Group Study Guide Flashcards
What is best practice?
Evidence
Experience
Empathy
What associations/entities define our scope of practice and the rules SLPs should adhere to when diagnosing and treating swallowing patients?
the entities are:
- ASHA
- state boards
- insurance companies like medicare and managed health care companies
- whoever you receive reimbursements from also defines what you can and cannot do
the rules SLPs should adhere to are:
- physician must be present when we are conducting a MBS
- we do not have exclusive rights to be the only providers of dysphagia
- OT’s can be the primary providers as well if they are adequately trained (evaluation and intervention are within their scope of practice)
- we cannot dictate what other professionals do
- we cannot control other professionals
Explain the four stages of swallowing, the normal physiology and the cranial nerves that innervate each of the stages.
Oral prep: the purpose is to break down food to a consistency appropriate for swallowing and mix it with saliva. Neuromuscular actions include labial seal, rotary chew, lateral motion of tongue and jaw. The larynx and pharynx are at rest. It is a sensory feast. For larger volumes the tongue subdivides and splits up the bolus in your mouth. Cranial nerves include V: trigeminal, VII:facial, X;vagus, and XII;hypoglossal. The stage ends when the tongue starts to propel the bolus to the back of the throat. The amount of time this stage lasts depends on what you are eating. chewing steak is very diferent than chewing ice cream. This stage is voluntary.
Oral: This stage is initiated when the tongue moves back. The main componanent is propulstion (stripping action). This stage ends with the pharyngeal swallow. Canial nerve XII, hypoglossal, is the primary nerve in this stage. The oral stage lasts for 1 second. It is hypothesizsed that the trigger for the pharyngeal swallow comes froms the lower brainstem. This stage is voluntary.
Pharyngeal: look at midterm
Esophageal: starts when the UES opens until the passing into the stomach. It is involuntary. It is controlled by vagus nerve. There are striated annd smoth muscles in the esophagus. Striatedmuscles are striped and found in the hear. The esophogus goes through the diagphragm. It is an ivoluntary stage that lasts for 2-6 seconds.
What are the 5 key activities that occur during the pharyngeal stage (in your notes).
- closure of the velopharyngeal port
- tongue base retraction (contacts an hits pharyngeal wal)
- elevation of hyoid and larynx
closure of larynx
relaxation.opening of the UES
What is the UES?
It is the upper esophageal sphincter. It is know as the cricopharyngeal opening or the pharyngeal esophageal segment. It is located inat the lower end of the parhynx and guards the entrance into the esophagus.
What is the UES’ role in swallowing?
- pressure drives the UES to open (this is caused by the larynx elevating)
- the cricopharyngeus muscle opens to permit entry o bolus into esophagus
- it prevents reflux contents into the pharynx to guard airway aspiration
- this stage is involuntary and lasts 1 second
What role does the floor of the mouth muscles play in swallowing?
the muscles of the floor of the mouth elevate the hyoid and larynx
What are the methods we utilize to evaluate swallowing (clincal and instrumental)?
besides swallow evaluation we give MS, FEES, manometry (mostly for research), and ultrasound.
What are the 4 categories of swallowing treatment that Groher and Crary discuss. Give an example of each one.
Behavioral: changing behavior to adapt to the swallowing disorder (i.e look left, no straws, slow down)
Dietary: changing the diet to adapt to the swallowing disorder, chopped meats, blended food
Medical: medication changes adapt to the swallowing disorder, N-G tube, botox
Surgical: surgical procedure to fix the swallowing disorder, Thyroplasty, G-tube
What is the main medical consequence of pharyngeal dysphagia?
aspiration pneumonia
Name a few normal changes of swallowing that occur in the elderly as it relates to each of the stages.
Oral stage: hold bolus more anteriorly, increased/prolonged masticationm reduction of tongue mobility, sensory changes
Pharyngeal stage: larger volumes to trigger the swalow, slower time for UES/PE segment to relax, triggering of pharyngeal swallow below ramus. coupling of swallowing seperates
Esophageal: transmit may be delayed, higher incidence of reflux and mobility issues
Why are the normal healthy elderly at risk for swallowing problems?
there is an overall reduction in reserve
anotomical and physiological changes take place
the uncoupling of oral and pharyngeal events occur
Where is the main neural control center located? Define the NTS.
It is called the nucleus tractus solitariIt is located in the medulla oblangata where clusters of cell bodies (nuclei) regulate sensory and taste; it is a junction box that coordinates a large amount of input/output sensory.mortor information.
The Vagus nerve in the medulla controls motor information. The NTS controls sensory information (including taste)
What is the difference between penetration and aspiration?
Penetration: some of the bolus enters the area above the glottis. The larynx and the hypod move up and the trace amount of bolus is removed from the glottis. Penration is normal for older aults as long as it clears. It is caused by problems with the back of the tongue, reduced laryngeal elevation, reduced hyoid movement forward
Aspiration: when the bolus enters the area above the glottis and it is not removed. It passes through the vocal folds and into the lungs. Aspiration can be normal as long as it is trace (we all aspirate once in a while).
What is the difference between nutritive and non-nutritive sucking?
Nutritive sucking: sucking for nutrition, 1 suck per second, apnea occurs, airway not always open
Non-nutrtive: 2 sucks per second, airway is open, apnea does not occur
What are the differences in the anatomy of swallowing in an infant vs. an adult?
The nose in infants:
- smaller nares
-sinuses are not completely formed
Oral cavity in infants:
-tongue fills the mouth
-edentulous (no teeth)
-tongue rests between lips, sits against palate
-sucking pads in cheeks
-smaller mandible
-sulci (space between gum and inside of cheek) important in sucking for an infant
Pharynx in infants
- no definite oropharynx so they have less risk of aspiration
- obtuse angle at skull base in nasopharynx
-single line of breathing allowing infants to suck and swallwo at the same time
larynx in infants
- 1/3 the size of an adults size
-1/2 true vocal folds are cartilage
-very narrow vertical epiglottis
- more forward and higher
-thyroid cartilage is round
Esophagus in infants
-1.5 cm in length
-LES is still immature, LES keeps acid from coming back up into esophagus -LES is still developing
-Usually matures by 6 months - may take 9-12 monnths
-delayed gastric emptying
-reflux is normal in infants
-40% regergitate at least once a day
*swallowing is voluntary and involuntary in adults,, but it is only involuntary in newborns
How is the infant’s anatomy customized to prevent aspiration?
there is no definite orpharynx, the soft palate and epiglottis are squished together, allowing the child to suck and breath simultaneously
What is RDS and how would it affect infant’s swallowing?
Respiratory Distress Syndrome
- affects lungs of preterm neonates due to lack of “surfactant” or (fluis decreed by lungs to stabilize and prevent them from collapsing upon exhalation)
- due to lack of flusid, premies have difficulty inflating and deflaing lungs
RDS affects the infannt’s swallow because they choose to protect thier repiratory systemm throuugh a volntary refusal to swallow
What are the most important reflexes for the infant?
rooting
suck/swallow
tongue thrust
gag reflex
What is the suck/swallow reflex and why is it important?
- infants/mouth area are touched, mouth opens and – - sucking/suckling begins
- its important because it facilitates transition from breast to bottle
When is the right time to introduce an infant to food?
around 4-6 mos when reflexive responses have diminisehd aling with motor development of body and upper extremeties - so they can hold a cup
From your textbook, what are some of the clinical signs of reflux in infants? How does this affect thier ability to feed?
gaggins choking apnea halitosis (bad breath) burping, frequent swallowing
