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PRAXIS EXAM > IV: Structural Communication and Swallowing Disorders > Flashcards

IV: Structural Communication and Swallowing Disorders Flashcards

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1
Q

craniofacial

outer nasal structures (4)

A

nasal bridge, columella (supports nasal tip), ala nasi (curved part around nostril), naris

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2
Q

craniofacial

nasal septum (6)

A

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)

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3
Q

craniofacial

upper lip (4)

A

philtrum, cupid’s bow, labial tubercle, vermillion (red lip tissue)

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4
Q

craniofacial

tongue (2)

A

dorsum of tongue (dorsal/top surface) :: ventrum of tongue (ventral/under surface)

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5
Q

craniofacial

faucial pillars and tonsils (4)

A

anterior/posterior faucial pillars, palatine tonsils, lingual tonsils

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6
Q

craniofacial

bones of the oral cavity (5)

A

alveolar ridge, incisive foramen, pre maxilla, hard palate, pterygoid process of the sphenoid bone

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7
Q

craniofacial

velar structures (3)

A

velum/soft palate, median palatine raphe, uvula

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8
Q

craniofacial

pharyngeal structures (3)

A

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)

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9
Q

craniofacial

properties related to velopharyngeal function (3)

A

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)

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10
Q

craniofacial

pharyngeal wall movement (2)

A

lateral:to close against velum :: posterior:assists in achieving contact against the velum

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11
Q

craniofacial

muscles of the velopharyngeal valve (1)*

A

velopharyngeal sphincter (levator veli palatini, superior constrictors, palatopharyngeus, palatoglossus, salpingopharyngeus, musculus uvulae, tensor veli palatini)

*all muscles are paired on each side of midline

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12
Q

craniofacial

innervation of velopharyngeal complex (6)

A

pharyngeal plexus (network of nerves that lies along the posterior pharyngeal wall), involvement of cranial nerves: V, VII, IX, X, IIX

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13
Q

craniofacial

variations in velopharyngeal closure (3)

A

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)

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14
Q

craniofacial

primary palate structures (3)

A

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

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15
Q

craniofacial

primary palate clefts (2)*

A

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

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16
Q

craniofacial

secondary palate structures (4)

A

located posterior to incisive foramen, develops at 9 weeks gestation, embryological path from the incisive foramen to the uvula, includes: hard palate, velum, uvula

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17
Q

craniofacial

secondary palate clefts (2)

A

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

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18
Q

craniofacial

effects of cleft lip and palate on speech (3)

A

dental and occlusal anomalies (cross bites, class III malocclusions), hearing loss due to eustachian tube malfunction, velopharyngeal insufficiency (VPI)

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19
Q

craniofacial

effects of cleft lip and palate on feeding (2)

A

cleft lip:usually does not affect feeding :: cleft palate:inability to build up suction/compress nipple (thus, breastfeeding is not possible)

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20
Q

craniofacial

pierre robin sequence (5)

A

a wide bell-shaped cleft palate, micrognathia (small mandible), glossoptosis (posterior tongue position), airway and feeding difficulties, speech issues secondary to velopharyngeal insufficiency (VPI)

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21
Q

craniofacial

velocardiofacial syndrome (5)

A

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)

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22
Q

craniofacial

stickler syndrome (5)

A

cleft palate only, pierre robin sequence, wide flat face, sensorineural hearing loss, risk for velopharyngeal insufficiency

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23
Q

craniofacial

FAS (5)

A

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

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24
Q

craniofacial

trisomy 13 (4)

A

cleft lip and palate with possible midline cleft, eye defects, midline facial deformities, fatal before first birthday

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25
Q

craniofacial

wolf-hirschhorn syndrome (6)

A

common cleft palate, microcephaly and micrognathia, short philtrum, developmental disabilities, speech and language disorders, occasional hearing loss

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26
Q

craniofacial

opitz g syndrome (3)

A

flat nasal bridge and thin upper lip, low set ears, type of cleft: laryngeal cleft (voice and swallowing problems), cleft lip, cleft palate

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27
Q

craniofacial

van der wood syndrome (3)

A

cleft lip and palate, bilateral lip pits on the lower lip and missing teeth, speech disorders related to cleft lip and palate

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28
Q

craniofacial

OFD I (5)

A

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

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29
Q

craniofacial

saethre-chotzen syndrome (4)

A

cleft palate or submucous cleft palate, ptosis of the eyelids, external ear anomalies, risk for developmental disabilities

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30
Q

craniofacial

crouzon syndrome (3)

A

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

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31
Q

craniofacial

apert syndrome (5)

A

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

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32
Q

craniofacial

pfeiffer syndrome (4)

A

cleft palate (rarely seen), shallow orbits with exophthalmos, tracheal anomalies and upper airway stenosis (upper airway obstruction), hearing loss

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33
Q

craniofacial

hemifacial microsomia (7)

A

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

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34
Q

craniofacial

CHARGE syndrome (5)

A

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

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35
Q

craniofacial

treacher collins syndrome (4)

A

clefts occur infrequently (despite pierre robin sequence and pronounced micrognathia), microbial or middle ear anomalies, glossoptosis, hearing loss

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36
Q

craniofacial

beckwith-wiedmann syndrome (5)

A

no cleft, hypertrophic facial features, macroglossia, airway problems, feeding and speech disorders

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37
Q

craniofacial

normal resonance (2)

A

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)

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38
Q

craniofacial

normal velopharyngeal structures (3)

A

dependent on normal anatomy (structures – velum, lateral and posterior pharyngeal walls), neurophysiology (function), and speech sound learning (articulation)

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39
Q

craniofacial

velopharyngeal insufficiency (3)

A

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

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40
Q

craniofacial

velopharyngeal incompetence (2)

A

the movement of the velum is too poor during speech, usually requires physical management (palatal lift, surgery)

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41
Q

craniofacial

velopharyngeal mislearning (2)

A

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

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42
Q

craniofacial

effects of velopharyngeal dysfunction on speech (2)

A

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)

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43
Q

craniofacial

hypernasality vs hyponasality (1::1)*

A

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

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44
Q

craniofacial

cul-de-sac resonance (2)

A

when sound resonates in the pharynx or nasal cavity but is not released due to obstruction, commonly caused by enlarged tonsils

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45
Q

craniofacial

instrumental assessments (4)

A

nasometer, aerodynamic instrumentation, video fluoroscopy, nasopharyngoscopy

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46
Q

craniofacial

common surgical procedures for VPI (4)

A

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)

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47
Q

craniofacial

treating hypernasality or nasal emission due to VPI (2)

A

CANNOT be treated using speech therapy, speech therapy is only appropriate after the structures have been repaired

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48
Q

voice

suprahyoid muscles (6)

A

moves the larynx superiorly and anteriorly or superiorly and posteriorly, includes: mylohyoid, geniohyoid, anterior belly of digastric, hyoglossus, stylohyoid

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49
Q

voice

infra hyoid muscles (6)

A

lowers and stabilizes the larynx, includes: thyrohyoid, sternohyoid, sternothyroid, omohyoid, inferior constrictor

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50
Q

voice

laryngeal abductors (1) vs adductors (2)

A

posterior cricoarytenoids :: lateral cricoarytenoids, interarytenoids (oblique, transverse)

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51
Q

voice

laryngeal tensor muscles (2)

A

stiffens-lengthens the vocal folds, includes: cricoarytenoids (pars recta, pars oblique), thyroarytenoids (thyrovocalis, thyromuscularis)

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52
Q

voice

glottis vs ventricle

A

space between the vocal folds :: space between the true and false vocal folds

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53
Q

voice

supraglottal vs infraglottal areas

A

space above the vocal folds and below the base of tongue :: space below the true vocal folds

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54
Q

voice

aditus (1)

A

opening to the larynx

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55
Q

voice

ventricular folds (1)

A

false vocal folds

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56
Q

voice

layer structure of vocal folds (3)

A

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)

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57
Q

voice

cranial nerve input to the larynx

A

CN X and its three branches: pharyngeal nerve, superior laryngeal nerve (SLN), inferior laryngeal nerve (recurrent laryngeal nerve)

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58
Q

voice

vital capacity (1)

A

amount of air available for use when lungs are inflated maximally

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59
Q

voice

expiratory vs inspiratory pressure

A

positive :: negative

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60
Q

voice

phonation types (7)

A

normal, breathy, whisper, voiceless, strained/creaky, glottal fry/gravelly, glottal stop (folds shut with no vibration)

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61
Q

voice

registers (4)

A

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)

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62
Q

voice

acoustic measures (5)

A

fundamental frequency, intensity, jitter, shimmer, noise measures

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63
Q

voice

subglottic pressure (1)

A

pressure measured below the vocal folds, usually during vibration

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64
Q

voice

airflow rate (1)

A

average rate of airflow through the vocal tract during phonation

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65
Q

voice

glottal resistance (1)

A

the ratio of subglottic pressure to airflow rate

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66
Q

voice

timbre (2)

A

quality of voice perceived by listeners as distinguished from pitch and loudness, aspects include: severity, roughness, breathiness, strain, nasality

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67
Q

voice

ADMET (2)

A

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

68
Q

voice

cover-body theory (3)

A

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

69
Q

voice

disorders associated with phonotrauma (3)

A

vocal nodules, polyps, polypoid degeneration (reinke’s edema)

70
Q

voice

organic voice disorders (3)

A

cysts, human papilloma virus (HPV), laryngitis

71
Q

voice

functional voice disorders (5)

A

muscle tension dysphonia (hyper functional dysphonia), psychogenic dysphonia/aphonia, puberphonia (mutational falsetto), ventricular phonation (plica ventricularis), vocal cord dysfunction (paradoxical vocal fold motion)

72
Q

voice

voice disorders of neurologic origin (4)

A

inferior (recurrent) laryngeal nerve paralysis, superior laryngeal nerve (SLN) paralysis, spasmodic dysphonia (SD), essential tremor of the voice (organic voice tremor)

73
Q

voice

congenital pediatric voice problems (3)

A

laryngomalacia (floppy airway), subglottic stenosis (respiratory distress), laryngeal web (stridor)

74
Q

voice

acquired pediatric voice problems (1)

A

bilateral vocal nodules

75
Q

voice

persons with VPI vs persons with hearing loss (1)

A

the effect on voice (for both) is primarily that of resonance

76
Q

voice

VHI (2)

A

voice handicap index, 30-item questionnaire (functional, physical, emotional)

77
Q

voice

VRQOL (2)

A

voice-related quality of life, 10-item questionnaire (6 in physical domain and 4 in social-emotional domain)

78
Q

voice

FCM (2)

A

functional communication measure, voice capability and quality is assessed on a 7-point scale reflecting functional capability

79
Q

voice

GRBAS (1)

A

most common measurement tool used worldwide for estimating voice quality for the following features: grade, rough, breathy, asthenic, strained

80
Q

voice

CAPE-V (2)

A

created by ASHA voice SIG, clinicians rate three voice quality features (overall severity, roughness, breathiness, strained) for three contexts (vowel, sex specified sentences, conversation)

81
Q

voice

perturbation measures (1)

A

instability measures reflecting variability in period and amplitude from cycle to cycle aka jitter and shimmer

82
Q

voice

resonant voice therapy (1)

A

optimizing vocal quality through a focus on maximizing oral-pharyngeal resonance and the degree of medial compression between the vocal folds

83
Q

voice

botox (1)

A

injection into the thyroarytenoid (usually) for treatment of spasmodic dysphonia and sometimes essential tremor of the voice

84
Q

voice

strategies to cure head and neck cancer (4)

A

surgery, radiotherapy, chemotherapy, chemoradiation

85
Q

voice

effects related to chemotherapy vs radiation (5::8)

A

fatigue, nausea, loss of appetite, changes in taste, hair loss :: inflammatory reactions, tissue fibrosis, loss of appetite, fatigue, xerostomia, necrosis, mucositis, pain

86
Q

voice

total laryngectomy (3)

A

entire larynx removed, a permanent tracheostomy separates the respiratory tract from the oral/digestive tract, no longer able to use vocal folds

87
Q

voice

alaryngeal voice (2)

A

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

88
Q

voice

supra-glottic laryngectomy (1)

A

a type of partial laryngectomy where laryngeal structures and tissues above the level of the true vocal folds are surgically removed

89
Q

voice

hemi-laryngectomy (2)

A

a type of partial laryngectomy where a vertical (sagittal) portion of laryngeal tissue is resected, involves part or all of one vocal fold

90
Q

voice

glossectomy (3)

A

surgical removal of the tongue tissue, in partial glossectomy affected parts of the tongue are removed, in total glossectomy the entire tongue is removed

91
Q

voice

areas susceptible to head and neck tumors (5)

A

larynx, tongue, floor of the mouth, tonsils, palate

92
Q

dysphagia

swallowing (2)

A

a patterned behavioral response, including: oral preparatory phase, oral phase, pharyngeal stage, esophageal stage

93
Q

dysphagia

feeding (1)

A

the oral manipulation of food and drink prior to the initiation of the swallow

94
Q

dysphagia

dysphagia (2)

A

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”

95
Q

dysphagia

swallowing anatomy (9)

A

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)

96
Q

dysphagia

cranial nerves involved with swallowing (6)

A

CN V (mastication, floor of mouth), VII, IX, X (base of tongue, larynx, stomach), XI (motor only, velopharyngeal elevation), XII (motor only, hyolaryngeal elevation)

97
Q

dysphagia

the swallowing center (1)

A

central pattern generator located in the medulla and pons

98
Q

dysphagia

end of oral phase (2)

A

when the bolus passes the ramus of the mandible (on fluroscopic studies), then the pharyngeal stage begins

99
Q

dysphagia

hyolaryngeal elevation (2)

A

innervated by CN XII, aids in the opening of the upper esophageal sphincter

100
Q

dysphagia

bolus flow through the pharynx via constrictor muscles (3)*

A

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

101
Q

dysphagia

muscles that elevate the hyoid bone during swallowing (4)

A

digastric floor of mouth (CN VII), stylohyoid (CN VII), mylohyoid floor of mouth (CN V), geniohyoid floor of mouth (CN XII)

102
Q

dysphagia

muscles that depress the hyoid bone during swallowing (4)*

A

omohyoid, sternohyoid, sternothyroid, thyrohyoid

*all innervated by CN XII

103
Q

dysphagia

muscles of mastication (4)*

A

temporal, masseter, lateral pterygoid, medial pterygoid

*all innervated by CN V

104
Q

dysphagia

extrinsic tongue muscles (4)

A

genioglossus (CN XII), hyoglossus (CN XII), styloglossus (CN XII), palatoglossus (CN X)

105
Q

dysphagia

intrinsic tongue muscles (4)*

A

superior longitudinal, inferior longitudinal, transverse, vertical

*all innervated by CN XII

106
Q

dysphagia

muscles of the lower face (lip function) (6)*

A

obicularis oris, zygomaticus, buccinator, risorius, mentalis, platysma

*all innervated by CN VII

107
Q

dysphagia

intrinsic laryngeal muscles (6)*

A

cricothyroid, thyroarytenoid, posterior cricoarytenoid, lateral cricoarytenoid, interarytenoids (transverse and oblique), vocalis

*all innervated by CN X

108
Q

dysphagia

xerostomia (2)

A

lessening of salivary flow, risks include: dental decay, reduced lubrication, mineralization of teeth, neutralization of stomach acid, changes in oral sensation

109
Q

dysphagia

stroke and parkinson’s disease (2)

A

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

110
Q

dysphagia

stroke and cerebrovascular attack (CVA) (2)

A

primary cause of dysphagia, caused by vascular dysfunction (disruption of blood flow) which leads to lack of oxygen in the brain

111
Q

dysphagia

pontine (pons) stroke symptoms (5)

A

results in: hypertonicity, delayed/absent swallow response, reduced laryngeal elevation, cricopharyngeal dysfunction, slow recovery

112
Q

dysphagia

medullary stroke symptoms (3)

A

longer pharyngeal phase response times, increased duration of velar and laryngeal elevation, longer response time for cricopharyngeal sphincter (UES) opening

113
Q

dysphagia

wallenberg’s syndrome (1)

A

a form of brainstem stroke causing pharyngeal phase problems

114
Q

dysphagia

subcortical strokes (3)

A

symptoms are milder, pharyngeal phase is most affected, therapy includes triggering of pharyngeal swallow and tongue base movement

115
Q

dysphagia

cortical strokes (2)*

A

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

116
Q

dysphagia

parkinson’s disease (3)

A

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

117
Q

dysphagia

PSP (3)

A

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

118
Q

dysphagia

ALS (5)

A

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

119
Q

dysphagia

MG (5)

A

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)

120
Q

dysphagia

MS (3)

A

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

121
Q

dysphagia

huntington’s disease (3)

A

an autosomal-dominant neurogenerative disease (detectable via blood tests), marked by choreatic movements, treatment is aimed towards controlling impulsivity and slowing eating rate

122
Q

dysphagia

postpolio syndrome (3)

A

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

123
Q

dysphagia

guillain-barre syndrome (2)

A

an autoimmune disorder affecting the peripheral nervous system (demyelination of cranial nerves), causes weakness and sensory loss in the pharynx/larynx

124
Q

dysphagia

dystonias (5)

A

generalized, neck, oromandibular (OMD-meige syndrome), lingual, treatments include: botox injections and/or lesion surgery

125
Q

dysphagia

dermatomyositis (4)

A

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

126
Q

dysphagia

TBI (3)

A

traumatic brain injury, may result in dysphagia if pharyngeal anatomy is damaged, spinal surgeries and/or neck bracing may also restrict swallowing

127
Q

dysphagia

dementia (6)

A

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

128
Q

dysphagia

principles of neuroplasticity (10)

A

use it or lose it, use it and improve it, specificity, repetition matters, intensity matters, time matters, salience matters, age matters, transference, inference

129
Q

dysphagia

head and neck cancers (4)

A

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

130
Q

dysphagia

total glossectomy (3)

A

reduced BOT motion, difficulty with bolus propulsion, reduced hyolaryngeal elevation

131
Q

dysphagia

hypopharyngeal tumors (1)

A

may appear as a sore throat until dysphagia appears

132
Q

dysphagia

laryngeal tumors (2)

A

high risk of aspiration due to reduced airway protection, categorized by location in the glottis (supraglottic, glottic, subglottis)

133
Q

dysphagia

pseudoepiglottis (2)

A

a tissue fold at the base of tongue that may obstruct the pharynx or collect residue, may need surgical intervention

134
Q

dysphagia

TEP (2)

A

tracheoesophageal puncture, a small flexible prosthesis placed into a tracheal stoma to prevent back flow and aspiration, also serves as a voice prosthesis

135
Q

dysphagia

passy-muir valve (2)

A

a speaking valve, also has benefits for swallowing including: restoring sensation, taste and laryngeal closure

136
Q

dysphagia

aspiration (3)

A

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)

137
Q

dysphagia

aspiration pneumonitis (2)

A

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)

138
Q

dysphagia

penetration (1)

A

occurs when material enters the laryngeal aditus or laryngeal ventricle at some level above the vocal folds but does not pass into the airway

139
Q

dysphagia

silent aspiration (2)

A

no reaction to aspirated material, sign of sensory deficit

140
Q

dysphagia

aspiration-penetration scale (2)

A

quantifies penetration/aspiration events during a videofluroscopic swallow study (VFSS), rating scale is commonly used for MBS

141
Q

dysphagia

8-point aspiration-penetration scale

A

(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

142
Q

dysphagia

esophageal motility disorders (4)*

A

GERD, gastroesophageal reflux (GER), laryngopharyngeal reflux (LPR), backflow

*typically treated using antireflux medications (proton pump inhibitors)

143
Q

dysphagia

esophageal abnormalities (5)

A

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

144
Q

dysphagia

MBS (4)

A

modified barium swallow, aka video fluoroscopic swallowing study (VFSS), radiation exposure, lateral view

145
Q

dysphagia

FEES (4)

A

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

146
Q

dysphagia

FEEST (2)

A

fiberoptic endoscopic evaluation of swallowing with sensory testing, uses air puffs or touching structures to scope tip

147
Q

dysphagia

US (2)

A

ultrasound imaging, safe and noninvasive

148
Q

dysphagia

manometry (1)

A

a medical procedure to view the pressure changes in the esophagus and pharynx during swallowing

149
Q

dysphagia

scintigraphy (2)

A

a radiographic procedure that uses radioactive tracer T99 mixed into foods, bolus flow and location detected by a specialized gamma camera (collimator)

150
Q

dysphagia

fMRI (2)

A

functional magnetic resonance imaging, uses alternating magnetic fields to delineate soft tissues and blood vessels

151
Q

dysphagia

SEMG (2)

A

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

152
Q

dysphagia

direct vs indirect treatments (1::1)*

A

use food :: do not use food

*swallowing is the most effective exercise to retrain the swallow

153
Q

dysphagia

supraglottic swallow (5 steps)*

A

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

154
Q

dysphagia

mendelsohn maneuver (3)

A

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

155
Q

dysphagia

masako maneuver (2)

A

swallowing (without food) is practiced with the tongue held outside of the mouth, used to create more pharyngeal pressure

156
Q

dysphagia

thermal tactile stimulation (2)

A

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

157
Q

dysphagia

treatments for geriatric patients (3)

A

more likely to fatigue with rigorous exercise, isometric exercises (uses resistance to retrain lingual muscles), other tasks: bolus flow, posture and diet modifications

158
Q

dysphagia

shaker exercise (4)

A

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

159
Q

dysphagia

effortful swallow (2)

A

hard swallow used to reduced risk of aspiration, demonstrates: increased oral lingual pressure, increased duration of maximum hyoid elevation, closure of the laryngeal vestibule

160
Q

dysphagia

postural changes (7)

A

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

161
Q

dysphagia

functional oral intake scale (7)

A

(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

162
Q

dysphagia

NMES (4)

A

neuromuscular electrical stimulation, uses electrodes placed sub mentally to provide electrical stimulation to the muscles of the neck, controversial, no proven benefits

163
Q

dysphagia

mcneill dysphagia therapy program (1)

A

a systematic exercise-based program combined with traditional swallowing therapy and surface electromyography feedback

164
Q

dysphagia

mealtime strategies (1)

A

direct feeding supervision so clinician may provide cues/feedback, facilitate techniques/strategies and modify bolus/food intake

165
Q

dysphagia

goals of surgical options (4)

A

improve opening of UES, enhance airway protection, improve glottal closure, close the glottis

PRAXIS EXAM (5 decks)

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