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Dysphagia > Neurogenic Dysphagia in Adults > Flashcards

Neurogenic Dysphagia in Adults Flashcards

1
Q

What disorders will about 90% of your patients present with?

A

Neurogenic or Cancers (head and neck)

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2
Q

What is the most common cause of a neurogenic disorder that results in dysphagia?

A

Stroke

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3
Q

What is the boundary of the frontal lobe and parietal lobe?

A

The Rolandic Fissure or the Central Sulcus

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4
Q

What constitutes the Brain stem? (3)

A

Medulla, Pons, and Midbrain

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5
Q

What’re the functions of the frontal lobe with respect to swallowing?

A

Motor Movements

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6
Q

What are the subcortical structures?

A

Basal ganglia, thalamus, etc.

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7
Q

What is the role of the parietal lobe with respect to swallowing?

A

Sensory processing. (swallow initiation, poor residue/aspiration sensation)

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8
Q

With respect to swallowing, why is sensory ability important?

A

The sense of the bolus for swallow initiation.

Proprioception, sense residue.

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9
Q

What is the role of the subcortical structures with respect to swallowing?

A

Thalamus is a relay center.
Fine motor coordination.
Refines the output from the motor strip.

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10
Q

What is the function of the brainstem with respect to swallowing?

A

It has the central pattern generator, which houses the tractus solitarius (sensory) and the tractus ambiguous (motor).

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11
Q

What is the function of the cerebellum with respect to swallowing?

A

Timing, direction, force of movement.

Good for feed-back and feed-forward.

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12
Q

With respect to swallowing, what would we see if someone had a stroke in their frontal lobe?

A

Pre-swallow pooling (lack of swallow initiation)

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13
Q

What are some sensory impairments with regards to swallowing?

A

Swallow Initiation
Silent Aspiration
Poor Residue Sensation
Poor Aspiration Sensation

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14
Q

What are some motor impairments with regards to swallowing?

A 
Oral Motor Issues
Velopharyngeal Closure Issues
Back of Tongue to posterior pharyngeal wall movement
Epiglottic inversion 
Hyolaryngeal Excursion 
Vestibule Squeeze
Pharyngeal Stripping
UES opening
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15
Q

What is another name for the UES?

A

Cricopharyngeus

PES (Pharyngoesophageal Sphincter)

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16
Q

Damage to the subcortical structures will result in motor or sensory impairments?

A

Predominately Motor

17
Q

Damage to the brainstem will cause motor or sensory impairments?

A

It could be both, even respiratory problems!

18
Q

What might we see if someone had a lesion to the prefrontal area?

A

Feeding issues

Might forget how to use a fork, not knowing what is food/what isn’t.

19
Q

What might we see if there is a lesion to the cerebellum?

A

Motor issues

20
Q

What nerve damage causes spasticity?

A

Bilateral Upper Motor Neuron damage

21
Q

What causes flaccidity?

A

Lower Motor Neuron Lesions

22
Q

What would a unilateral UMN lesion cause?

A

Problems with the lower half of the face

23
Q

What is the pathophysiology of Parkinson’s?

A

Reduced dopamine in the substatia nigra resulting in reduced inhibition of motor movements.
Rigidity
Pill-rolling tremors
Hypokinesia - decreased/slowed body movements
(Hypokinetic dysarthria: Reduced movement of the muscles of speech and swallowing.)

24
Q

What could the swallowing impairments be in a patient with Parkinson’s?

A

Any motor impairments! They would be slowed, affected by tremors, etc.

Oral Motor Issues: predominantly with the tongue drumming
Velopharyngeal Closure Issues
Back of Tongue to posterior pharyngeal wall movement
Epiglottic inversion 
Hyolaryngeal Excursion 
Vestibule Squeeze
Pharyngeal Stripping
UES opening
25
Q

What is the pathophysiology of ALS (Amyotrophic Lateral Sclerosis)

A

UMN impairments
LMN impairments
Muscle atrophy and spasticity
In the limbs and bulbar muscles (swallowing related muscles)

26
Q

What could the swallowing impairments be in a patient with ALS?

A 
Motor-based: 
Oral Motor Issues
Velopharyngeal Closure Issues
Back of Tongue to posterior pharyngeal wall movement
Epiglottic inversion 
Hyolaryngeal Excursion 
Vestibule Squeeze
Pharyngeal Stripping
UES opening

Because their UMN and LMN are both affected, we will see flaccidity and spasticity.

27
Q

What is the pathophysiology of Multiple Sclerosis?

A

Depletion/damage of myelin sheaths (Demyelinating)

28
Q

What could the swallowing impairments be in a patient with Multiple Sclerosis?

A 
Mostly Motor impairments:
Oral Motor Issues
Velopharyngeal Closure Issues
Back of Tongue to posterior pharyngeal wall movement
Epiglottic inversion 
Hyolaryngeal Excursion 
Vestibule Squeeze
Pharyngeal Stripping
UES opening

Some sensory impairments depending upon the nerve affected.

29
Q

What is the pathophysiology of myasthenia gravis?

A

Myasthenia = Muscle Weakness Gravis = Grave

The ACH (Acetylcholine) (Neurotransmitters) receptors on the myoneural junction are depleted.

30
Q

What could the swallowing impairments be in a patient with myasthenia gravis?

A

Because it is a lower motor neuron disease, we would see flaccidity in specific motor movements.
There is also general fatigue of muscles.

31
Q

What is the pathophysiology of apraxia?

A

A = w/o or not Praxis = Order

Disorder at the planning stage of vountary motor movement. They will exhibit target-searching or groping behaviors.

32
Q

What could the swallowing impairments be in a patient with apraxia?

A

Predominatly oral dysphagia struggling with mastication, tongue movements, etc. This is becasue it affects vountary movments, the pharyngeal stage is mostly reflexive.
Lack of coordination of labial, lingual, and mandibular movement during the oral stage.

33
Q

What is an Embolic stroke?

A

Cholesterol plaque is dislodged from vessel, travels to the brain, blocks an artery.

34
Q

What is a Thrombotic stroke? or Thrombosis?

A

Cholesterol plaque within an artery ruptures, platelets aggregate and clog a narrow artery.

35
Q

What are some common symptoms associated with stroke?

A

Sensory and motor deficits.

Aspiration is very common and pneumonia due to aspiration needs to controlled.

Physiological parameters in all phases of swallow are affected.

36
Q

Which disease that we spoke about in class often terminates with the patient requiring a PEG tube?

A

ALS

Dysphagia (17 decks)

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