Neuro and Structural Dysphasias Flashcards
2 types of dysphagia
Neurological/neurogenic and structural
Dysphagia is usually attributed to (neurogenic/structural) causes:
neurogenic
Neurogenic dysphagia (definition):
any type of swallowing disorder that is caused by the central or peripheral nervous system
Causes of neurogenic dysphagia
CVA, PD, Huntington’s, TBI, MS, ALS, Alzheimer’s disease, Guillian-Barre syndrome, Brain tumors, myasthenia gravis
T/f: Dysphagia can be due to disease and/or an acute insult (someone hitting you in the head with a bat)
True
Two types of CVA
ischemic (a blockage) and hemorrhagic (brain bleed)
Most common type of stroke
ischemic, specifically targeting the MCA (middle cerebral artery)
Sequelae for CVA depend on (2):
site of lesion and extent/severity of lesion (cerebral cortex, subcortical structures, brainstem)
Name 3 sequalae of a CVA:
hemiparesis, oral acceptance, lingual/labial coordination, sensory impairments, pharyngeal swallow timing, reduced contraction, reduced laryngeal excursion
If a CVA occurs in the cerebral cortex we would expect what from their swallow?
Some amount of intact swallow function
If a CVA occurs in subcortical regions we would expect what from their swallow?
Some amount of swallow function, less than cerebral cortex, may have difficulties with sensory or motor impairments
If a CVA occurs in the brainstem we would expect what from their swallow?
A lot less functional swallow (due to issues with NTS/NA)
The ___ parts of the brain are more “thinking” while the _____ parts of the brain are more “reflexive”
cortex/cortical structures are “thinking” while the brainstem and subcortical structures are more reflexive
Sequelae for Brain Injury depend on:
severity of damage, open or closed injury, multisystem trauma, type of force causing damage (blunt force, blast injury)
Meninges and intraparenchymal:
bleeding in the meninges are intraparenchymal. Meninges are small vessels on the outside of the brain (may break and bleed but won’t drain into cerebrospinal fluid) causes pressure on the brain tissues that control the body
T/f: multi-system trauma is not common in TBI
False- it is very common!
Why is dysphagia hard to treat in Brain injury patients:
often a more diffuse injury (damage not localized)!! Also due to other issues such as respiratory issues, behavioral issues, and impulsivity
To treat someone in the beginning of their TBI rehab or someone severe we should (compensate/rehabilitate)
compensate. Focus on positioning, diet modifications, altering their environment
To rehab someone with a TBI you should focus on:
strengthening muscles and reigniting sensory receptors
T/F: If a person with a TBI has cranial nerve damage you should choose rehabilitative strategies
FALSE!! You cannot rehab that, will need to compensate
Multiple Sclerosis means ____ ____
Multiple scars
t/f: Multiple Sclerosis is an immune-mediated disorder
True, causes inflammation which results in demyelination
Demyelination is a component of which neurological etiology of dysphagia?
MS
t/f: MS is hereditary:
FALSE, but genetics can influence
t/f: people with MS tend to have many smaller lesions in either the brain or spinal cord
True
Sequelae for someone with MS depends on
site(s) of lesion(s) (brainstem, cerebellum, corticospinal tracts, cranial nerves), oral dysphagia (motor component), pharyngeal dysphagia (sensory/constriction/delay)
Oral dysphagia in MS indicates…
Incoordination and/or decreased strength of the oral musculature
Pharyngeal dysphagia in MS indicates what?
Likely to see a sensory delay, aka a delayed swallow trigger. (sensory/constriction/delay)
Most common type of MS
Secondary progressive
What happens in progressive-relapsing MS?
patient gets worse, periodically has flare ups and gets better, but their baseline does not go 100% back down (close but always a little worse off after a flare up).
What happens in Secondary Progressive MS?
flare up, goes back to almost baseline and plateaus for a while, then flares up again.
What happens in primary progressive MS?
progressively gets worse over time.
T/f: we would want to take an aggressive approach to strengthening the musculature in individuals with MS
False… focus on maintaining strength they have
Medical management is a big role in which neurological etiology of dysphagia?
MS
Rehabilitative/Compensatory approach to MS should include:
giving the patients educational information, work on positioning, thermal/tactile stimulation, use of specific maneuvers (supraglottic, cough), supplemental/non-oral nutrition
Parkinson’s Disease includes cell death in the _____ ____ (part of the midbrain and basal ganglia)
Substantia Nigra
Parkinson’s Disease 3 main takeaways (from lecture)
Substantia nigra, basal ganglia, trouble initiating
PD results from a reduction in what neurotransmitter specifically?
Dopamine.. not enough is created
Treatment for PD should focus on
staying “fit” rather than “body building”
Characteristics for PD include:
reduction in dopamine, movement disorder, difficulty initiating/slowed movements, tremors, cognition/mood/behavior differences
Sequelae for PD:
oral movement deficits (tremors, difficulty forming and containing bolus, presents with tongue rocking/pumping), pharyngeal deficits (some delay, reduced pharyngeal wall contraction, reduced laryngeal excursion, reduction in strength), towards the end they may experience rigidity
Type of Neurological etiology of dysphagia where the patient experiences tongue rocking or tongue pumping:
PD
People with PD typically have trouble with what stage of swallow the most and why?
Oral phase due to tongue pumping