General Flashcards
Uncategorised Miscellany
Name the Range of Practice Areas
Swallowing, Speech, Voice, Fluency, Language and Multi Modal Communication
How many Range of Practice Areas are there?
6
Where is ‘Activities’ situated on the ICF diagram?
Right in the centre of the whole diagram
Where is ‘Environmental factors’ situated on the ICF diaagram?
Bottom row, LHS (Personal factors is next to it, on the RHS)
Where is ‘Personal factors’ situated on the ICF diagram?
Bottom row, RHS. (‘Environamental factors’ is next to it, on the LHS)
Where is ‘Body function and structure’ situated on the ICF diagram?
Middle (2nd) row, far LHS (‘Activites’ is next to it, in the centre of the whole diagram).
Where is ‘Participation’ situated on the ICF diagram?
Middle (2nd) row, far RHS (‘Activities’ is next to it, in the centre of the whole diagram).
Where is ‘Health condition (disorder/disease)’ situated on the ICF diagram?
At the top of the diagram (the only thing in the first row).
What is the negative term associated with ‘Body function and structure’?
Impairment
What is the negative term associated with ‘Activities’?
Limitation
What is the negative term associated with ‘Participation’?
Restriction
How does the ICF conceptualise functioning and disability?
As a dynamic interaction between a person’s health condition and their contextual factors. (Contextual factors = the complete background of an individual’s life and living). (WHO, 2001).
What do ‘personal factors’ in the ICF refer to?
Features of the individual that are not part of
the health condition’’ such as gender, age, and
coping styles (WHO, 2001, p. 17).
What do ‘environmental factors’ in the ICF refer to?
All aspects of the external world of an individual’s life that may have an impact on his or her functioning (WHO, 2001. p. 17).
Why is it important for SLPs to focus on contextual factors?
*holistic approach *ensuring that communication skills are generalisable to client’s real-life communication contexts. *Communication is collaborative -> needs a communication partner (environmental factor) *SLP can address environmental factors that influence a with speech & language difficulties’s participation. *consistent terminology within SP and across disciplines and countries. *ICF is a good social policy tool that can be used to advocate for greater community access for clients. *easier to identify specific barriers and facilitators that need to be considered. *attention to personal factors helps SLPs deliver more person-centred, personalise therapy
Which of the ICF ‘factors’ are not coded in the ICF?
Personal factors
Is dysphagia a disease?
No, it is a symptom of some underlying neurological or physical process
How many swallows per day?
Mean = ~580/day (b/n 500-700/day)
How often do we swallow (roughly)?
about 1/minute while awake and 3/hour while asleep. More when eating/drinking
dysphagia
Medical term for swallowing disorders. Can refer to any part of the swallow.
Some causes of dysphagia in adults:
- Neurological (stroke, MND, PD….)
- Structural (H&N cancer either cancer itself or surgeries (Iatrogenic) for this)
- Respiratory compromise
- Psychogenic conditions
- Iatrogenic (radiation/chemo, intubation/tracheostomy, medication…)
Some causese of dysphagia in children:
*Structural
*Neurological
*Behavioural
(Usually overlap between these)
How many stroke patients suffer dysphagia?
Up to 65% in the first week (Daniels et al, 1998)
How many Parkinson’s disease patients suffer dysphagia?
Up to 90% have some problems in the pharyngeal phase (Crary & Groher, 2016).
Many people have spontaneous recovery of functions in the week after stroke. So why is it important to assess swallowing quickly?
- immediate risk of aspiration (or even choking).
* early intervention = better outcomes
Higher prevalence of dysphagia in data from acute vs community settings may be because of…?
*Spontaneous recovery in the week after stroke….
Why is the prevalence and incidence data for dysphagia important?
- Plan and advocate for resourcing
* Assist in the assessment and management process
What is expected of new graduates re: dysphagia?
- Standard (not complex) client management (w/ adequate supervision)
- Complex clients or settings (tracheostomy, neonatal feeding, ICU…) - SUPERVISION from a senior is ESSENTIAL
Supervision is V. important in the area of dysphagia for new grads because…
If you do something contraindicated, you can actually cause damage and there can be serious outcomes if mismanaged. Know your limitations.
Why do we eat?
- Pleasure
* Nutrition/hydration
Dysphagia - example mapped onto ICF…
Health condition - Dysphagia
Body function and structure - delayed initiation
Activities - changes in oral intake
Participation - distress because unable to join in socially
Potential consequences of dysphagia:
- Aspiration
- Risk of developing aspiration pneumonia or chest infection
- Malnutrition and dehydration
- Decreased funtioning of pulmonary system
- inability to take oral medication
- Increased length of stay and costs
- Poorer outcomes, nursing home admission
- Psychosocial implications and quality of life
- Poor oral health (from decreased saliva production) with later risk of oral bacteria spreading around body
Dysphagia and Nutrition
Malnutrition and dehydration are serious consequences
- Poorly nourished - perform @ lower level, have overall worse outcomes than well nourished patients
- Work with dietician - get nutrition assessment
- Dysphagia may not be primary cause of malnutrition (ie, cancer…)
Consequences of poor nutrition:
- General fatigue
- Depression
- Muscle degradation
- decreased day to day functioning
Consequences of poor hydration (bear in mind esp. if client on modified fluids):
- Poor skin turgor
- Darkened urine
- Dry mucous membranes
Psychosocial impact of dysphagia:
- Depression, fear, trust, loss of control and embarrassment (refs in presentation).
- Eating less enjoyable, more anxiety provoking.
Aspiration:
Silent aspiration:
- entry of food/fluid into airway, below level of vocal folds.
- Silent -> as above but with no obvious clinical signs like cough or wet voice.
Laryngeal penetration:
When substance enters airway but doesn’t go below the level of the vocal folds.
Can you determine aspiration from a bedside clinical assessment alone?
NO! Need a videofluroscopy.
A potential indicator of a history of aspiration:
A history of chest infections.
Aspiration pneumonia:
*chest infection caused by aspiration of foreign matter, bacteria or gastric juices into lower respiratory tract (BUT not always caused by dysphagia [although a contributing factor]. AND not everyone who aspirates will get it. People who are not mobile are at higher risk).
Study (Langmore et al, 1998) showed other risk factors often present in people with oropharyngeal dysphagia who developed aspiration pneumonia. Other risk factors were:
- Dependency for oral feeding
- Dependent for oral care
- Number of decayed teeth.
- Tube feeding
- Multiple medical diagnosis
- Number of medications
- Smoking
Why is using the ICF framework so important in dysphagia management?
Dysphagia has a huge impact on how a person lives their life. (Psychosocial impact/QoL reduction, activity/participation limitations).
Which of the stages of swallowing is voluntary, therefore requires cognitive input to complete successfully?
Oral stage.
Why does the pharyngeal stage of the swallow require cognitive input to function optimally?
Because it’s initiated by specific oral manipulations of food by the tongue, and since this (oral) stage is vountary and requires cognition, this will also affect the involuntary pharyngeal phase.
2 primary instrumental evaluations for dysphagia:
- Fibreoptic endoscopic evaluation of Swallowing (FEES)
2. Videofluoroscopic modified barium swallow evaluation
Why might basing therapy and recommendations for dysphagia management just on the results from FEES or Videofluoroscopy have limited relevance or practicality for a given patient?
Tests done in clinical conditions without their normal foods and environments. Can’t tell what they typically eat (ie dried meats) or how they chew or swallow this particular food, while drinking alcohol and talking with friends, for example….
Dysphagia assessment and subsequent intervention must achieve the four goals of (Threats, 2007, p.332):
1) adequate nutrition and hydration
2) decreased risk of aspiration related illnesses
3) decreased choking risk
4) decreased risk of psychosocial effects (ie social isolation, depression…)
List four levels of neural control for swallowing:
- Cortex
- Cerebellum
- Brainstem
- Peripheral
- impairment at any of these levels can result in swallowing impairment
Afferent
coming in
efferent
going out
Two important nuclei in brainstem, referred to the ‘swallowing centre’:
- Nucleus tractus solitaris (NTS)
* Nucleus ambiguous (NA)
Nucleolus tractus solitarius (NTS)
- Sensory (afferent) info from CN V, VII and X (touch, temp. and taste)
- Located dorsal medulla
- surrounded by reticular formation
- Imp. for cardio, respiratory and tone regulation -> coordinates this info
Nucleus ambiguous (NA)
- Located in ventral medulla
- surrounded by reticular formation
- Afferent info from CN V, VII, IX and X from NTS sent on to NA, and NA coordinates motor output to CN V, VII, IX, X and XII.
Which CN involved in swallowing only has a motor, not a sensory, function?
CN XII
Cortical input to the swallow
- Nec. for voluntary swallow - novel bolus, or being asked to swallow something on cue.
- role in volitional control (oral phase) and influences timing of pharyngeal phase
Brain parts involved in cortical input to voluntary swallow:
- input is bilateral and multifocal:
- Anterior insular cortex
- Primary and supplementary motor cortices
- Sensoricortex
- Anterior cingulate gyrus
- Cerebellum
- Thalamus
- Amygdala
- Internal capsule
- How much, and under what circumstances, each area has an input is still unknown
Why is it important to assess both reflexive and voluntary swallow?
They have different brain inputs.
‘Hunger centre’
Hypothalamus
Which area of the brain regulates thirst and hunger?
Hypothalamus
(*Also recieves input from NTS - damage to NTS can also affect how much intake people who may present with dysphagia actually feel)
What might be impacted if areas governing taste and smell are damaged?
- eliciting responses to food (salivation etc)
* desire to eat / how appetising food is.
CN I (name, function, type)
- Olfactory
- Smell
- Special Sensory
CN II (name, function, type)
- Optic
- Sight
- Special Sensory
CN III (name, function, type)
- Oculomotor
- Eye movements
- Somatic motor
CN IV (name, function, type)
- Trochlear
- Eye movements
- Somatic motor
CN V (name, function, type)
- Trigeminal
- Sensation and Chewing
- Sensory and Branchiomotor
CN VI (name, function, type)
- Abducent
- Eye movements
- Somatic motor
CN VII (name, function, type)
- Facial
- Facial expression
- Branchiomotor
CN VIII (name, function, type)
- Vestibulocochlear
- Hearing and Balance
- Special Sensory
CN IX (name, function, type)
- Glossopharyngeal
- Oropharynx sensation*
- Sensory and Branchiomotor
CN X (name, function, type)
- Vagus
- Parasympathetic to thorax and abdomen
- Parasympathetic
CN XI (name, function, type)
- Accessory - S and C
- S: Sterno and trap mvt, C: pharynx and larynx mvt (SLN)
- Somatic and Branchiomotor
CN XII (name, function, type)
- Hypoglossal
- Motor to tongue
- Somatic motor
