Mahler comps swallow tx

Question 1

consequences of swallow disorders

Answer 1

Dehydration
malnutrition
aspiration pneumonia
asphyxia

Question 2

cough reflex critical points

Answer 2

1. Triggered by penetration of food into larynx
2. may signal neurogenic dysphagia
3. No cough m/b silent dysphagia

Question 3

cough reflex reduction causes

Answer 3

1. disruption of sensation and / or motor response

also TIM: Tracheostomy, Intubataion, Medications

Question 4

Diseas3e most likely to be associated with dysphagia and why?

Answer 4

Brain stem vs cortical or sucortical. Nucleus tratus solitaris in brainstem

Question 5

common causess of dysphagia? Why

Answer 5

STROKE: because stroke interrupts the corticobulbar pathways that connect cortical and brain stem centers for swallowing

Question 6

brainstem strokes cause dysphagia how?

Answer 6

disruption of

1. corticobulbar tracts
2. Nucleus tractus solitaris
3. swallow centers either side of medulla and pons

Question 7

brain stem stroke dysphagia symptoms: by oral, pharyngeal, laryngeal and VF

Answer 7

1. Oral: reduced strength of lips, tongue, jaw (ipsilataeral)
2. Pharyngeal swallow: delay, unilateral paresis or reduced contractions
3. Larynx: reduced elevation, closure and/or CP opening
4. vocl fold paresis: unilateral

Question 8

Left CVA dysphagia symptoms

Answer 8

1. Langauge: readingl, writing, understanding symbols
2. . oral:CONTRALATERAL weakness of lips and tongue, drooling, residue, delayed OTT
3. delayed pharyngeal swallow
4. SWALLOW APRAXIA: delay in initiation of swallow, lingual groping, lack of recognition of bolus as to be swallowed

Question 9

Right CVA dysphagia symptoms

Answer 9

LOSS OF INTELLECTUAL CONTROL OVER SWALLOWING.
Frontal: lack of attention, insight, reasoning and judgement, impulsivity
2. IF PARIETAL: perceptual deficits and lack of tontopic orientation, hemineglect: loss of visualiztion of spatial relationships of left-side space
3. contralateral weakness of lips, tongue, delayed OTT, residue
4. delayed pharyngeal swallow

Question 10

Right CVA patients need feeding oversight why?

Answer 10

reduced orientation, percption, attention, impulsivity, errors in judgment, impulsivity, loss of intellectual control over swallow

Question 11

Wnen do SLP’s evaluate Right CVA patients?

Answer 11

as soon as they wake up, first consult

Question 12

TBI/Head Injury dysphagia symptoms?

Answer 12

Cognitive probs of attention, impulsivity, poor memory, reasoning, judgement., and (parietal) orientation

2. Oral: reduced tongue control, delayed or prolongued OTT
3. Pharyngeal swallow delay or absent
4. silent laryngeal penetration and aspiration (w/o cough due to intubation or trecheaostomy)

Question 13

Dementia deficits and dysphagia

Answer 13

1. Cognition: decreased awareness
2. Reduced initiation or oral preparatory movements: nonpurposful bolus manipulation and loss of control
3. Poor BOT retraction
4. delayed pharyngeal swallow
5. reduced larngeal elevation

Question 14

PD and dysphagia key points 2 key points and rationale

Answer 14

1. with PD, deficits in all stages of swallow
2. 95% of PD have dysphagia and OFten not aware of swallow deficits which show in MBS
   Rationale: basal ganglia influence sensory components in trigeminal system and cause abnormalities in sensorimotor responses throughout swallow

Question 15

PD and oral stage defictis

Answer 15

1, rationale: reduced elevation of middle and posterior tongue during speech and swallow (due to rigifidy not weakness) =
2. limited tongue and mandibular excursion
3. Lingual hesitation, peicemeal deglutition (aka rocking)
4. poor posterior bolus formation
5 = overall excessive mastication and OTT

Question 16

PD and pharyngeal stage deficitis: rationale and symptoms

Answer 16

RAtionale: the pharyngeal contrractions of striated muscle of pharynx are often delayed, therefore laryngeal
1. lowed laryngeal elevation –> slowed laryngeal closure

Question 17

PD and spiration

Answer 17

prevalence of aspiration w/o cough in patients w/o dysphagic complaints

Question 18

Oncologic conditions and dysphagia key points

Answer 18

1. cognition and language generally intact

2. tx depends on amt and location of ablative surgery, reconstruction, scar tissue and remaining functional structures

Question 19

Oncologic conditions and pretreatment counseling?

Answer 19

1. Query patient’s understanding of swallow
2. explain role of SLP
3. Discuss outcomes of various medical/surgical interventions

Question 20

Oncologic conditions and typical oral phase disorders (3)

Answer 20

1. prolonged OTT
2. Increased oral residue secondary to decreased tongue strength
3. Reduced ability to propel bolus into pharyx (BOT)
   3.

Question 21

Oncologic conditions and typical pharyngeal phase disorders

Answer 21

1. reduced BOT retraction
   2 reduced laryngeal elevation and vestibule closure
2. reduced bolus clearance = residue in valleculae or pyriform sinuses

Question 22

Oncologic conditions and late effects of radio therapy?

Answer 22

1, impaired neural transmission

2. impaired muscled contractions
3. fewer, smaller muscle fibers
4. muscle replaced with fibrotic tissue due to reduced blood supply
5. restricted mouth opening (trismus)
6. bone loss (necrosis)
7. altered or reduced taste

Question 23

Oncologic conditions and early effects of radiation?

Answer 23

pain, soreness
ulcers and bleeding
mucositis (inflammation)
xerostomia

Question 24

Oncologic conditions and dysphagia symptoms?

Answer 24

1. aspiration after swallow due to reduced pharyngeal contraction
2. reduced bolus formation and transport
3. aspiration before the swallow due to delayed phayngeal swallow (residue left in pyriform sinuses and vallecutae inspirated before next phayngeal initiation

Question 25

Oncology and swallow tx after oral | sx?

Answer 25

1. ROM, tongue and jaw 2. lingual control 3. tongue strengthening 4. thermo-tactile stimlation 5. introral prostehetics 6. swallow maneuvers 7. speech treatment

Question 26

Partial laryngectomy: hemilaryngectomy and supraglottic laryngectomy? what ahppens

Answer 26

removal of one lateral half of larynx+ | reduced laryngeal vestibule and glottis closure especially if resection involves the epiglottis or arytenoid cartilage

Question 27

Supraglottic laryngectomy

Answer 27

1. reduced: closure of airway entrance due to arytenoids, epiglottis or VF's resected also 2. reduced pharyngeal clearance 3. impaired BOT motion if excised, scarred

Question 28

Xerostomia causes, consequences and tx

Answer 28

result of radiation. | discomfort, loss of ability to cleanse teeth, moisten food for mastication and deglutition

Question 29

MBS rationale

Answer 29

1. assessment or anatomy of swallow mechanism 2. dx physiology of underling cause of dysphagia 3. assess effectiveness of tx strategies

Question 30

clinical management of dysphagia, rationale and purpose

Answer 30

1. based on understanding of normal bio mechanical and physiology properties of normal swallow ID deviations from normal patterns

Question 31

COMPENSATORY STRATEGIES: rationale

Answer 31

to eliminate symptoms

Question 32

THERAPY PROCEDURES: rationale

Answer 32

to change swallow physiology.

Question 33

Cognition and THERAPY: populations not suitable. Why?

Answer 33

requires cognitive participation of patients: 1. no one under 2 years 2. no dementia 3. no severe rt hemi stoke/ syndrome/ tbi

Question 34

Therapy procedures, what's included?

Answer 34

1. ROM oral and pharyngeal structures 2. sensory input prior to swallow 3. Impose voluntary control over timing or co-ordiantion of oropharyngeal movements

Question 35

Indirect management techniques

Answer 35

1. structure of eating environment (utensils, plates with sides) 2. specifying degree of supervision 3. diet modification for consistency or calorie count

Question 36

Direct management

Answer 36

1. cognitive stimulation, 2. compensatory postures/positions 3. compensatory maneuvers 4. sensory stimulation 5. motor control activities and exercises

Question 37

What is the purpose of an assessment?

Answer 37

To diagnose type of impairment, severity of impairment, provide a prognosis, develop a treatment plan

Question 37

oral pharyngeal exercises and rationale

Answer 37

to overload the muscles to increase 1. ROM 2. timing 3. coordination