lecture 5 Flashcards
Medulla CVA- where is it? what do you see with this?
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
Pontine CVA
High brainstem- Pharyngeal hypertonicity, delayed/absent pharyngeal swallow, pharyngeal wall paresis/paralysis, reduced laryngeal elevation, cp dysfxn
Subcortical CVA
Delayed oral transit time, delayed pharyngeal swallow, incoordination/ lack of neurom. control for pharyngeal swallow
Cerebral Cortex (L or R)
LEFT: apraxia (delayed oral, no tongue motion/fasciculations), delayed triggering of pharyngeal swallow
RIGHT: oral transit delay, pharyngeal delay, delayed laryngeal elevation
Multiple Strokes
Delayed oral, repetitive tongue mvmts, delayed triggering pharyngeal, reduced laryngeal elevation & closure, pharyngeal & pyriform residues on weak side
List some sudden conditions with some partial recovery
CVA, TBI, Spinal cord injury, Anterior cervical fusion, Neurosurgery, Poliomyelitis, Guillain-Barre, CP, Dysaytonomia (Riley-Day)
List some conditions that are degerative
PD, MG, ALS, MS, MD, Alzheimers, Werdnig-Hoffman, Postpolio, Dystonia, Dermatomyositis
What happens with Neurolgic dysphagia?
_cognitive problems, linguistic problems, anosognosia, weak/absent cough, fatigue, silent aspiration
If the client is intubated, when should u test swallowing?
1 week after
what to do with comatose clients?
5 finger test (5-10 mins) or sEMG, try to stimulate pharyngeal swallow, attempt a videofluoro if you can
TBI - what do you see with this sometimes?
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
Spinal Cord Injury - what do you see?
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)
Anterior Cervical Fusion
- what is common with this population?
U vf paralysis (reduced closure), reduced laryngeal excursion, reduced cp opening, U or B pharyngeal wall dysfxn, oral dysfxn, delayed triggering of pharyngeal swallow
Surgery on Medulla - what do you see?
Absent pharyngeal swallow
Tongue & tongue base “struggle”
what do you see with CN surgery?
U pharyngeal wall paresis/paralysis U vf paralysis U soft palate weakness U tongue paresis Delayed pharyngeal swallow
Poliomyelitis (Polio)- what is common with this condition?
Reduced lingual control Reduced mastication Reduced bolus propulsion by tongue Reduced pharyngeal contraction Reduced vp closure (nasal regurgitation) U pharyngeal paralysis
Guillain-Barré
Weak oropharyngeal swallow
Reduced tongue, tongue base, larynx ROM
CP
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
Dysautonomia (Riley-Day)
Tongue incoordination, reduced tongue base contraction, reduced pharyngeal wall contraction, delayed pharyngeal, LES dysfxn (reflux), reduced esophageal motility
PD
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
ALS
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
MS
Reduced lingual control, reduced chewing, delayed oral transit, reduced tongue base mvmt, reduced pharyngeal wall mvmt, reduced laryngeal fxn, delayed pharyngeal
MG
Tongue weakness, velar weakness, lack of chewing, laryngeal dysfunction, progressive use reduction of pharyngeal contraction
MD
Myotonic dystrophy
Prolonged contraction of cp & muscles of mastication
Oculopharyngeal dystrophy
Reduced pharyngeal contraction, cp dysfunction
Alzheimer’s
Agnosia for food, feeding & swallowing apraxia, oral tactile agnosia, delayed oral & pharyngeal, pharyngeal weakness, reduced laryngeal elevation
Werdnig-Hoffman (pediatric motor neuron disease)
Pharyngeal dysfxn (delayed pharyngeal swallow, severely reduced pharyngeal wall contraction, reduced laryngeal elevation
Postpolio (polio in 1950’s epidemic)
Pharyngeal wall weakness, reduced tongue base retraction, reduced laryngeal elevation & closure
Dystonia
Reduced labial seal, premature spillage, delayed oral transit, incoordinated lingual propulsion, usually normal pharyngeal swallow
Dermatomyositis (DM)
Reduced pharyngeal contraction, cp dysfxn
RA
Cricoarytenoid joint>reducing arytenoid mvmt (reduced glottic closure), airway residues
Cervical vertebrae>pharyngeal wall impingement
Temporomandibular joint>painful/reduced chewing
COPD
Airway closure problems, incoordination/weak respiration/dyspnea
