Pruebas Flashcards
INSTRUMENTAL PROCEDURES FOR DIAGNOSIS OF DYSPHAGIA:
Swallowing is a very complex sequential behavior that occurs rapidly in the transport of bolus. Therefore, the best instrumental procedure should provide moving images of the swallow it they occurs in real time (dynamic). Procedures that produce still images at a single instant (static) like computed tomography (CT), magnetic resonance imaging (MRI), endoscopy and still X-rays are of minimal value in the diagnosis of motility disorders. These procedures are best used for clarification of an organic cause of dysphagia.
Endoscopy can be used when a tumor mass, obstruction or abnormality is suspected. CT has proved to be useful for evaluating the brainstem in patients with neurogenic dysphagia. MRI, in contrast to CT, simultaneously gathers sequential images in the same plane and can obtain direct reconstructions in any plane of interest. MRI has proven to be more sensitive than CT in demonstrating neoplastic masses that may produce neurogenic dysphagia.
The most common diagnostic techniques to be discussed are videofluoroscopy, ultrasound, manometry, and manofluorography.
Other procedures to be discussed are scintigraphy, fiberoptic endoscopic examinations (FEES), electroglottography (EEG), and electromyography (EMG).
VIDEOFLUOROSCOPY
The only fully complete instrumental procedure used to evaluate swallowing is videofluoroscopy. None of the other techniques, used alone, show the flow of a bolus through the entire aerodigestive system while simultaneously displaying the anatomy of these areas. However, when manometry is combined with videofluoroscopy as with manofluorography, the combined technique constitutes a complete system. A complete system captures the anatomy, the physiology, and the bolus flow.
Videofluoroscopy remains to be the most widely used and effective technique in dysphagia diagnosis. This procedure was modified by Logemann (1983, 1986) for clinical use to study swallowing. According to Logemann (1990), the purposes of radiographic assessment using a modified barium swallow are:
- To measure the speed of swallow
- To measure the efficiency of swallow
- To define movement patterns of structures in the oral cavity, pharynx, and larynx
- To examine the effectiveness of rehabilitation strategies
This procedure examines the details of oral, pharyngeal, and cervical esophageal physiology during swallowing. This modified barium swallow is designed to assess not only whether the patient is aspirating, but also the reason for the aspiration, so appropriate treatment can be initiated (as shown on Table 3-2).
Liquid barium, barium paste, and a cookie coated with barium paste are used in this swallow study. Two swallows of each material are given in very small amounts: (1/3 teaspoon or 1/4 small cookie). The importance of giving small amounts must be stressed because these clients are referred for reasons of aspiration, and large amounts of barium entering their airway could cause complications.
Often the most difficult and time-consuming part of the videofluoroscopy is positioning the patient. The patient should be seated and the vocal tract viewed laterally. A patient unable to sit unassisted can lie on a cart with the head elevated to at least a 45 degree angle so the upper aerodigestive tract can also be viewed laterally.
Repeated or extended use of videofluoroscopic techniques exposes patients to excessive amounts of radiation. Thus, videofluoroscopic studies of a patient swallowing wide varieties of food with several trials for each variety and consistency should be avoided. This technique must not be used as a biofeedback technique for improving swallowing and should be used cautiously, as a diagnostic technique only.
Describe GOLDMAN FRISTOE TEST OF ARTICULATION
Ronald Goldman, Ph. D. And Macalyne Fristoe, Ph. D. (1986)
For ages 2 through 16 primarily assess an individual’s articulation of consonant sounds
PURPOSE: To provide a method of assessing an individual’s articulation of consonant sounds. Deviations can be noted to study vowel and diphthong production.
SUBTESTS:
1) SOUNDS-IN-WORDS: Compares articulation in a simple response.
2) SOUNDS-IN-SENTENCES: Compares articulation in contextual speech. The child’s sample can also be used for a comprehensive language sample.
3) STIMULABILITY SUBTEST: Produces previously misarticulated phonemes correctly when given maximum stimulation both visually and orally.
ARAM AND NATION MODEL:
1) Speech Programming–Formulation (Broca’s, Frontal)
2) Speech Initiation–Sequencing (Motor Cortex, Frontal)
3) Speech Coordination Transmission–Motor Control (Cranial Nerves)
4) Speech Production–Articulators
MINNESOTA TEST FOR DIFFERENTIAL DIAGNOSIS OF APHASIA (MTDDA)
The MTDDA was written by Hildred Schuell. It is designed to serve as a guide in planning treatment and determines the strengths and weakness in language functions within all modalities. The manual does not provide guidelines for differentiating among language disorders; however, results can facilitate diagnosis of motor and perceptual disorders which might accompany aphasia.
The MTDDA is the most comprehensive major test of Aphasia available. It contains five sections: speech and language; auditory, visual and reading; visuomotor and writing; and numerical relations and arithmetic processes. The sections for the four modalities are graded from easy to difficult and contain from nine to fifteen subtests. MTDDA takes two to six hours to administer and Schuell recommended that it be given over more than one session. Scoring for most of the subtests involves a plus-minus method. The other subtests vary.
Thompson and Enderby designed a short form by deleting the items and subtests that were too easy or too hard. Their short form had only five items per subtest. Powell, Bailey and Clark also designed a short form. Using the complete MTDDA, Schuell suggested a method for shortening the test by using a baseline and ceiling in each section.
The sixth form (the research edition) was made available for experimental use at the Minneapolis VA Hospital in 1955. It was given to 157 aphasic patients and 50 nonaphasic hospitalized patients. A few subtests were given to all 157 aphasic patients, but 80 percent of the subtest means were taken from 75 aphasic patients. These mean subtest errors are included in the test with respect to Schuell’s diagnostic categories. The nonaphasic patients had no trouble with most of the subtests, but possibly due to their educational an/or cultural background, 74 percent made an average of 1.86 of eight possible errors.
Powell, Clark and Bailey demonstrated validity with two construct analyses, and both were supportive of her views. Content validity was analyzed using a Guttman scaling of eighteen subtests to support her view that aphasia varies in degree and not in kind.
Presence of errors is the basis for diagnosis of deficit. A percentage of correct responses determines the degree of impairment. The MTDDA does not contain devices for diagnosing syndromes. The short version does include differences among aphasia, apraxia of speech, confusion after head trauma and intellectual impairment of dementia.
