observations / COPD

Question 1

Maintains Symmetry of Posture - observe what and what should posture be?

Answer 1

leans to the right or the left during the meal, should be symmetric when taking a mouthful or swallowing.
(do they re-position or may lose his position after a few minutes of the meal and does not regain a symmetric posture)

Question 2

Adequate Head Control for Feeding- observe the patients ability to? what should it be?

Answer 2

observe the patient’s ability to hold his head in a neutral position. During eating, the neck should not be extended or flexed more than a few degrees, so that the chin is tucked in

Question 3

cranial nerve VII 7 has two nuclei, what do each control?

Answer 3

upper and lower part of face

Question 4

The upper nuclei CN VII is innervated how?
The lower nuclei CN VII is

Answer 4

the upper bilaterally from both sides of the brain
while the lower receives input from only the contralateral side

Question 5

if you damage only the L motor cortex, the Upper Motor Neuron lesion for CN VII - what would you expect to see

Answer 5

all of your upper face muscles should be working, the right or contralateral side of your face will be droopy

Question 6

However in a Lower Motor Neuron lesion, where CN VII is knocked out at the level of the brainstem or below what would you see?
Give example of condition where it is seen

Answer 6

-the entire side of the face on the side that was damaged will be impaired
-ex: Bell’s palsy, - eye forhead and lower corner of the mouth affected on the same side as the CN VII damage lower motor neuron lesion on the left side

Question 7

Unilateral damage to vagus nerve, soft pallet drooping on L side, and see some movement on that side at back of mouth arch with ahh ahh ahh, what would this mean?

Answer 7

the movement seen is the tensor veli palatini (muscle is a broad, thin, ribbon-like muscle in the head that tenses the soft palate is still being innervated by cranial nerve 9) but the CN VII is still not working despite that mvmt,

Question 8

if you see a split bifid uvula be certain that you check for subuchal clefting, with the ahh ahh ahh, if you see _____ what? then they probably have a congenital ____ _____.

Answer 8

Uvula crossing
mucus pallet

mucus pallet confirmed if the uvula crosses in the ahh ahh ahh

Question 9

tongue innervation is motor neuron that is bilaterally innervated with a contalateral dominant side innervation that takes over.
It’s easier to think that?

lesion affecting corticobulbar track - upper motor neuron. Tongue deviation will go to the side of the affected or nonaffected side of brain?

Answer 9

the R hemisphere controls the L side of tongue, and L hemisphere controls the R side of tongue.

tongue to go away from the sight of lesion.

Question 10

Is the gag reflex a good indicator of swallowing dysfunction?
What is important indicator?

Answer 10

No. because 37% of healthy ppl don’t have a gag refelx
muscles are independent of normal swallowing
limited to assess for swallowing disorders
but the prescense of pharyngeal sensation is important determinant for normal swallowing

Question 11

CN VII - the motor control for Voluntary facial and lip mvmts, differs from Spontaneous expression, how does this show up in patients?

Answer 11

patient with L lower facial paresis, damage to central nervous system may sometimes smile symmetrically spontaneously to a joke or music. But ask them to smile voluntarily and they show L lower facial weakness

Question 12

increase range of motion in movements for spontaneous mvmts compared to voluntary mvmts - what disease is opposite?

Answer 12

Parkinson’s opposite.
spontaneous mvmts are restricted - masked facial expression

Question 13

can’t say that a certain nerve is damaged but can say

Answer 13

that part of exam was passed or failed

Question 14

How does COPD affect swallowing? 10
which means, over all…

Aspiration can lead to COPD exacerbation.

Answer 14

Muscle weakness and fatigue associated with carbon dioxide retention.
Prolonged oral transit time.
Respiratory-swallow discoordination.
Longer pharyngeal transit times.
Increased time of the laryngeal vestibule closure (LVC).
Incomplete LVC.
Delayed LVC.
Longer duration of hyoid movement.
Pharyngeal residue.
Decreased sensation in the oral cavity, pharynx, and larynx.

slower and less-complete movements of swallow muscles, decreased sensation, and impaired coordination between breathing and swallowing.

Question 15

because ______is a common symptom in patients with COPD, it should not necessarily be assumed to be associated with dysphagia.”

Answer 15

cough

Question 16

_____% of people with stable COPD showed penetration-aspiration while drinking 100-mls of ____ liquid (reported in Mancopes et al., 2021, p. 1215).

Answer 16

20%
thin

Question 17

COPD
Chart review and intake interview:

Assessment:

Answer 17

COPD symptoms?
Recent exacerbations?
GERD or LPR?
Supplementary oxygen?
Chest X-rays?

Oxygen saturation at baseline (low is <94%).
Respiratory rate at baseline (rapid RR is >25 bpm).
Dyspnea with speech or swallowing.
Respiratory muscle strength.

Question 18

COPD
As we conduct our clinical swallow evaluations, we can monitor:

We can place our hand on their upper chest to get a sense of:

We can see if there is a change in these measures between ___ and ___ or ___. We can also see if there is a change across _____ _____and sizes. Finally, we can see if there is a change between the start of a ____ and the end of a ____.

Answer 18

-O2 saturation, RR, and dyspnea.

-the breathing -swallow coordination.

• rest and eating or drinking
  -bolus types
  -meal, meal

Question 19

Dysphagia treatment for people with COPD

Answer 19

Sit upright.
Take breaks to conserve energy.
Use pursed-lip breathing.
Take small bites and sips to allow more time for breathing.
Eat and drink at a slow pace.
Use an oral hold.
Avoid breath-holding maneuvers.

Question 20

COPD how does an oral hold help?

Answer 20

an oral hold taps into voluntary swallow control and increases time for breathing. This may improve breathing and increase post-swallow exhalation.

Question 21

COPD Expiratory Muscle Strength Training is a treatment option to improve:

Answer 21

Research shows that completing EMST leads to higher maximum expiratory pressures and improved respiratory muscle strength.

Question 22

COPD diet recommendations

Answer 22

Choose high-calorie foods and drinks.
Consider easy-to-chew foods.
Eat high protein snacks.
Limit salt intake.
Consume fluids at the end of meals to avoid early fullness.

Question 23

chart check for blood values - health status: looking at what values

Answer 23

lab values: albumin and RBC count
Immune system: WBC, Neutrophils & Lymphocytes