongue mobility and driving force
facial
cn vii
hypoglossal
cn xii
glossopharyngeal
cn ix
trigeminal
cn v
Tracheotomy results in several changes to the physiology of swallowing. Which is NOT one of those changes?
Aspiration is eliminated
