Neurologic Impairments Flashcards
What are the two biggest concerns you should have with neurologic disorders?
- Silent Aspiration– reduced sensation
2. Fatigue
Concerns for patients with lesions in the lower brainstem (medulla).
- Significant Impairment
- Near normal oral control with impaired pharyngeal swallow trigger
- Absent pharyngeal swallow in 1st week
- Reduced hyolaryngeal elevation and anterior motion (UES opening)
- Unilateral pharyngeal weakness
Concerns for patients with high brainstem (pontine) stroke.
- Severe hypertonicity –> Delay in triggering pharyngeal swallow
- Unilateral spastic pharyngeal wall paresis or paralysis
- Reduced laryngeal elevation with a severe cricopharyngeal dysfunction
- Recovery is slow and difficulty.
Concerns for patients with subcortical stroke.
- Mild delays in oral transit time
- Mild delays in triggering the pharyngeal swallow
- Mild to moderate impairments in timing of the neuromusculature components of the pharyngeal swallow
- Motor and sensory pathways
Concerns for patients with stokes in the cerebral cortex.
- Very different depending on the area of the cortex
Concerns for patients with stroke in the anterior left hemisphere.
- Apraxia of swallow
- Oral apraxia
- Mild oral transit delays
- Mild delay in triggering the pharyngeal swallow
Concerns for patients with stroke in the right hemisphere.
- Mild oral transit delays
- Slightly longer pharyngeal delays (3 to 5 sec)
- Laryngeal elevation may be slightly delayed
- Aspiration before or as the pharyngeal swallow is triggered
- Cognitive disorders
- Relative inattention
Effects of multiple strokes.
- Oral function slower
- more severe delay in triggering the pharyngeal swallow
- Reduced laryngeal elevation
- Reduced closure of the laryngeal entrance
- Unilateral weakness of the pharyngeal wall
- Inattention
Concerns for patients with closed head injuries.
- Delay in triggering pharyngeal swallow*
- Laryngeal damage (physical damage due to accident or emergency trach)
- Oral disorders (reduced lip closure, reduced lingual ROM, poor bolus control)
- Neuromuscular abnormalities (controling pharyngeal stage of swallow)
- Cognitive deficits
- Impulsivity
- Reduced sensation
Concerns for patients with cervical spinal cord injuries.
- Delay triggering pharyngeal swallow
- reduced laryngeal elevation/anterior motion
- reduced tongue base motion
- unilateral or bilateral pharyngeal wall dysfunction
Side note: Can’t do a head turn with this population due to cervical bracing.
Concerns for patients who had an acoustic neuroma removed (or other cranial nerve tumor)
- Most likely affected CN IX, X, XII and possibly VII.
- Exhibits one or more of the following:
- -unilateral facial weakness
- -unilateral pharyngeal wall paresis or paralysis
- -unilateral vocal fold adductor paralysis
- -unilateral soft palate weakness
- -unilateral tongue paresis.
Concerns for patients who had an acoustic neuroma removed (or other cranial nerve tumor)
- Most likely affected CN IX, X, XII and possibly VII.
- Exhibits one or more of the following:
- -unilateral facial weakness
- -unilateral pharyngeal wall paresis or paralysis
- -unilateral vocal fold adductor paralysis
- -unilateral soft palate weakness
- -unilateral tongue paresis.
Concerns for patients with poliomyelitis.
- Reduced lingual control of bolus in chewing
- Disturbed pattern of lingual bolus propulsion
- Reduced pharyngeal constriction
- Reduced velopharyngeal closure during swallow
- Unilateral pharyngeal paralysis
Concerns for patients with Guillian-Barre.
- Rapid onset of paresis
- Progressing to paralysis that requires trach and vent
- Generalized weakness in the oral and pharyngeal swallow
- Reduced ROM in the oral tongue, tongue base, and larynx
