maggie praxis 2 Flashcards
CNs involved in swallowing
Trigeminal (V), Facial (VII), Glossopharyngeal (IX), Vagus (X), Hypoglossal (XII)
Describe oral preparatory phase of swallow (adults)
Food/liquid is manipulated in the oral cavity, chewed (if necessary), and made into a bolus, which is sealed with the tongue against the hard palate
Describe oral phase of swallow
Tongue moves food or liquid toward the back of the mouth (toward the anterior faucial pillars). To achieve this, the tongue presses the bolus against the hard palate and squeezes the bolus posteriorly
Describe pharyngeal phase of swallow
:Swallow reflex triggered and bolus is carried through the pharynx. These simultaneous actions occur: (a) the velopharyngeal port closes; (b) the bolus is squeezed to the top of the esophagus (cricopharyngeal sphincter); (c) the larynx elevates as the epiglottis, false vocal folds, and true vocal folds close to seal the airway; and (d) the cricopharyngeal sphincter relaxes to allow the bolus to enter the esophagus
Esophageal phase
Bolus is transported through the esophagus into the stomach
Neurological causes associated w/ dysphagia
CVA, TBI, muscular dystrophy, Parkinson’s, myasthenia gravis, ALS, MS, CP
Non-neurologic causes associated w/ dysphagia
Head and neck cancer, GERD, esophageal tumors
Diagnostic tests for dysphagia
Videofluoroscopy, fiber-optic endoscopy, scintigraphy
Videofluoroscopy
e.g. modified barium swallow): a moving radiograph of the mouth, pharynx, larynx, and cervical esophagus during swallowing. can identify the specific nature of the oropharyngeal dysphagia; it can define abnormality of movements, trace progress of bolus, and demonstrate aspiration
Fiber-optic endoscopy
useful in assessing swallowing by providing direct observation of pharyngeal activity during the swallowing process
Scintigraphy
produces an image of the swallowing mechanism by first covering the vocal tract with a specific nuclide and recording the distribution of the radioactivity w/ a scanning external scintillation camera
Laryngeal penetration
occurs when swallowed material penetrates laryngeal side of epiglottis, aryepiglottic folds, or spills over arytrenoid cartilages above level of true VFs
Aspiration
swallowed material has entered the trachea below the level of the true vocal folds
Tx for dysphagia
Lip exercises, tongue exercises, jaw exercises, swallowing exercises
Postural tx methods for dysphagia
Chin tuck, head turn, head tilt, head back, chin tuck w/ head turn
Chin tuck
pushes base of tongue towards pharyngeal wall; expands vallecular recesses; narrows entrance to laryngeal vestibule by moving epiglottis posteriorly. Used for delayed onset pharyngeal swallow; reduced base of tongue retraction to posterior pharyngeal wall approximation; decreased airway protection; aspiration DURING swallow
Head turn (to weak side)
blocks bolus from traveling down weak side by twisting the pharynx; applies pressure to the vocal fold to increase approximation; reduces resting pressure or the cricopharyngeus by pulling the larynx away from the posterior pharyngeal wall (increasing the space)used for unilateral pharyngeal weakness; unilateral laryngeal weakness; cricopharyngeal dysfunction
Head tilt (to stronger side)
directs bolus to stronger side of oral/pharyngeal cavities used for unilateral oral weakness; unilateral pharyngeal weakness
Head back posture
used for oral transit dysfunction. gravity helps clear the oral cavity
Chin tuck w/ head turn
increases epiglottic deflection to narrow the entrance to the laryngeal vestibule; increases VF approximation by applying extrinsic pressure used for reduced airway closure
Swallow maneuvers (not appropriate for those w/ cognitive deficits)
Supraglottic swallow, super-supraglotic swallow, Mendelsohn Maneuver, effortful swallow
Supraglottic swallow
Patient holds breath and coughs immediatly following a swallow to close VFs before and during swallow. Used when there is reduced airway protection (at the vocal fold level); Aspiration DURING the swallow
Super-supraglottic swallow
Patient holds breath, bears down, and coughs immediately following swallow and immediately swallows hard again. Used when there is reduced airway closure; aspiration BEFORE and DURING the swallow
Mendelsohn Maneuver
Increased laryngeal movement stretches/opens the CP; Prolonging hyolaryngeal elevation keeps the CP open longer. used for 1) Decreased range/duration hyolaryngeal elevation; (2) Decreased range/duration cricopharyngeal opening; (3) Decreased pharyngeal swallow coordination
Effortful swallow
Used to clear residue in valleculae. The increased effort increases the posterior movement of the base of tongue
Shaker Exercise & Mendelsohn exercise
Rehab swallowing exercises to improve function of strap muscles
Gastrostomy
creating an opening of a stoma in the stomach wall when normal food ingestion is not possible or ill-advised
Odynophagia
pain during swallow
Surgical/medical tx to protect airway
Stents, laryngotracheal separation, laryngectomy, trach tubes, feeding tubes
Surgical treatments to improve glottal closure
Medialization thyroplasty and injection of biomaterials
Medialization thryoplasty
surgical procedure which moves the paralyzed vocal fold closer to the mid glottis to allow better compensation by the unaffected fold
Surgical/medical tx to improve opening of pharyngoesophageal segment
Dilatation, Myotomy, Botox Injection
Bedside swallow exam
Obtain case history. Observe function of jaw, lips, tongue, phayrnx, larynx, and eating various textures
Blom-Singer
indwelling low-pressure voice prosthesis kit (laryngectomy)
ProVox
low-resistance indwelling prosthetic (laryngectomy)
Servox
transcervical electrolarynx
Cooper-Rand
intraoral electrolarynx
HME device
Heat and moisture exchanger. Filter placed on tracheostoma which heats and humidifies air. laryngectomy)
7 Extrinsic muscles of larynx
Digastric,Stylohyoid, Mylohyoid, Geniohyoid,Hypoglossus, Genioglossus, Thropharyngeus
7 Intrinsic muscle of larynx
Cricothyroid, Lateral cricoarytenoid(lateral), Posterior cricoarytenoid, Arytenoid, Thyroarytenoid,Aryepiglottis, Thyroepiglottis
Muscle with greatest control of fundamental frequency
Cricothyroid
Muscles of abduction
Posterior cricoarytenoid
Muscles of adduction
Lateral cricoarytenoid, transverse arytenoid
Spastic dysphonia
overadduction of VFs = strained, choked, or creaky voice
Functional dysphonia
Likely results in no voice due to underadducted VFs.
Vocal cord paralysis-vocal characteristics
hoarse, breathy, decreased vocal intensity, loss of pitch range
Ventricular dysphonia
Patient adducts & vibrates ventricular bands instead or in addition to the vocal cords
Laryngeal web
Web grows btw VFs, usually triggered by mucosal surface laryngeal injury or irritation. Can cause severe dysphonia and shortness of breath but NOT total absence of voice
Acute laryngitis
person may lose the use of voice and may become aphonic during episode. **not approriate to provide voice tx to these individuals
Vocal nodules characteristics
hoarse voice quality, hard glottal attacks, and lowering of pitch
Ventricular phonation
Person uses false VFs- A rough type of phonation that, when used in conjunction with the true VFs, can result in diplophonia
Spastic dysphonia
involves aphonic breaks due to sudden over adduction or under adduction of VFs
Contact ulcers
stress, use voice extensively in daily life, has a tense, hard-driving personality, and exhibits glottal fry
Glottal fry
when VFs vibrate very slowly and the vibration causes a slow, low pitch vocal burst making the voice sound crackly or creaky, airflow rate and air pressure that produces the VF vibration are both low and lung volume is less
