MWF 10 - 3 Flashcards
What is a Sulcus?
the groove between the gum and the cheek or lip; continuous structure labeled as either anterior or lateral
What are the Faucial Pillars?
the arch-like structures that signal start of pharyngeal stage of swallowing
What kind of structures are the Sulcus and the Faucial Pillars?
Oral Structures
What are the Valleculae?
the pocket formed between the epiglottis and the base of tongue
What are the Pyriform Sinuses?
a way for food and liquids to travel around the larynx through these spaces
What are the Pharyngeal constrictors (3)?
the three muscles that squeeze a bolus down into the esophagus; superior, middle, and inferior
What kind of structures are the Valleculae, Pyriform Sinuses, and Pharyngeal Constrictors?
Pharyngeal Structures
What are the Esophageal Structures involved in swallowing?
Esophagus
Upper Esophageal Sphincter
Lower Esophageal Sphincter
What are the six valves of swallow?
- Lips
- Oral tongue & Anterior Hard Palate
- Velum & Posterior Pharyngeal Wall
- Tongue base & Posterior Pharyngeal Wall
- Larynx (epiglottis & true vocal folds & false vocal folds)
- Upper Esophageal Sphincter
What are the 4 stages of swallow?
I. Oral Preparatory Phase
II. Oral Phase
III. Pharyngeal Phase
IV. Esophageal Phase
When the bolus reaches the area of the faucial arches, the swallow response is triggered and the ______________ phase begins
Pharyngeal Phase
In the Pharyngeal Phase, the ______ palate elevates to prevent the bolus from entering the nasal cavity
Soft palate
In order to swallow food properly, we need (low/high) pharyngeal pressure and (low/high) tracheal pressure
HIGH pharyngeal pressure
LOW tracheal pressure
Esophageal _______________ (a wave of contraction) moves food through the esophagus
esophageal PERISTALSIS
Aging delays triggering of _________ stage of swallow
Pharyngeal Stage
Aging leads to decreased _________ elevation
Laryngeal elevation
Aging impeded _________ function and increases reflux
Esophageal function
What are the common diagnoses associated with Dysphagia?
What are characteristics of Parkinson’s Disease?
- Movement limitations
- Difficult swallow
- Tremor
- Rigidity
- Slow movement
Repeated evaluation is needed for ________ Disease because of the progressive nature of the diagnosis
Parkinson’s
What is Progressive Supranuclear Palsy and symptoms?
Attributed to the accumulation of tau protein in the brain
- Stiffness and tremor
- Cognitive changes
What disease is known as “the other Parkinson’s”?
Progressive Supranuclear Palsy
True or False: The cognitive changes in Progressive Supranuclear Palsy presents later than in Alzheimers
False; The cognitive changes in Progressive Supranuclear Palsy presents EARLIER than in Alzheimers
What is Dementia?
a cognitive decline, often accompanied by swallowing impairment as the condition progresses
What is the most common form of Dementia?
Alzheimer’s disease
What is Multi-infarct Dementia?
a number of small stroked cause significant cognitive impairment over time
What is Huntington’s Disease?
a genetic degenerative disease that affects the basal ganglia
What is Amyotrophic Lateral Sclerosis?
a progressive illness causing both upper and lower motor neuron damage, thus both spastically and flaccidly
What is a more common name for Amyotrophic Lateral Sclerosis?
Lou Gehrig’s Disease
What is Friedrich’s Ataxia?
a genetic disorder that affects mitochondrial function that impedes speech and swallowing, and is progressive
What disease is characterized by poor initial coordination and then progressive loss of mobility?
Friedrich’s Ataxia
What can cause Aspiration Pneumonia?
Aspiration of food, stomach acid, or oral secretions
What happens in a bedside evaluation?
- Oral Mech Exam
- Observe Swallowing
- Probe possible strategies to assist patient
- Recommendations
What structures can you NOT see in a bedside evaluation?
Pharyngeal structures including:
- Valleculae
- Pyriform Sinuses
What should you observe in an oral mechanism exam?
- Symmetry
- Range of Motion (ROM)
- Strength
- Sensitivity (gag reflex, tongue blade on faucial pillars)
True or False: Using a thicker consistency with a patient will cause more residue
True
True or False: Using a thinner consistency with a patient has poorer control
True
What to do in a Swallowing Observation?
- Try a variety of observations
- Listen for cough, gag, choke, splutter
- Watch for leakage, delayed swallow, residue, and deteriorating performance
- Budget enough time for patient to become fatigued to see if swallow worsens
What are two swallowing assessments?
VFSS and FEES
Describe a Videofloroscopic Swallowing Study (VFSS)
Uses x-rays to obtain videos of patient’s swallowing radiopaque material that can provide evidence of penetration and/or aspiration
Describe a Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Uses nasal endoscopy to view pharynx while patient swallows without radiation
What are the advantages of using FEES Swallow Eval compared to the VFSS?
- Less expensive
- Portable
- No radiation
- No barium
What is Total Parenternal Nutrition (TPN)?
a short-term solution for intensive care patients
What are the three types of feeding tubes?
- Nasogastric tube (NG tube)
- Gastrostomy tube (G tube)
- Jejunostomy tube (J tube)
What are Gavage feeding tubes?
short-term that disrupts esophagus causing more leakage, includes NG tubes and Orogastric tubes
What is an Orogastric tube?
feeding tube for babies
What are the two feeding tubes that avoid the esophagus?
- Gastrostomy Tubes (G tube)
- Jejunostomy Tubes (J tube)
A Gastrostomy tube is a surgical opening in the stomach where aspiration is very possible
True
What are the compensatory position changes?
- Chin down
- Chin up
- Head turn
- Head tilt
- Lying down on side
What compensatory position change protects the airway?
Chin down
What compensatory position change relies on gravity to bring the bolus to back of mouth when tongue function is limited?
Chin up
What compensatory position change goes towards the weaker side?
Head turn to the right if the right side has weakness
What compensatory position change goes toward the strong side?
Head tilt to the strong side; if a patient has a RH stroke, tilt left towards the strong side
What compensatory position change makes the bolus favor one side?
Lying down on side that we want bolus to go down
What three cues amplify the sensory input?
Taste cues, Temperature cues, Tactile cues
True or False: the clinician should let the patient pace the feeding
True
Why should you allow the patient to pace the feeding?
- Less likely to get something they are not ready to swallow
- Cues clinician for anything that feels off
- Assuming patient has no issues with impulsivity
What is Indirect therapy for swallowing?
patient practices without food or liquid due to known risk of aspiration
What is Direct therapy for swallowing?
patient swallows food and liquid during therapy
What is the Shaker exercise?
to exercise swallowing techniques, this exercise has the patient lean back in a chair and bring their chin to chest for 30 sec which causes the larynx and the neck muscles to tense up
What are the five swallowing modifications?
Mendelson Maneuver
Masako Maneuver
Effortful Swallow
Supra-glottic Swallow
Super Supra-glottic swallow
What is the Mendelson Maneuver?
hold the larynx to prevent elevation during swallow; can be a safer alternative for patient to use in swallow
What is the Masako Maneuver?
no food/liquid, hold the tongue between teeth and swallow; strengthen tongue base and pharyngeal constriction
What is Effortful Swallow?
swallow imaginary ping-pong ball; instruct patient to emphatically swallow
What is Supra-glottic Swallow?
improve laryngeal swallow by holding breath and swallowing, then cough to clear throat and swallow again all quickly
What is Super Supra-glottic Swallow?
hold breath tightly to “bear down”, swallow hard, cough, and swallow again
What areas of the brain do cognitive changes occur due to aging?
- Brain volume
- Myelin integrity
- Cortical thickness
- Neurotransmitter
- Neurofibrillary tangles
Every decade of life after 20 years of age, dopamine levels decrease by __% therefore affecting cognition
10%
What specific cognitive changes occur due to aging?
- Processing speed
- Reasoning
- Spatial Orientations
- Memory
- Word Retrieval
- Selective Attention
- Short-term Memory
- Episodic Memory
True or False: In healthy older adults, we expect to see declines in long-term memory and procedural memory
False; we do NOT expect to see these declines since they are healthy
What causes Dementia?
- Degenerative disease
- Vascular disease
- Other neurological impairment
- Nutritional inadequacy
- Infection
- Metabolic
- Toxin exposure
- Chronic, low-level trauma
Most cases of dementia are the result of __________?
Degeneration; in brain
Which disease features neurofibrillary tangles, amyloid plaques, and granulovacuolar degeneration?
Alzheimer’s disease
Describe Frontotemporal Dementia (FTD)
spherical accumulations of tau protein affecting frontal and temporal lobes that affect behavior and judgement
10% of dementia cases are __________ dementia
Frontotemporal Dementia
What is required in a dementia diagnosis?
Requires significant memory impairment along with deficits in at least one of the following:
- Visual perception/Object recognition
- Attention/Executive Function
- Communication
- Reasoning/Judgement
A diagnosis of Neuro-cognitive Decline requires clinicians to look at 6 domains, including:
- Complex attention
- Executive Functioning
- Learning and Memory
- Language
- Perceptual-motor Function
- Social Cognition
What kind of dementia is progressive but slower than typical dementia?
Prodromal Dementia
What is Reminiscence therapy?
semi-cued conversation about past events using objects, music, or smells that evoke a memory
What is Montessori therapy?
learning to do real life things by doing it themselves, like folding towels, washing dishes; meaningful tasks to bring purpose
What is Spaced Retrieval therapy?
practicing easy material at increasingly wider intervals; tasks within one’s skillset
What is Errorless Learning?
target items within a patient’s ability; aim easy, support these abilities to preserve them
What is Primary Progressive Aphasia (PPA)?
a disruption of semantic and syntactic networks that will worsen overtime, not caused by stroke or TBI, that affects language (unlike dementia) though many cognitive skills are preserved
What is the cause of PPA?
Most commonly caused by Frontotemporal Dementia
What is the difference between Alzheimer’s Disease and Alzheimer’s Dementia?
The location of the tumor
What are early symptoms of PPA?
- Slower speech
- Word Retrieval issues
- Circumlocution
- Paraphasic errors
- Disruption of written language
What are the three subtypes of PPA?
Logopenic
Semantic
Agrammatic Nonfluent
What is Logopenic PPA?
the patient can only handle small talk; “not enough words”
What is Semantic PPA?
intact language, impaired comprehension, similar to Wernicke’s Aphasia
What kind of PPA is most similar to Wernicke’s Aphasia?
Semantic PPA
What is Agrammatic Nonfluent PPA?
issues with word order production, intact comprehension of word meanings, not correct order
What types of PPA are fluent?
Logopenic PPA
Semantic PPA
What is the difference between PPA and Aphasia?
Aphasia is more sudden, has a motor aspect, and is more often caused by stroke or TBI*
PPA is progressive and caused by FTD*
True or False: In assessing PPA, it is important to thoroughly assess nonverbal cognitive skills including driving, problem solving, and pattern recogntion
True
What are some management techniques in treating PPA?
AAC device
Direct intervention
Family/Caregiver strategies
True or False: Compliance is the goal in treating clients who are grieving
False
True or False: Grief is more of an upward spiral than an upward arrow
True
What is Learned Helplessness?
a form of controlling others by acting helpless
What is Displacement of Grief?
projecting your pain onto others
What are some manifestations of grief?
- Feelings of loss
- Depression and Anxiety
- Learned Helplessness
- Displacement
- Dissociation
- Avoidance Behaviors
- Demotivation
What are the symptoms of Flaccid Dysarthria?
Hypotonia*
Muscle weakness*
Hypernasality, Nasal Emissions
Audible inspiration, Inhalatory Phonation
Breathiness, Short Phrases
Diplophonia
What are the symptoms of Spastic Dysarthria?
Bilateral Spasticity*
Hypertonia*
Harsh, strained, strangled voice
Low pitch, pitch breaks
Slow, effortful, fatiguing speech
Drooling
What are the symptoms of UUMN Dysarthria?
Milder than other forms
Slurred, slow speech
Fatigue exasterbates symptoms
Often accompanied by hemiplegia, hemiparesis, or unilateral sensory impairment; limb or facial
What are symptoms of Hypokinetic Dysarthria?
Decreased Rate of Movement
Rigidity, tremor at rest
Masked facies
Monopitch, Monoloudness
Reduced loudness driven by faulty self-perception
Short bursts of speech, increased speech rate overall, rapid AMR’s
Palilalia
What are symptoms of Hyperkinetic Dysarthria?
unpredictable involuntary movement*
intermittent breathiness or harshness or aphonia
tense vowel prolongation, irregular/slow AMR’s
intrusive phonation
Echolalia/Coprolalia
Sudden intrusive respiration
What are the features of Ataxic Dysarthria
Slurred speech*
Gait/Stance*
Irregular AMR’s
Primary effects on artic and prosody
Excess and equal stress
Excess loudness variation
Vowel distortions and phoneme prolongations
What causes Mixed Dysarthria?
Caused by lesions affecting different neurological structures will result in different clinical presentation
- Degenerative disease
- Stroke
- Trauma
- Tumor
- Metabolic (hypothyroidism, Wilson’s Disease)
- Encephalopathy
