midterm Flashcards
(29 cards)
dysphagia
swallowing disorder involving the oral cavity, pharynx, esophagus, and/or gastroesophageal junction
consequences may include: malnutrition, dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, death
PES/UES
4cm tract connecting pharynx to esophagus attached to cricoid cartilage
3 parts: inferior pharyngeal constrictor, cricopharyngeus, proximal esophagus
4 phases of swallowing
1- oral prep stage
2- oral transit stage
3- pharyngeal stage
4- esophageal stage
1- oral prep stage
from prep as food approaches mouth to beginning of transit
hands as visual/sensory cues
labial seal, facial tension, spoon stripping, lingual cupping, mastication
lingual pull of the bolus centrally onto the tongue in prep of transit
sensation is being integrated to prep swallow muscles
2- oral transit
from movement of bolus posteriorly to it’s leading edge passing anterior faucial pillars
stripping of the bolus between tongue and palate
should take approx 1-1.5 secs
receptors send info to cortex and medulla
3- pharyngeal stage
from leading edge passing anterior faucial pillars to passing through UES
rim of mandible crosses tongue bas
velar elevation
hyoid and laryngeal elevation and excursion
3 levels of laryngeal closure
opening of UES
4- esophageal stage
when bolus tail passes through UES until it passes gastroesophageal juncture
primary and secondary peristaltic waves
SLP domain is only upper esophagus
3 levels of laryngeal closure
1- true VF close
2- laryngeal entrance: false VF close, anterior tilt of arytenoids, thickening of epiglottis base
3- epiglottic deflection
central pattern generator
the swallowing center
a network of neurons housed in the nucleus ambiguous and nucleus tractus solitarius in the medulla of brainstem
responsible for creating the pattern of events that occurs during each swallow
cranial nerves send sensory info to nucleus tractus solitarious
motor components housed in the nucleus ambigious
cranial nerves for swallowing
CN V - trigeminal
CV VII - facial
CN IX - glossopharyngeal
CN X - vagus
CN XI - accessory
CN XII - hypoglossal
CN V - trigeminal
3 branches - ophthalmic, maxillary, mandibular
all sensation to face
motor to temporalis and masseter
damage can affect chewing, oral phase, skin sensation
can affect hyolaryngeal excursion –> impacting vallecular residue, pyriform residue, impaired epiglottis inversion, impaired UES opening
exam: skin sensation test, open mouth against resistance, clench teeth, swallow (palpation), lateral jaw movement
CN VII - facial
sensation and taste to anterior 2/3 of tongue, motor to bilateral upper face, contralateral lower face, hyolaryngeal excursion, base of tongue to PPhW
exam: smile, pucker, puff cheeks, raise eyebrows, ID taste items on tongue
CN IX - glossopharyngeal
sensory to posterior tongue
sensory arc of gag reflex
damage causes impairments in sensing arrival of bolus at palate, gag reflex, velar elevation, pharyngeal constriction
exam: ID hot/cold items at back of tongue, symmetrical velar elevation
CN X - vagus
motor arc of gag reflex
velar elevation
sensation to 90% of oropharynx –> damage causing residue in larynx/pharynx
innervates intrinsic laryngeal/pharyngeal muscles and palatoglossus
PES relaxation
exam: symmetrical velar elevation, phonate for vocal quality
CN XI - accessory
motor to two neck muscles
assists in velopharyngeal closure
exam: turn head left-right and up-down
CN XII - hypoglossal
motor to tongue muscles and anterior hyoid movement
exam: lingual mobility, strength, symmetry in movement
respiration & swallowing
connected; impairment in one can cause an impairment in the other
laryngeal penetration
material entering the airway above the level of the VF
aspiration
material entering airway below the level of the VF
can aspirate:
before you swallow, with impaired oral phase/control
during the swallow, with impaired VF closure
after the swallow, with refluxed materials
signs/symptoms: throat clear, cough, wet/gurgly voice, choking
aspiration pneumonia
pneumonia caused by aspiration of material
treated with antibiotics, aggressive oral hygiene, and dysphagia therapy
dependent on position - right bronchus straighter than left
3 pillars of aspiration pneumonia
impaired general health
poor oral hygiene
aspiration
etiologies of dysphagia
presbyphagia
any neuro disorder: stroke, TBI
respiratory disorders
neurodegenerative disease: ALS, PD, dementia
presence of cancer/surgical innervation
structural anatomic differences
medication-related
temporary causes: surgery, intubation, fatigue, delirium, prolonged or traumatic NG tube
esophageal disorders
can be structural, motility, sphincter abnormalities, or GERD
gastroenterologist diagnoses and treats
SLP can only observe/comment
dysphagia screening
quick, 10secs, to assess risk of dysphagia, not performed by SLP
3oz Water Test
Barnes-Jewish Hospital Stroke Dysphagia Screen
Toronto Bedside Swallowing Screening Test
SSA
Mini MASA
GUSS
