lecture 5

Question 1

Medulla CVA- where is it? what do you see with this?

Answer 1

lower brainstem stroke- Absent/weak pharyngeal swallow (1st wk post-stroke), severely delayed pharyngeal swallow (after 1st wk post), valleculae & U pyriform residues, reduced laryngeal excursion, reduced CP opening, U vf paresis

Question 2

Pontine CVA

Answer 2

High brainstem- Pharyngeal hypertonicity, delayed/absent pharyngeal swallow, pharyngeal wall paresis/paralysis, reduced laryngeal elevation, cp dysfxn

Question 3

Subcortical CVA

Answer 3

Delayed oral transit time, delayed pharyngeal swallow, incoordination/ lack of neurom. control for pharyngeal swallow

Question 4

Cerebral Cortex (L or R)

Answer 4

LEFT: apraxia (delayed oral, no tongue motion/fasciculations), delayed triggering of pharyngeal swallow
RIGHT: oral transit delay, pharyngeal delay, delayed laryngeal elevation

Question 5

Multiple Strokes

Answer 5

Delayed oral, repetitive tongue mvmts, delayed triggering pharyngeal, reduced laryngeal elevation & closure, pharyngeal & pyriform residues on weak side

Question 6

List some sudden conditions with some partial recovery

Answer 6

CVA, TBI, Spinal cord injury, Anterior cervical fusion, Neurosurgery, Poliomyelitis, Guillain-Barre, CP, Dysaytonomia (Riley-Day)

Question 7

List some conditions that are degerative

Answer 7

PD, MG, ALS, MS, MD, Alzheimers, Werdnig-Hoffman, Postpolio, Dystonia, Dermatomyositis

Question 8

What happens with Neurolgic dysphagia?

Answer 8

_cognitive problems, linguistic problems, anosognosia, weak/absent cough, fatigue, silent aspiration

Question 9

If the client is intubated, when should u test swallowing?

Answer 9

1 week after

Question 10

what to do with comatose clients?

Answer 10

5 finger test (5-10 mins) or sEMG, try to stimulate pharyngeal swallow, attempt a videofluoro if you can

Question 11

TBI - what do you see with this sometimes?

Answer 11

Delayed/absent triggering of pharyngeal swallow
Reduced lip closure
Reduced tongue ROM
Poor bolus control
Abnormal oral reflexes
Reduced tongue base motion
Reduced vp closure
Reduced laryngeal elevation
Reduced laryngeal closure
Reduced cp opening
U or B pharyngeal wall paresis/paralysis

Question 12

Spinal Cord Injury - what do you see?

Answer 12

Delayed triggering of pharyngeal swallow
Reduced laryngeal excursion
Reduced cp opening
Reduced tongue base motion
U or B pharyngeal wall dysfxn
Reduced airway closure (intubation/prolonged trach)

Question 13

Anterior Cervical Fusion

- what is common with this population?

Answer 13

U vf paralysis (reduced closure), reduced laryngeal excursion, reduced cp opening, U or B pharyngeal wall dysfxn, oral dysfxn, delayed triggering of pharyngeal swallow

Question 14

Surgery on Medulla - what do you see?

Answer 14

Absent pharyngeal swallow

Tongue & tongue base “struggle”

Question 15

what do you see with CN surgery?

Answer 15

U pharyngeal wall paresis/paralysis
U vf paralysis
U soft palate weakness
U tongue paresis
Delayed pharyngeal swallow

Question 16

Poliomyelitis (Polio)- what is common with this condition?

Answer 16

Reduced lingual control
Reduced mastication
Reduced bolus propulsion by tongue
Reduced pharyngeal contraction
Reduced vp closure (nasal regurgitation)
U pharyngeal paralysis

Question 17

Guillain-Barré

Answer 17

Weak oropharyngeal swallow

Reduced tongue, tongue base, larynx ROM

Question 18

CP

Answer 18

Oral dysfunction (reduced lip closure, inappropriate oral reflexive behaviors, non-cohesive bolus, incoordinated tongue mvmts), premature spillage, pharyngeal delay, reduced tongue base retraction, reduced laryngeal elevation, pharyngeal residue

Question 19

Dysautonomia (Riley-Day)

Answer 19

Tongue incoordination, reduced tongue base contraction, reduced pharyngeal wall contraction, delayed pharyngeal, LES dysfxn (reflux), reduced esophageal motility

Question 20

PD

Answer 20

Tongue pumping or rolling, delayed pharyngeal swallow, reduced pharyngeal wall contraction, reduced tongue base motion, valleculae & pyriform residues (increasing w/ each swallow), reduced laryngeal elevation & closure (bowed vf’s), cp dysfxn, tremor

Question 21

ALS

Answer 21

Corticobulbar tract
Reduced tongue mobility, tongue fsciculations, loss of bolus control, reduced lip closure, vp weakness, reduced laryngeal elevation
Corticospinal tract
Reduced velar mvmt, reduced pharyngeal wall contraction

Question 22

MS

Answer 22

Reduced lingual control, reduced chewing, delayed oral transit, reduced tongue base mvmt, reduced pharyngeal wall mvmt, reduced laryngeal fxn, delayed pharyngeal

Question 23

MG

Answer 23

Tongue weakness, velar weakness, lack of chewing, laryngeal dysfunction, progressive use reduction of pharyngeal contraction

Question 24

MD

Answer 24

Myotonic dystrophy
Prolonged contraction of cp & muscles of mastication
Oculopharyngeal dystrophy
Reduced pharyngeal contraction, cp dysfunction

Question 25

Alzheimer’s

Answer 25

Agnosia for food, feeding & swallowing apraxia, oral tactile agnosia, delayed oral & pharyngeal, pharyngeal weakness, reduced laryngeal elevation

Question 26

Werdnig-Hoffman (pediatric motor neuron disease)

Answer 26

Pharyngeal dysfxn (delayed pharyngeal swallow, severely reduced pharyngeal wall contraction, reduced laryngeal elevation

Question 27

Postpolio (polio in 1950’s epidemic)

Answer 27

Pharyngeal wall weakness, reduced tongue base retraction, reduced laryngeal elevation & closure

Question 28

Dystonia

Answer 28

Reduced labial seal, premature spillage, delayed oral transit, incoordinated lingual propulsion, usually normal pharyngeal swallow

Question 29

Dermatomyositis (DM)

Answer 29

Reduced pharyngeal contraction, cp dysfxn

Question 30

RA

Answer 30

Cricoarytenoid joint>reducing arytenoid mvmt (reduced glottic closure), airway residues
Cervical vertebrae>pharyngeal wall impingement
Temporomandibular joint>painful/reduced chewing

Question 31

COPD

Answer 31

Airway closure problems, incoordination/weak respiration/dyspnea