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Dysphagia > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

Prevalence of dysphagia in acute care?

A

33%

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2
Q

Prevalence of dysphagia in rehab facility?

A

42%

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3
Q

Prevalence of dysphagia in chronic care setting?

A

60%

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4
Q

Primary function of the larynx?

A

Protect the airway

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5
Q

Prevalence of dysphagia based on cause…

A

Stroke - 49%
TBI - 19.5%
Spinal cord injury/brain tumors - 6.8%
Progressive neurological disorders - 5.2%

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6
Q

Dysphagia

A

A swallowing disorder

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7
Q

Oral intake

A

Placement of food in the mouth for nutrition and hydration

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8
Q

Bolus

A

The food, liquid, or other material placed in the mouth for ingestion

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9
Q

Aspiration

A

Occurs when food/liquid penetrates the airway below the true VFs

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10
Q

Laryngeal Penetration

A

Occurs when food/liquid penetrates the portion of the airway above the true VFs

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11
Q

Functional Swallow

A

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

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12
Q

Ingestion/Swallow

A

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

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13
Q

deglutition

A

Refers only to acts associated with bolus transfer and transport

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14
Q

NPO

A

not eating by mouth

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15
Q

Anatomic structures of the oral cavity used for swallowing

A 
lips
teeth
hard palate
soft palate (uvula)
mandible
floor of mouth
tongue
faucial arches
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16
Q

what are the faucial arches

A

arch on either side of the uvula when looking into the mouth

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17
Q

Muscles that squeeze the bolus down

A

pharyngeal constrictors

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18
Q

Three pharyngeal constrictors

A

superior, medial, and inferior

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19
Q

Cricopharyngeus muscle AKA

A

upper esophageal sphincter (UES), pharyngoesophageal juncture, P-R segment

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20
Q

Is the cricopharyngeus natrually open or closed? Why?

A

Closed. It prevents air from entering the esophagus during respiration and prevents material from refluxing into the pharynx

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21
Q

When is the cricopharyngeus open?

A

When we swallow - it opens and allows the bolus into the esophagus

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22
Q

What/where are the pyriform sinuses?

A

a spaced formed between the fibers which attach the inferior pharyngeal constrictor to the thyroid cartilage

Space created by the inferior constrictors when they contract

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23
Q

What is at the top of the esophagus?

A

UES

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24
Q

What is at the bottom of the esophagus?

A

LES

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25
Q

Layers of the esophagus

A

2 layers of muscle

  • inner is circular
  • outer is longitudinal
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26
Q

what are the layers of the muscles of the esophagus made up of?

A

upper third - striated
middle third - striated and smooth
lower third - smooth

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27
Q

Lower esophageal sphincter (LES) AKA

A

gastroesophageal juncture

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28
Q

What happens after the LES passes bolus into the stomach?

A

It closes to prevent reflux

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29
Q

Top most structure of the larynx that rests against the base of the tongue

A

epiglottis

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30
Q

Web-shaped space by the base of the tongue and the epiglottis

A

Valleculae**

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31
Q

Opening to the top of the layrnx

A

Laryngeal cestibule

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32
Q

Laryngeal vestibule AKA

A

laryngeal aditus

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33
Q

Suspended from the base of the tongue

A

Hyoid bone

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34
Q

The only free-floating bone in the body

A

hyoid bone

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35
Q

Pharyngeal recesses

A

the valleculae and the pyriform sinuses

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36
Q

Why are the pharyngeal recesses important?

A

In an inefficient swallow, residue is often seen here**

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37
Q

What are the 5 stages of swallowing?**

A
  1. Anticipatory stage
  2. Oral preparatory stage
  3. Oral stage
  4. Pharyngeal stage
  5. Esophageal stage
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38
Q

Anticipatory stage of swallowing

A

make cognitive judgments about oral intake (e.g., rate, temperature, size of bite)

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39
Q

Oral prep stage of swallowing

A

Breakdown food and mix it with saliva

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40
Q

In which stage of swallowing is lip seal maintained, mastication occurs, buccal musculature tension is maintained, food collected into a bolus, etc.?

A

Oral prep stage

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41
Q

what are the 10 components of the oral prep 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. linguavelar seal
  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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42
Q

Where is buccal musculature tension held?

A

In cheeks

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43
Q

Linguavelar seal

A

Back of the tongue is elevated and soft palate is pulled anteriorly against tongue to keep material in the oral cavity

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44
Q

How long is the oral prep stage?

A

Depends what we are eating (e.g., steak vs. water)

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45
Q

Tongue against the soft palate

A

Linguavelar seal

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46
Q

Soft palate against the wall of the pharynx

A

Velopharyngeal seal

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47
Q

What are the 4 components of the 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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48
Q

3 reasons the pharyngeal stage is considered physiologically most important

A
  1. Airway protection (when the larynx elevates, the valves of the larynx close)
  2. opening of the esophagus
  3. Downward propulsion of the bolus into the esophagus (due to contraction of the pharyngeal constrictors)
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49
Q

4 components of the pharyngeal stage of swallowing

A
  1. Begins with triggering of the pharyngeal response
  2. When the response triggers, a number of physiological activities occur simultaneously
    2a. Tongue base move posteriorly to contact the anteriorly moving posterior pharyngeal wall
    2b. velum elevates to achieve VP closure
    2c. Pharyngeal contraction begins (squeezing action of the constrictors)
    2d. Elevation and anterior displacement of the larynx occurs with laryngeal closure at three levels (aryepliglottic folds, false folds, true folds)
    2e. opening of the cricopharyngeus as a result of relaxation of UES, elevation of larynx, and pulsion force of the bolus
  3. Transit time is 1 second
  4. This stage is involuntary
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50
Q

5 components of the esophageal stage of swallowing

A
  1. Transit time is appx 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
    3a. Primary peristalsis is initiated by the pharyngeal response (when laryngeal elevation occurs) - which opens the UES
    3b. secondary peristalsis is initiated in response to local distention
  4. at the lower end of the esophagus, the 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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51
Q

Peristalsis

A

A rhythmic contraction of muscles to move things through a tube

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52
Q

The ability to introduce bolus to the mouth

A

Feeding

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53
Q

Movement of the bolus from the oral cavity to the esophagus

A

Deglutition

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54
Q

Swallow vs. Gag reflex*

A
  1. No physiologic or protective relationship between swallow response and gag reflex
  2. Gag is triggered by noxious or foreign stimulus
  3. Purpose of gag: eliminate foreign stimuli from the mouth or pharynx
  4. The neuromuscular response that characterizes gagging involves sudden and strong contractions of pharyngeal walls, soft palate, and larynx to squeeze from the pharynx the stimuli that elicited the gag.
  5. Gag is not protective for swallowing.
  6. The cough reflex is the protective reflex for the swallow
  7. Gag cannot predict presence or adequacy of swallow because the force of the gag is the opposite of the swallow and normal subjects exhibit no gag reflex but have a normal and intact swallow.
  8. Gag is useful for observing pharyngeal and palatal contraction.
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55
Q

What is the purpose of the gag?

A

To eliminate foreign stimuli from the mouth or pharynx

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56
Q

What is the protective reflex for the swallow?

A

The cough reflex

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57
Q

How can we tell if someone has unilateral pharyngeal weakness?

A

By the way they gag

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58
Q

What is the curtain effect?

A

Everything gets pulled to one side in unilateral weakness

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59
Q

What is it called when bolus comes up through the nasal cavity?

A

Nasal regurgitation

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60
Q

What is the most important cough? Why?

A

Reflexive cough - it prevents aspiration

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61
Q

9 anatomical differences between the adult and newborn mouth?

A
  1. size of oral space
  2. size of lower jaw - child is also retracted
  3. infants have sucking pads
  4. Tongue takes up most of oral cavity
  5. child’s tongue is restricted
  6. newborns - nose breathers
  7. epiglottis and soft palate approximate
  8. larynx is higher in newborn
  9. eustachian tube is horizontal in newborn
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62
Q

Swallow apnea

A

cessation of respiration during the swallow

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63
Q

Adaptive reflexes

A

assist in the acquisition of food

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64
Q

Protective reflexes

A

designed to protect the airway

65
Q

Rooting reflex

A
  • Used to find food
  • Touch corner of mouth, baby turns its face that direction
  • birth to three months
  • adaptive reflex
66
Q

Transverse Tongue Reflex

A
  • elicated by touch/taste stimulation applied to the lateral border of tongue
  • important for developing the chew
  • AKA lateral tongue reflex
67
Q

Phasic Bite Reflex

A

Rhythmic closing and opening of jaws in response to stimulation

  • Assists with positive pressure sucking
  • E.g. put your finger in the infants mouth and they begin sucking
68
Q

Gag reflex

A
  • Serves a protective function in infants, preventing infant from ingesting food for which its not ready
  • Present throughout life (but integrates into our system)
69
Q

Suckling is a….

A

reflexive movement

70
Q

Sucking is a…

A

voluntary movement

71
Q

Positive pressure suck

A

Push tongue against the nipple and liquid squirts into mouth (suckling)

72
Q

Negative pressure suck

A
  • what we do

- Seal lips around straw and drop back of tongue in order to decrease the pressure

73
Q

Tonic Bite Reflex

A
  • Abnormal bite

- bite down on object in mouth hard and wont let go

74
Q

Babkin and Grasp Reflexes

A

Show the neurological and functional connections between the hand and the mouth

  • little relevance for human survival
  • building blocks for future development of self-feeding skills
75
Q

Grasp reflexes

A

If you press on the baby’s pal,, will grasp

76
Q

Babkin reflex

A

occurs when you press both of the baby’s palms - their eyes close, the mouth opens, and the head turns to one side

77
Q

Reflexes can tell us what about a child?

A

neurological maturity

78
Q

Purpose of nutritive sucking

A

Obtain nourishment

79
Q

Purpose of non-nutritive sucking

A

State regulation, satisfy sucking desire, exploration

80
Q

rhythm of nutritive sucking

A

Initial continuous sucking burst, moving to intermittent sucking bursts with bursts becoming shorter and pauses longer over the course of the feeding

81
Q

rhythm of non-nutritive sucking

A

repetitive patterns of bursts and pauses; stable number of sucks per burst and duration of pauses

82
Q

Has a rate of one suck/second and is constant over the course of feeding

A

Nutritive sucking

83
Q

Have a rate of about 2 sucks/second

A

Non-nutritive sucking

84
Q

Ratio is 1:1 to 3:1

A

Nutritive SSB

85
Q

Ratio is 6:1 to 8:1

A

Non-nutritive SSB

86
Q

When have swallowing and breathing movements been documented in infants (age)

A

18-19 weeks gestation

87
Q

Two biochemical methods of nutritive sucking

A
  1. Positive pressure (suckling)

2. Negative pressure (suck)

88
Q

Pressure is put on the nipple that expresses the liquid

A

Positive pressure method

89
Q

The lips seal around the nipple and then the back of the tongue is depressed

A

Negative pressure method

90
Q

Strength and control of the tongue develops from…

A

back to front

91
Q

When does the larynx dissend in infants?

A

After about 3 months

92
Q

What do we change while feeding infants once the larynx dissends?

A

move them to a more vertical feeding position

93
Q

Swallow apnea

A

Cessation of respiration during swallow to prevent aspiration

94
Q

Which takes prescendence, swallowing or respiration?

A

respiration - if child has trouble with SSB, they tend to choke - they will breathe first, not feed

95
Q

What is Aspiration

A

Action of material penetrating thte larynx and entering the airway BELOW the level of the true VFs

96
Q

Once material is in the airway, it may be expectorated…

A

patient mush have intact cough reflex and adequate laryngeal and respiratory control

97
Q

Once material is in the airway, it may be silently aspirated…

A

if patient does not have a cough reflex, the material remains in the trachea and bronchial tree; may result in aspiration pneumonia

98
Q

When food enters the airway, but stays above the true VFs

A

Penetration

99
Q

How do we describe the timing of ASPIRATION?

A

Before, during or after (when aspiration occurs in relation to when the pharyngeal response occurs)

100
Q

For materials to be aspirated, what three valves must it penetrate?

A
  • Aryepiglottic folds
  • False Folds
  • True Folds
101
Q

Aspiration when the larynx has not yet elevated to close the airway

A

Aspiration before

102
Q

Aspiration when the laryngeal valves are not functioning adequately

A

Aspiration during

103
Q

Aspiration when the larynx lowers and opens for inhalation

A

Aspiration after

104
Q

How do we know when the pharyngeal response occurs?

A

Hyoid and larynx elevate

105
Q

Is aspiration a swallowing problem?

A

No, it is a symptom

106
Q

Why does it help to know the timing of aspiration?

A

Can help to rule in/out certain disorders

107
Q

How do we treat aspiration?

A

treat the CAUSE of the problem

108
Q

Reduced lip closure.

A

Oral Prep Phase Disorder

-results in food falling from the mouth anteriorally

109
Q

Reduce range of tongue motion of coordination.

A

Oral Prep Phase Disorder

-Results in inability to form a bolus

110
Q

Reduced tongue shaping and coordination.

A

Oral Prep Phase Disorder

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

111
Q

Reduced labial tension or tone.

A

Oral Prep Phase Disorder

-Results in material falling into the anterior sulcus

112
Q

Reduces buccal tension or tone.

A

Oral Prep Phase Disorder

-Results in material falling into the lateral sulcus

113
Q

Tongue thrust; reduced tongue control.

A

Oral Prep Phase Disorder

-Results in abnormal hold position

114
Q

Reduced mandibular movement.

A

Oral Prep Phrase Disorder

-Results in inability to align teeth and difficulty chewing

115
Q

Where is the anterior/lateral sulcus

A

Between the gums/teeth and the cheeks

116
Q

Where is the floor of the mouth?

A

Under the tongue

117
Q

reduced tongue lateralization.

A

Oral Prep Phase Disorder

-Results in inability to lateralize material with tongue to place onto teeth

118
Q

Reduced tongue elevation.

A

Oral Prep Phase Disorder

-Results in inability to mash materials

119
Q

Reduced tongue control.

A

Oral Prep Phase Disorder

-Results in material falling to the floor of the mouth

120
Q

Apraxia of swallow.

A

Oral Phase Disorder

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

121
Q

Reduced oral sensation.

A

Oral Phase Disorder
-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

122
Q

Tongue thrust.

A

Oral Phase Disorder

-Results in tongue moving forward to start the swallow and possible pushing food from the mouth

123
Q

Reduced labial tension.

A

Oral Phase Disorder

-results in residue (stasis) in the anterior sulcus

124
Q

Reduced buccal tension or tone.

A

Oral Phase Disorder

-Results in residue (stasis) in the lateral sulcus

125
Q

Reduces tongue shaping or coordination.

A

Oral Phase Disorder

-Results in residue (stasis) on the floor of the mouth

126
Q

Scar tissue in tongue.

A

Oral Phase Disorder

-Results in residue (stasis) in a midtongue depression

127
Q

Reduced tongue ROM.

A

Oral Phase Disorder

-Results in residue (stasis) of food on the tongue

128
Q

Lingual discoordination.

A

Oral Phase Disorder

-Results in disturbed lingual contraction (peristalsis)

129
Q

Reduced tongue elevation.

A

Oral Phase Disorder

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

130
Q

Reduced lingual strength.

A

Oral Phase Disorder
-Results in adherence 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

131
Q

Repetitive lingual rolling.

A

Oral Phase Disorder

  • typical in pts. with Parkinsons
  • Characterized by a repetitive upward and backward movement of the central portion of the tongue
132
Q

Reduced tongue control.

A

Oral Phase Disorder
-Results in uncontrolled bolus or premature loss of liquid or pudding consistent into the pharynx with a risk of aspiration BEFORE the swallow

133
Q

Reduced linguavelar seal.

A

Oral Phase Disorder

-Results in same as reduced tongue control

134
Q

Piecemeal deglutition.

A

Oral Phase Disorder

-Characterized by two, three, or more repeated swallows to empty the oral cavity

135
Q

Delayed pharyngeal swallow.

A

Disorder in Triggering the Pharyngeal Swallow
-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.

136
Q

Look at slide 55 and 56

A

Has info about item that will be on test…

137
Q

How do you time a delayed pharyngeal swallow?

A

The delay is timed from the point where the bolus head passes the point where the lower edge of the mandible crosses the tongue base until the pharyngeal swallow is initiated (where laryngeal and hyoid elevation begin as part of the pharyngeal swallow)***

138
Q

When is a pharyngeal swallow response determined to be absent?

A

a pharyngeal response delay of greater than 10 seconds*** (because it wont work for the purpose of ingesting food orally)

139
Q

what is the delay of the pharyngeal response measured in?

A

Seconds

140
Q

Reduced velopharyngeal closure.

A

Pharyngeal Stage Disorder

-results in nasal penetration during the swallow

141
Q

Fold of mucosa at the base of the tongue.

A

Pharyngeal Stage Disorder

-results in pseudoepiglottis (after total laryngectomy)

142
Q

Cervical osteophytes.

A

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

143
Q

Reduced pharyngeal contraction bilaterally.

A

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

144
Q

Reduced posterior movement of the tongue base (retraction).

A

Pharyngeal Stage Disorder

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

145
Q

Pharyngeal pouch/scar tissue.

A

Pharyngeal Stage Disorder

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

146
Q

Residue AKA

A

Stasis

147
Q

Diverticulum AKA

A

Pharyngeal Pouch (bad breath is a symptom of this)

148
Q

Reduced laryngeal elevation.

A

Pharyngeal Stage Disorder

  • results in residue at the top of the airway and a risk of aspiration AFTER…
  • If the larynx doesn’t fully elevate, then the epiglottis wont fully invert
149
Q

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

A

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

150
Q

Reduced laryngeal closure.

A

Pharyngeal Stage Disorder

-results in aspiration DURING the pharyngeal swallow response (this is the only one that is during)***

151
Q

Reduced anterior/superior laryngeal movement.

A

Pharyngeal Stage Disorder

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

152
Q

Cricopharyngeal dysfunction.

A

Pharyngeal Stage Disorder

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

153
Q

Generalized reduction in pharyngeal contraction.

A

Pharyngeal Stage Disorder

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

154
Q

Where are the pyriform sinuses located in relation to the USE?

A

Just superior

155
Q

If the pyriform sinuses are just above the UES, why would reduced laryngeal elevation result in residue in the pyriforms?

A

Because the UES doesn’t open

156
Q

Unilateral damage to posterior movement of the tongue base.

A

Pharyngeal Stage Disorder

-results in unilateral vallecular residue and risk of aspiration AFTER…

157
Q

Unilateral pharyngeal wall damage.

A

Pharyngeal Stage Disorder

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

158
Q

Unequal height of the vocal folds.

A

Pharyngeal Stage Disorder

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

Dysphagia (1 decks)

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