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dysphagia > test 1 > Flashcards

test 1 Flashcards

1
Q

Aspiration

A

Occurs when food/liquid (bolus) penetrates the airway below the true vocal folds*.

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2
Q

Laryngeal Penetration

A

Occurs when food/liquid penetrates the portion of the airway above the true vocal cords.

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3
Q

Functional Swallow

A

A swallow which may be abnormal but does not result in aspiration.

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4
Q

Ingestion/Swallow

A

Refers to all processes associated with bolus introduction, preparation, transfer, and transport.

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5
Q

Deglutition

A

Refers only to acts associated with bolus transfer and transport.

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6
Q

Anatomic Structures of Swallowing:

Oral Cavity

A 
Lips
Teeth
Hard palate
Soft palate (uvula)
Mandible
Floor of mouth
tongue
Faucial arches
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7
Q

PURPOSE: Oral Preparatory Stage

A

Purpose of the stage is to break down food and mix it with saliva.

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8
Q

Oral Preparatory Stage:

A
  1. Lip seal is maintained.
  2. Mastication occurs.
  3. Buccal musculature tension is maintained.
  4. Food is collected into a bolus.
  5. Bolus is held anteriorly and laterally by the tongue against the hard palate.
  6. Back of the tongue is elevated and soft palate is pulled anteriorly against tongue to keep material in the oral cavity.
  7. Airway is open.
  8. Larynx and pharynx are at rest.
  9. Movements vary depending on amount and consistency of food.
  10. This stage is under voluntary control.
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9
Q

Oral Stage:

A
  1. Tongue propels food posteriorly with a rolling or stripping action.
  2. Normal transit time is 1 second.
  3. Oral stage terminates when the bolus passes the anterior faucial arches and the pharyngeal response is triggered.
  4. This stage is under voluntary control (Cranial nerves V, VII, XII).
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10
Q

Pharyngeal Stage:

A
  1. Begins with triggering of the pharygneal response.
  2. When the response triggers, a number of physiological activities occur simultaneously:
  3. Transit time is 1 second.
  4. This stage is involuntary.
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11
Q

Pharyngeal stage is considered physiologically most important for 3 reasons:

A

a. Airway protection
b. Opening of the esophagus
c. Downward propulsion of bolus

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12
Q

When the response triggers, a number of physiological activities occur simultaneously:

A

a. Tongue base moves posteriorly to contact the anteriorly moving posterior pharyngeal wall.
b. Velum elevates to achieve velopharyngeal closure
c. Pharyngeal contraction begins
d. Elevation and anterior displacement of the larynx occurs with laryngeal closure at three levels:
e. Opening of the cricopharyngeus as a result of:

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13
Q

Opening of the cricopharyngeus as a result of:

A
  • relaxation of UES tone
  • elevation of the larynx
  • pulsion force of the bolus
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14
Q

Esophageal Stage:

A
  1. Transit time is approx. 8-20 seconds.
  2. Commences with lowering of the larynx, contraction of the cricopharyngeus to prevent regurgitation, and resumption of respiration.
  3. Esophageal peristalsis begins:
  4. At the lower end of the esophagus, the Lower Esophageal sphincter (LES) relaxes prior to arrival of the esophageal peristalic wave to allow passage of the bolus into the stomach. The LES is otherwise closed to prevent gastroesophageal reflux.
  5. This stage is involuntary.
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15
Q

Gag cannot predict presence or adequacy of swallow because:

A
  • the force of the gag is opposite ofthe swallow

- normal subjects exhibit no gag reflex but have a normal and intact swallow

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16
Q

ANATOMICAL DIFFERENCES BETWEEN THE NEWBORN AND THE ADULT MOUTH AND PHARYNX

A
  1. Oral space of newborn is smaller than adults
  2. Lower jaw of newborn is small and retracted
  3. Sucking pads are present in infants
  4. Tongue takes up more relative space in the newborn because of sucking pads and jaw size
  5. Newborn’s tongue is restricted in movement because of the smaller intraoral cavity
  6. Newborns are essential nose breathers.
  7. The epiglottis and soft palate are approximating in the newborn as a protective mechanism.
  8. Larynx is higher in newborn–eliminates the need for sophisticated laryngeal closure to protect the airway during swallowing.
  9. Eustachian tube in infant is in horizontal position. It is a vertical angle in the adult.
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17
Q

Rooting Reflex

A

Infants use this reflex to find food. When the corner of the mouth is stimulated, the baby turns its face toward the source of stimulation. Present from birth to approximately 3 months.

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18
Q

Transverse Tongue Reflex

A

Elicited by touch or taste stimulation applied to the lateral border of the tongue. Has little functional significance for newborn but is the pattern of tongue lateralization for chewing at 6-8 mos.

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19
Q

Phasic Bite Reflex

A

Rhythmic closing and opening of jaws in response to stimulation. Assists with positive pressure sucking.

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20
Q

Gag Reflex

A

Serves a protective function in infants, preventing infant from ingesting solid food for which it is not ready. Present throughout life.

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21
Q

Babkin and Grasp Reflexes:

A

Show the neurological and functional connections between the hand & mouth. These reflexes have little relevance for survival in human infants but serve as building blocks for future development of self-feeding skills.

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22
Q

SUCK/SWALLOW/BREATHE SYNCHRONY IN INFANTS

- suck component

A

Coordinated swallowing & breathing movements have been documented as young as 18-19 weeks gestational age.

  • Synchronization of nutritive sucking with a pause in respiration prevents aspiration while allowing adequate breathing to support the necessary ingestion.
  • The baby achieves strength and gradation of the tongue from the back 1/3 progressively toward the front. Size and shape of the nipple used in feeding contribute to this progression when it fills the oral cavity appropriately.
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23
Q

The Swallow Component of the SSB:

A
  • Oral phase consists of sucking and moving the food to the back of the oral cavity in continuous movement while containing the bolus with the tongue to prevent premature spillage into the pharynx. Requires coordination of oral motor musculature.
  • The pharyngeal and esophageal phases of swallowing in the infant are similar to the adult swallow.
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24
Q

The Breathe Component of the SSB:

A
  • Respiration is first and foremost a survival function independent of suck or swallow activities.
  • Respiration is associated with suck/swallow components as a function of the necessity to inhibit breathing while swallowing, to avoid aspiration.
  • When respiratory rate is high, the sucking pattern will be compromised and the SSB synergy will become disorganized leading to feeding difficulties. The result is that the child may become fearful of eating and refuse to eat, or only be able to ingest small amounts.
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25
Q

Timing of Aspiration

A
  1. BEFORE the swallow response is triggered, when the larynx has not elevated to close the airway
  2. DURING the swallow if the laryngeal valves are not functioning adequately.
  3. AFTER the swallow when the larynx lowers and opens for inhalation.
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26
Q

Oral Preparatory Phase Disorders

A
  • Reduced lip closure:
  • reduced range of tongue motion or coordination
  • reduced tongue shaping and coordination
  • reduced labial tension or tone
  • reduced buccal tension or tone
  • tongue thrust; reduced tongue control
  • reduced mandibular movement
  • reduced tongue laterialization
  • reduced tongue elevation
  • reduced tongue control
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27
Q

Reduced lip closure

A

results in food falling from the mouth anteriorly

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28
Q

Reduced range of tongue motion or coordination:

A

results in inability to form a bolus

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29
Q

Reduced tongue shaping and coordination

A

results in difficulty holding a bolus and risk of aspiration BEFORE the swallow

30
Q

Reduced labial tension or tone:

A

results in material falling into the anterior sulcus

31
Q

Reduced buccal tension or tone:

A

results in material falling into the lateral sulcus

32
Q

Tongue thrust; reduced tongue control

A

results in abnormal hold position

33
Q

Reduced mandibular movement:

A

results in inability to align teeth and difficulty chewing

34
Q

Reduced tongue lateralization

A

results in inability to lateralize material with tongue to place onto teeth

35
Q

Reduced tongue elevation

A

results in inability to mash materials

36
Q

Reduced tongue control

A

results in material falling to the floor of the mouth

37
Q

ORAL PHASE DISORDERS

A
  • Apraxia of swallow:
  • Reduced oral sensation:
  • Tongue thrust
  • Reduced labial tension
  • Reduced buccal tension or tone
  • Reduced tongue shaping or coordination
  • Scar tissue in tongue
  • reduced tongue range of movement
  • lingual discoordination
  • reduced tongue elevation
  • reduced lingual strength
  • repetitive lingual rolling
  • reduced tongue control
  • reduced lingua velar
  • piecemeal glutition
38
Q

Reduced oral sensation:

A

results in delayed oral onset of swallow. Bolus may be held with no lingual movement due to lack of recognition of the bolus as something to be swallowed

39
Q

Apraxia of swallow

A

results in delayed oral onset of swallow and/or searching motion/inability to organize tongue movements

40
Q

Tongue thrust

A

results in tongue moving forward to start the swallow and possibly pushing food from the mouth
`

41
Q

Reduced labial tension

A

results in residue (stasis) in the anterior sulcus

42
Q

Reduced buccal tension or tone

A

results in residue (stasis) in the lateral sulcus

43
Q

Reduced tongue shaping or coordination

A

results in residue (stasis) on the floor of the mouth

44
Q

Scar tissue in tongue

A

results in residue (stasis) in a midtongue depression

45
Q

Reduced tongue range of movement

A

results in residue (stasis) of food on the tongue

46
Q

Lingual discoordination

A

results in disturbed lingual contraction (peristalsis)

47
Q

Reduced tongue elevation

A

results in incomplete tongue-to-palate contact and adherence (residue) of food on the hard palate

48
Q

Reduced lingual strength

A

results in adherence (residue) of food on the hard palate. Distinguished from above because of build-up of food collecting on the palate as more viscous food is presented.

49
Q

Repetitive lingual rolling

A

typical in Parkinsonian pts. Characterized by a repetitive upward and backward movement of the central portion of the tongue.

50
Q

Reduced tongue control:

A

results in uncontrolled bolus or premature loss of liquid or pudding consistency into the pharynx with a risk of aspiration BEFORE the swallow

51
Q

Reduced linguavelar seal

A

results in same as the above

52
Q

Piecemeal glutition

A

characterized by two, three, or more repeated swallows to empty the oral cavity.

53
Q

Disorders in Triggering the Pharyngeal Swallow

A
  • Delayed pharyngeal swallow:

- Absent pharyngeal swallow response:

54
Q

Delayed pharyngeal swallow:

A

occurs when the head of the bolus enters the pharynx and the pharyngeal swallow has not been triggered. Risk of aspiration is BEFORE the pharyngeal swallow response triggers.

55
Q

Absent pharyngeal swallow response

A

defined as a pharyngeal response delay of greater than 10 seconds

56
Q

Pharyngeal Stage Disorders

A
  • Reduced velopharyngeal closure
  • Fold of mucosa at the base of the tongue
  • Cervical osteophytes
  • Reduced pharyngeal contraction bilaterally
  • Reduced posterior movement of the tongue base:
  • Pharyngeal pouch/scar tissue:
  • Reduced laryngeal elevation
  • Reduced closure of the airway entrance (arytenoid to base of epiglottis)
  • Reduced laryngeal closure:
  • Reduced anterior/superior laryngeal movement
  • Cricopharyngeal dysfunction
  • Generalized reduction in pharyngeal contraction:
  • Unilateral damage to posterior movement of the tongue base:
  • Unilateral pharyngeal wall damage:
  • Unequal height of the vocal folds:
57
Q

Reduced velopharyngeal closure

A

results in nasal penetration during the swallow

58
Q

Fold of mucosa at the base of the tongue

A

results in pseudoepiglottis (after total laryngectomy)

59
Q

Cervical osteophytes

A

bony outgrowth from the cervical vertebrae that can be large enough to interfere with the swallow by narrowing the pharynx

60
Q

Reduced pharyngeal contraction bilaterally:

A

results in coating on the pharyngeal walls after the swallow and presents a risk of aspiration AFTER the pharyngeal response when the pt. inhales

61
Q

Reduced posterior movement of the tongue base

A

results in vallecular residue bilaterally and a risk of aspiration AFTER…

62
Q

Pharyngeal pouch/scar tissue:

A

results in coating in a depression on the pharyngeal wall and a risk of aspiration AFTER…

63
Q

Reduced laryngeal elevation:

A

results in residue at the top of the airway and a risk of aspiration AFTER…

64
Q

Reduced closure of the airway entrance (arytenoid to base of epiglottis):

A

results in laryngeal penetration and, depending if the penetrated material remains in the larynx, aspiration AFTER the swallow upon inhalation

65
Q

Reduced laryngeal closure:

A

results in aspiration DURING the pharyngeal swallow response

66
Q

Reduced anterior/superior laryngeal movement:

A

results in stasis or a residue in both pyriform sinuses and a risk of aspiration AFTER…

67
Q

Cricopharyngeal dysfunction

A

results in residue in both pyriform sinuses and a risk of aspiration AFTER…

68
Q

Generalized reduction in pharyngeal contraction:

A

results in residue throughout the pharynx and a risk of aspiration AFTER…

69
Q

Unilateral damage to posterior movement of the tongue base

A

results in unilateral vallecular residue and risk of aspiration AFTER…

70
Q

Unilateral pharyngeal wall damage

A

results in residue in one pyriform sinus and risk of aspiration AFTER…

71
Q

Unequal height of the vocal folds

A

results in inadequate vocal fold closure and a risk of aspiration DURING…

dysphagia (1 decks)

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