IV: Structural Communication and Swallowing Disorders Flashcards
craniofacial
outer nasal structures (4)
nasal bridge, columella (supports nasal tip), ala nasi (curved part around nostril), naris
craniofacial
nasal septum (6)
divides the nasal cavity into two sections, includes: vomer bone, perpendicular plate of the ethmoid, quadrangular cartilage, turbinates/conchae (divided into superior, middle and inferior), meatus (also divided into superior, middle and inferior)
craniofacial
upper lip (4)
philtrum, cupid’s bow, labial tubercle, vermillion (red lip tissue)
craniofacial
tongue (2)
dorsum of tongue (dorsal/top surface) :: ventrum of tongue (ventral/under surface)
craniofacial
faucial pillars and tonsils (4)
anterior/posterior faucial pillars, palatine tonsils, lingual tonsils
craniofacial
bones of the oral cavity (5)
alveolar ridge, incisive foramen, pre maxilla, hard palate, pterygoid process of the sphenoid bone
craniofacial
velar structures (3)
velum/soft palate, median palatine raphe, uvula
craniofacial
pharyngeal structures (3)
pharynx (oropharynx, nasopharynx, hypopharynx, posterior pharyngeal wall, lateral pharyngeal walls), adenoids/pharyngeal tonsils (removal can affect velopharyngeal function), eustachian tube (connects middle ear to pharynx, responsible for middle ear function)
craniofacial
properties related to velopharyngeal function (3)
knee action (bending to provide maximum contact with the posterior pharyngeal wall), velar dimple (formed by contraction of the levator muscles), passavant’s ridge (shelf-like projection from the posterior pharyngeal wall)
craniofacial
pharyngeal wall movement (2)
lateral:to close against velum :: posterior:assists in achieving contact against the velum
craniofacial
muscles of the velopharyngeal valve (1)*
velopharyngeal sphincter (levator veli palatini, superior constrictors, palatopharyngeus, palatoglossus, salpingopharyngeus, musculus uvulae, tensor veli palatini)
*all muscles are paired on each side of midline
craniofacial
innervation of velopharyngeal complex (6)
pharyngeal plexus (network of nerves that lies along the posterior pharyngeal wall), involvement of cranial nerves: V, VII, IX, X, IIX
craniofacial
variations in velopharyngeal closure (3)
coronal (most common, complete closure with little contribution from lateral pharyngeal walls), circular (second most common, complete true-sphincter closure), sagittal (complete closure due to lateral movement medially)
craniofacial
primary palate structures (3)
those located anterior to the incisive foramen, includes lip and alveolar ridge, develops at 7 weeks gestation, embryological path from the incisive foramen to the lip
craniofacial
primary palate clefts (2)*
complete clefts of the primary palate:extend through the lip and alveolus to incisive foramen :: incomplete clefts:do not extend all the way to the incisive foramen and can include: forms frustrating (slight lip notch), cleft of the lip only, or cleft of the lip and just part of the alveolus
*can be unilateral or bilateral where incisive sutures are primarily affected
craniofacial
secondary palate structures (4)
located posterior to incisive foramen, develops at 9 weeks gestation, embryological path from the incisive foramen to the uvula, includes: hard palate, velum, uvula
craniofacial
secondary palate clefts (2)
complete clefts of the secondary palate:extend from the uvula to the incisive foramen :: incomplete clefts:do not extend all the way to the incisive foramen and can include: bifid uvula, cleft of the velum only, or cleft of the velum and just part of the hard palate
craniofacial
effects of cleft lip and palate on speech (3)
dental and occlusal anomalies (cross bites, class III malocclusions), hearing loss due to eustachian tube malfunction, velopharyngeal insufficiency (VPI)
craniofacial
effects of cleft lip and palate on feeding (2)
cleft lip:usually does not affect feeding :: cleft palate:inability to build up suction/compress nipple (thus, breastfeeding is not possible)
craniofacial
pierre robin sequence (5)
a wide bell-shaped cleft palate, micrognathia (small mandible), glossoptosis (posterior tongue position), airway and feeding difficulties, speech issues secondary to velopharyngeal insufficiency (VPI)
craniofacial
velocardiofacial syndrome (5)
deletion 22q11.2 syndrome, usually occult submucous cleft palate or velopharyngeal hypotonia, velopharyngeal dysfunction causing hyper nasality, cardiac and vascular anomalies, facial anomalies (microcephaly, micrognathia, nasal)
craniofacial
stickler syndrome (5)
cleft palate only, pierre robin sequence, wide flat face, sensorineural hearing loss, risk for velopharyngeal insufficiency
craniofacial
FAS (5)
fetal alcohol syndrome, pierre robin sequence, cleft palate and cleft lip, short nose and flat philtrum and thin upper lip, developmental disabilities with behavioral problems
craniofacial
trisomy 13 (4)
cleft lip and palate with possible midline cleft, eye defects, midline facial deformities, fatal before first birthday
craniofacial
wolf-hirschhorn syndrome (6)
common cleft palate, microcephaly and micrognathia, short philtrum, developmental disabilities, speech and language disorders, occasional hearing loss
craniofacial
opitz g syndrome (3)
flat nasal bridge and thin upper lip, low set ears, type of cleft: laryngeal cleft (voice and swallowing problems), cleft lip, cleft palate
craniofacial
van der wood syndrome (3)
cleft lip and palate, bilateral lip pits on the lower lip and missing teeth, speech disorders related to cleft lip and palate
craniofacial
OFD I (5)
orofacialdigital syndrome type I, notching in alveolar ridge, absence of corpus collosum, developmental disabilities and speech and language disorders, type of cleft: cleft lip, cleft palate, midline cleft lip
craniofacial
saethre-chotzen syndrome (4)
cleft palate or submucous cleft palate, ptosis of the eyelids, external ear anomalies, risk for developmental disabilities
craniofacial
crouzon syndrome (3)
cleft palate (submucous cleft is occasionally seen), craniofacial features similar to apert syndrome (broad forehead, class III malocclusion, low-set ears), risk for developmental disabilities and upper airway obstruction
craniofacial
apert syndrome (5)
cleft palate occurs infrequently, craniofacial features similar to apert syndrome (broad forehead, class III malocclusion, low-set ears), developmental disabilities, speech and language disorders, upper airway obstruction
craniofacial
pfeiffer syndrome (4)
cleft palate (rarely seen), shallow orbits with exophthalmos, tracheal anomalies and upper airway stenosis (upper airway obstruction), hearing loss
craniofacial
hemifacial microsomia (7)
aka oculoauriculovertebral dysplasia, cleft lip and/or palate, facial asymmetry, cleft-like extension to corner of mouth, ear and eye anomalies, hearing loss, occasional velopharyngeal insufficiency or incompetence
craniofacial
CHARGE syndrome (5)
pierre robin sequence and cleft lip/palate, Coloboma-Heart disease-Atresia of the choanae-Retarded growth/development-Genital anomalies-Ear anomalies, hearing loss or deafness, developmental disabilities, speech and language disorders
craniofacial
treacher collins syndrome (4)
clefts occur infrequently (despite pierre robin sequence and pronounced micrognathia), microbial or middle ear anomalies, glossoptosis, hearing loss
craniofacial
beckwith-wiedmann syndrome (5)
no cleft, hypertrophic facial features, macroglossia, airway problems, feeding and speech disorders
craniofacial
normal resonance (2)
determined by the function of the velopharyngeal valve, affected by the size and shape of cavities of the vocal tract (pharynx, oral cavity, nasal cavity)
craniofacial
normal velopharyngeal structures (3)
dependent on normal anatomy (structures – velum, lateral and posterior pharyngeal walls), neurophysiology (function), and speech sound learning (articulation)
craniofacial
velopharyngeal insufficiency (3)
the structure of the velum is too short (misshapen) for closure against the posterior pharyngeal wall during speech, always requires physical management (surgery, obturator), speech therapy generally geared towards changing compensatory productions resulting from VPI
craniofacial
velopharyngeal incompetence (2)
the movement of the velum is too poor during speech, usually requires physical management (palatal lift, surgery)
craniofacial
velopharyngeal mislearning (2)
caused by faulty articulation learning (abnormal resonance due to severe hearing loss or deafness, phoneme-specific nasal emissions, phoneme-specific hypernasality), treatment always requires speech therapy and never surgery
craniofacial
effects of velopharyngeal dysfunction on speech (2)
hypernasality, nasal air emission (resulting in: inadequate air pressure for pressurized consonants, short utterance length due to need for frequent breath replenishment, obligatory distortions due to abnormal structure or VPI)
craniofacial
hypernasality vs hyponasality (1::1)*
too much sound resonating in nasal cavity (most perceptible on vowels) :: not enough sound resonating in nasal cavity (most perceptible on nasal consonants)
*can be mixed
craniofacial
cul-de-sac resonance (2)
when sound resonates in the pharynx or nasal cavity but is not released due to obstruction, commonly caused by enlarged tonsils
craniofacial
instrumental assessments (4)
nasometer, aerodynamic instrumentation, video fluoroscopy, nasopharyngoscopy
craniofacial
common surgical procedures for VPI (4)
pharyngeal augmentation (implant/injection to increase bulk), furlow z-plasty (technique to lengthen velum), sphincter pharyngoplasty, pharyngeal flap (posterior pharyngeal wall is sutured into the velum to partially close the nasopharynx)
craniofacial
treating hypernasality or nasal emission due to VPI (2)
CANNOT be treated using speech therapy, speech therapy is only appropriate after the structures have been repaired
voice
suprahyoid muscles (6)
moves the larynx superiorly and anteriorly or superiorly and posteriorly, includes: mylohyoid, geniohyoid, anterior belly of digastric, hyoglossus, stylohyoid
voice
infra hyoid muscles (6)
lowers and stabilizes the larynx, includes: thyrohyoid, sternohyoid, sternothyroid, omohyoid, inferior constrictor
voice
laryngeal abductors (1) vs adductors (2)
posterior cricoarytenoids :: lateral cricoarytenoids, interarytenoids (oblique, transverse)
voice
laryngeal tensor muscles (2)
stiffens-lengthens the vocal folds, includes: cricoarytenoids (pars recta, pars oblique), thyroarytenoids (thyrovocalis, thyromuscularis)
voice
glottis vs ventricle
space between the vocal folds :: space between the true and false vocal folds
voice
supraglottal vs infraglottal areas
space above the vocal folds and below the base of tongue :: space below the true vocal folds
voice
aditus (1)
opening to the larynx
voice
ventricular folds (1)
false vocal folds
voice
layer structure of vocal folds (3)
cover (squamous epithelium, superficial layer of the lamina propria), transition (forms the vocal ligament and includes: intermediate layer of the lamina propria, deep layer of the lamina propria), body (thyroarytenoid muscle)
voice
cranial nerve input to the larynx
CN X and its three branches: pharyngeal nerve, superior laryngeal nerve (SLN), inferior laryngeal nerve (recurrent laryngeal nerve)
voice
vital capacity (1)
amount of air available for use when lungs are inflated maximally
voice
expiratory vs inspiratory pressure
positive :: negative
voice
phonation types (7)
normal, breathy, whisper, voiceless, strained/creaky, glottal fry/gravelly, glottal stop (folds shut with no vibration)
voice
registers (4)
a series or range of consecutively phoned frequencies that can be produced with nearly identical voice quality and do not overlap, types: pulse (lowest portion of phonational range, 30-80Hz), modal (largest portion of frequency range comprised of 1.5 octaves), loft (highest portion of range aka falsetto)
voice
acoustic measures (5)
fundamental frequency, intensity, jitter, shimmer, noise measures
voice
subglottic pressure (1)
pressure measured below the vocal folds, usually during vibration
voice
airflow rate (1)
average rate of airflow through the vocal tract during phonation
voice
glottal resistance (1)
the ratio of subglottic pressure to airflow rate
voice
timbre (2)
quality of voice perceived by listeners as distinguished from pitch and loudness, aspects include: severity, roughness, breathiness, strain, nasality
voice
ADMET (2)
aerodynamic myoelastic theory of phonation, proposed by van den berg to reflect mechanisms involved in one cycle of glottal vibration that results in vocal fold vibration
voice
cover-body theory (3)
the vocal fold cover moves independently of the body (aka thyroarytenoid muscle), the theory suggests that anything that interferes with the movement of the cover will affect the resulting voice quality, proposed by hirano and kaki in 1985
voice
disorders associated with phonotrauma (3)
vocal nodules, polyps, polypoid degeneration (reinke’s edema)
voice
organic voice disorders (3)
cysts, human papilloma virus (HPV), laryngitis
voice
functional voice disorders (5)
muscle tension dysphonia (hyper functional dysphonia), psychogenic dysphonia/aphonia, puberphonia (mutational falsetto), ventricular phonation (plica ventricularis), vocal cord dysfunction (paradoxical vocal fold motion)
voice
voice disorders of neurologic origin (4)
inferior (recurrent) laryngeal nerve paralysis, superior laryngeal nerve (SLN) paralysis, spasmodic dysphonia (SD), essential tremor of the voice (organic voice tremor)
voice
congenital pediatric voice problems (3)
laryngomalacia (floppy airway), subglottic stenosis (respiratory distress), laryngeal web (stridor)
voice
acquired pediatric voice problems (1)
bilateral vocal nodules
voice
persons with VPI vs persons with hearing loss (1)
the effect on voice (for both) is primarily that of resonance
voice
VHI (2)
voice handicap index, 30-item questionnaire (functional, physical, emotional)
voice
VRQOL (2)
voice-related quality of life, 10-item questionnaire (6 in physical domain and 4 in social-emotional domain)
voice
FCM (2)
functional communication measure, voice capability and quality is assessed on a 7-point scale reflecting functional capability
voice
GRBAS (1)
most common measurement tool used worldwide for estimating voice quality for the following features: grade, rough, breathy, asthenic, strained
voice
CAPE-V (2)
created by ASHA voice SIG, clinicians rate three voice quality features (overall severity, roughness, breathiness, strained) for three contexts (vowel, sex specified sentences, conversation)
voice
perturbation measures (1)
instability measures reflecting variability in period and amplitude from cycle to cycle aka jitter and shimmer
voice
resonant voice therapy (1)
optimizing vocal quality through a focus on maximizing oral-pharyngeal resonance and the degree of medial compression between the vocal folds
voice
botox (1)
injection into the thyroarytenoid (usually) for treatment of spasmodic dysphonia and sometimes essential tremor of the voice
voice
strategies to cure head and neck cancer (4)
surgery, radiotherapy, chemotherapy, chemoradiation
voice
effects related to chemotherapy vs radiation (5::8)
fatigue, nausea, loss of appetite, changes in taste, hair loss :: inflammatory reactions, tissue fibrosis, loss of appetite, fatigue, xerostomia, necrosis, mucositis, pain
voice
total laryngectomy (3)
entire larynx removed, a permanent tracheostomy separates the respiratory tract from the oral/digestive tract, no longer able to use vocal folds
voice
alaryngeal voice (2)
accomplished using prosthetic for tracheoesophageal (T-E) voice or artificial-electronic larynx, most common type of prothesis is a one-way low-pressure valve place at the back of the permanent stoma
voice
supra-glottic laryngectomy (1)
a type of partial laryngectomy where laryngeal structures and tissues above the level of the true vocal folds are surgically removed
voice
hemi-laryngectomy (2)
a type of partial laryngectomy where a vertical (sagittal) portion of laryngeal tissue is resected, involves part or all of one vocal fold
voice
glossectomy (3)
surgical removal of the tongue tissue, in partial glossectomy affected parts of the tongue are removed, in total glossectomy the entire tongue is removed
voice
areas susceptible to head and neck tumors (5)
larynx, tongue, floor of the mouth, tonsils, palate
dysphagia
swallowing (2)
a patterned behavioral response, including: oral preparatory phase, oral phase, pharyngeal stage, esophageal stage
dysphagia
feeding (1)
the oral manipulation of food and drink prior to the initiation of the swallow
dysphagia
dysphagia (2)
difficulty or abnormality in moving food from the mouth to the stomach, “dysphagia is a symptom of an underlying condition or disease that may result from a variety of neurologic, neuromotor, systemic, immunologic, developmental or iatrogenic conditions as well as infectious processes, surgery or trauma”
dysphagia
swallowing anatomy (9)
tongue, pharyngeal tongue, oropharynx, nasopharynx, hypopharynx, laryngopharynx (epiglottis, valleculae, pyriform sinuses, laryngeal additus), constrictor muscles (superior, middle, inferior), posterior and lateral pharyngeal walls, esophagus (upper esophageal sphincter composed of the cricopharyngeal muscles)
dysphagia
cranial nerves involved with swallowing (6)
CN V (mastication, floor of mouth), VII, IX, X (base of tongue, larynx, stomach), XI (motor only, velopharyngeal elevation), XII (motor only, hyolaryngeal elevation)
dysphagia
the swallowing center (1)
central pattern generator located in the medulla and pons
dysphagia
end of oral phase (2)
when the bolus passes the ramus of the mandible (on fluroscopic studies), then the pharyngeal stage begins
dysphagia
hyolaryngeal elevation (2)
innervated by CN XII, aids in the opening of the upper esophageal sphincter
dysphagia
bolus flow through the pharynx via constrictor muscles (3)*
superior pharyngeal constrictor muscle -> middle pharyngeal constrictor muscle -> inferior pharyngeal constrictor muscle aka cricopharynxgeus muscle (part of the UES)
*these contract the walls of the pharynx during swallowing and are each innervated by CN X
dysphagia
muscles that elevate the hyoid bone during swallowing (4)
digastric floor of mouth (CN VII), stylohyoid (CN VII), mylohyoid floor of mouth (CN V), geniohyoid floor of mouth (CN XII)
dysphagia
muscles that depress the hyoid bone during swallowing (4)*
omohyoid, sternohyoid, sternothyroid, thyrohyoid
*all innervated by CN XII
dysphagia
muscles of mastication (4)*
temporal, masseter, lateral pterygoid, medial pterygoid
*all innervated by CN V
dysphagia
extrinsic tongue muscles (4)
genioglossus (CN XII), hyoglossus (CN XII), styloglossus (CN XII), palatoglossus (CN X)
dysphagia
intrinsic tongue muscles (4)*
superior longitudinal, inferior longitudinal, transverse, vertical
*all innervated by CN XII
dysphagia
muscles of the lower face (lip function) (6)*
obicularis oris, zygomaticus, buccinator, risorius, mentalis, platysma
*all innervated by CN VII
dysphagia
intrinsic laryngeal muscles (6)*
cricothyroid, thyroarytenoid, posterior cricoarytenoid, lateral cricoarytenoid, interarytenoids (transverse and oblique), vocalis
*all innervated by CN X
dysphagia
xerostomia (2)
lessening of salivary flow, risks include: dental decay, reduced lubrication, mineralization of teeth, neutralization of stomach acid, changes in oral sensation
dysphagia
stroke and parkinson’s disease (2)
most common neurological conditions that result in dysphagia, others include: amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), myasthenia gravis, muscular dystrophy, cerebral palsy (CP), huntington’s disease, TBI, dementia
dysphagia
stroke and cerebrovascular attack (CVA) (2)
primary cause of dysphagia, caused by vascular dysfunction (disruption of blood flow) which leads to lack of oxygen in the brain
dysphagia
pontine (pons) stroke symptoms (5)
results in: hypertonicity, delayed/absent swallow response, reduced laryngeal elevation, cricopharyngeal dysfunction, slow recovery
dysphagia
medullary stroke symptoms (3)
longer pharyngeal phase response times, increased duration of velar and laryngeal elevation, longer response time for cricopharyngeal sphincter (UES) opening
dysphagia
wallenberg’s syndrome (1)
a form of brainstem stroke causing pharyngeal phase problems
dysphagia
subcortical strokes (3)
symptoms are milder, pharyngeal phase is most affected, therapy includes triggering of pharyngeal swallow and tongue base movement
dysphagia
cortical strokes (2)*
damage to right hemisphere is more susceptible to pharyngeal problems, damage to left hemisphere results in oral phase difficulties
*right hemisphere cortical stroke yields more severe symptoms
dysphagia
parkinson’s disease (3)
dysphagia present in 50% of patients, marked by sensory deficits (results in pooling, lingual rocking, silent aspiration/penetration), treated using expiratory muscle strength training (EMST) and lee silverman voice therapy (LSVT) to help increase sensory awareness
dysphagia
PSP (3)
progressive supra nuclear palsy, a degenerative disorder of the CNS which results in widespread neuronal degeneration in multiple systems in the brain and basal ganglia, very similar to parkinson’s disease
dysphagia
ALS (5)
amyotrophic lateral sclerosis, a severe and rapid progressive degeneration of UMN and LMN tracts, results in a severe dysfunction of all stages of swallowing, cognition intact, no cure so dysphagia treatment is temporary and minimally successful
dysphagia
MG (5)
myasthenia gravis, a lower motor neuron disorder where impairment occurs at the myoneural junction, deficits in acetylcholine production/release, primary dysphagia symptom is weakness that exacerbates with repeated effort, dysphagia treatment includes energy conservation (smaller volume meals but more frequent, textures that require less chewing)
dysphagia
MS (3)
multiple sclerosis, an immune-mediated demyelination of nerve fibers in the brain and spinal cord, dysphagia occurs if corticobulbar tracts or brainstem pathways are affected
dysphagia
huntington’s disease (3)
an autosomal-dominant neurogenerative disease (detectable via blood tests), marked by choreatic movements, treatment is aimed towards controlling impulsivity and slowing eating rate
dysphagia
postpolio syndrome (3)
viral-induced degeneration of the lower motor neurons and brainstem, dysphagia typically occurs decades after the initial attack due to overuse of remaining motor neurons, dysphagia symptoms across all stages of the swallow
dysphagia
guillain-barre syndrome (2)
an autoimmune disorder affecting the peripheral nervous system (demyelination of cranial nerves), causes weakness and sensory loss in the pharynx/larynx
dysphagia
dystonias (5)
generalized, neck, oromandibular (OMD-meige syndrome), lingual, treatments include: botox injections and/or lesion surgery
dysphagia
dermatomyositis (4)
an immune system disorder which may appear during childhood (serious condition that appears as sun sensitivity), skin rashes and scales, weakness/pain in abdominal area, treated with steroid
dysphagia
TBI (3)
traumatic brain injury, may result in dysphagia if pharyngeal anatomy is damaged, spinal surgeries and/or neck bracing may also restrict swallowing
dysphagia
dementia (6)
cognitive impairment, dysphagia is not typical, oral motor sensory deficits occur usually if the disease is paired with a brain injury/other neurological condition, food agnosia (inability to recognize food), feeding apraxia (inability to remember how to swallow), treatment ineffective when cognition becomes more impaired
dysphagia
principles of neuroplasticity (10)
use it or lose it, use it and improve it, specificity, repetition matters, intensity matters, time matters, salience matters, age matters, transference, inference
dysphagia
head and neck cancers (4)
squamous cell cancers are the most prevalent, treatments can impair speech and swallowing (surgery, radiation, chemotherapy), mucositis causes pain and may be a limitation to swallowing, tumors may impact swallowing function depending on size and location
dysphagia
total glossectomy (3)
reduced BOT motion, difficulty with bolus propulsion, reduced hyolaryngeal elevation
dysphagia
hypopharyngeal tumors (1)
may appear as a sore throat until dysphagia appears
dysphagia
laryngeal tumors (2)
high risk of aspiration due to reduced airway protection, categorized by location in the glottis (supraglottic, glottic, subglottis)
dysphagia
pseudoepiglottis (2)
a tissue fold at the base of tongue that may obstruct the pharynx or collect residue, may need surgical intervention
dysphagia
TEP (2)
tracheoesophageal puncture, a small flexible prosthesis placed into a tracheal stoma to prevent back flow and aspiration, also serves as a voice prosthesis
dysphagia
passy-muir valve (2)
a speaking valve, also has benefits for swallowing including: restoring sensation, taste and laryngeal closure
dysphagia
aspiration (3)
entry of food/liquid into the airway below the true vocal folds, may occur at any time (not just after swallow trigger), may lead to aspiration pneumonia if the material is a respiratory pathogen (gram-negative bacteria)
dysphagia
aspiration pneumonitis (2)
aka mendelson’s syndrome, a chemical injury caused by inhalation of sterile gastric contents (different from aspiration pneumonia which is caused by the inhalation of respiratory pathogens)
dysphagia
penetration (1)
occurs when material enters the laryngeal aditus or laryngeal ventricle at some level above the vocal folds but does not pass into the airway
dysphagia
silent aspiration (2)
no reaction to aspirated material, sign of sensory deficit
dysphagia
aspiration-penetration scale (2)
quantifies penetration/aspiration events during a videofluroscopic swallow study (VFSS), rating scale is commonly used for MBS
dysphagia
8-point aspiration-penetration scale
(1) material does not enter the airway (2) material enters the airway, remains above the vocal folds and is ejected from the airway (3) material enters the airway, remains above the vocal folds and is NOT ejected from the airway (4) material enters the airway, contacts the vocal folds and is ejected from the airway (5) material enters the airway, contacts the vocal folds and is NOT ejected from the airway (6) material enters the airway, passes below the vocal folds and is ejected into the larynx or out of the airway (7) material enters the airway, passes below the vocal folds and is NOT ejected from the trachea, despite effort (8) material enters the airway, passes below the vocal folds and no effort is made to eject the material
dysphagia
esophageal motility disorders (4)*
GERD, gastroesophageal reflux (GER), laryngopharyngeal reflux (LPR), backflow
*typically treated using antireflux medications (proton pump inhibitors)
dysphagia
esophageal abnormalities (5)
zener’s diverticulum, pill-induced esophagitis, achalasia (failure of lower esophageal sphincter to relax, aka “bird’s beak”), scleroderma (weakened LES), tumors or neoplasms of the esophagus
dysphagia
MBS (4)
modified barium swallow, aka video fluoroscopic swallowing study (VFSS), radiation exposure, lateral view
dysphagia
FEES (4)
fiberoptic endoscopic evaluation of swallowing, aka nasoendoscopy, uses a flexible fiberoptic nano-pharyngo-laryngoscope to observe the pharynx and larynx and vocal folds before and after a swallow, view briefly obliterated by white-out period
dysphagia
FEEST (2)
fiberoptic endoscopic evaluation of swallowing with sensory testing, uses air puffs or touching structures to scope tip
dysphagia
US (2)
ultrasound imaging, safe and noninvasive
dysphagia
manometry (1)
a medical procedure to view the pressure changes in the esophagus and pharynx during swallowing
dysphagia
scintigraphy (2)
a radiographic procedure that uses radioactive tracer T99 mixed into foods, bolus flow and location detected by a specialized gamma camera (collimator)
dysphagia
fMRI (2)
functional magnetic resonance imaging, uses alternating magnetic fields to delineate soft tissues and blood vessels
dysphagia
SEMG (2)
surface electromyography, uses electrodes placed on the submittal or neck region, electrical signals are generated by muscle contractions of the thyrohyoid muscle and floor of mouth muscles
dysphagia
direct vs indirect treatments (1::1)*
use food :: do not use food
*swallowing is the most effective exercise to retrain the swallow
dysphagia
supraglottic swallow (5 steps)*
hold breath -> take sip -> swallow -> cough and clear the airway -> swallow again
*super supraglottic swallow uses increased effort used before the swallow in breath holding
dysphagia
mendelsohn maneuver (3)
a direct technique used during a swallow to manually lift the larynx and sustain a swallow at the hight of laryngeal elevation, designed for those with reduced opening of the UES and cricopharyngeal muscle dysfunction, effective with intensive use
dysphagia
masako maneuver (2)
swallowing (without food) is practiced with the tongue held outside of the mouth, used to create more pharyngeal pressure
dysphagia
thermal tactile stimulation (2)
aka thermal application, purpose is to trigger a pharyngeal swallow with use of sensory stimulation (cold) and contact (tactile pressure) to the anterior faucial arches and surrounding tongue and posterior pharyngeal area
dysphagia
treatments for geriatric patients (3)
more likely to fatigue with rigorous exercise, isometric exercises (uses resistance to retrain lingual muscles), other tasks: bolus flow, posture and diet modifications
dysphagia
shaker exercise (4)
upper esophageal sphincter (UES) augmentation, an isometric neck exercise, improved anterior laryngeal excursion and the anterior-posterior diameter of UES opening, consists of repetitions of sustained head-raising in supine position
dysphagia
effortful swallow (2)
hard swallow used to reduced risk of aspiration, demonstrates: increased oral lingual pressure, increased duration of maximum hyoid elevation, closure of the laryngeal vestibule
dysphagia
postural changes (7)
compensatory techniques used to improve patient safety and ability to transfer bolus safely into the pharynx, includes: fundamental posture, tilt chin downward, turn or tilt head, turn head to damaged side and tuck chin, tilt head back, side lying
dysphagia
functional oral intake scale (7)
(1) nothing by mouth (2) tube dependent with minimal attempts at food or liquid (3) tube dependent with consistent oral intake of food (4) total oral diet of a single consistency (5) total oral diet with multiple consistencies, but requiring special preparations or compensations (6) total oral diet with multiple consistencies, without special preparation but with specific food limitations (7) total oral diet with no restrictions
dysphagia
NMES (4)
neuromuscular electrical stimulation, uses electrodes placed sub mentally to provide electrical stimulation to the muscles of the neck, controversial, no proven benefits
dysphagia
mcneill dysphagia therapy program (1)
a systematic exercise-based program combined with traditional swallowing therapy and surface electromyography feedback
dysphagia
mealtime strategies (1)
direct feeding supervision so clinician may provide cues/feedback, facilitate techniques/strategies and modify bolus/food intake
dysphagia
goals of surgical options (4)
improve opening of UES, enhance airway protection, improve glottal closure, close the glottis
