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Dysphagia > Week 3, Quiz 1 > Flashcards

Week 3, Quiz 1 Flashcards

1
Q

When would the pharyngeal stage likely start to come back for someone who had a unilateral CVA to the medulla?

A

the second week of recovery

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2
Q

What would a pontine CVA result in?

A

hypertonicity

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3
Q

What would the hypertonicity from a pontine CVA a result in?

A

delay or absence of the pharyngeal swallow (reduced LE)

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4
Q

What cranial nerves come from the pons?

A

5, 6, 7, 8

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5
Q

What would you likely see for someone with a left hemisphere CVA?

A
  • some apraxia of swallowing

- oral delays more significant than pharngeal

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6
Q

What are the likely delay times of a left hemisphere CVA for oral and pharyngeal stages?

A
  • oral 3-5 seconds

- pharyngeal 2-3 seconds

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7
Q

What can help reduced oral and pharyngeal patients with cerebral CVA?

A

sensory stimulation

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8
Q

What are more significant in right hemisphere CVAs, oral delay or pharyngeal delay

A

pharyngeal delay

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9
Q

What are the delay times for pharyngeal and oral stages of a right hemisphere CVA?

A
  • oral: 2-3 seconds

- pharyngeal 3-5 seconds

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10
Q

What are some techniques that may be helpful for right hemisphere CVA?

A
  • chin tuck
  • sensory stimulation
  • supraglottic maneuver
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11
Q

Why are patients with right CVA likely to have trouble getting through therapy?

A
  • cognitive linguistic deficits are often present

- anosagnosia (lack of recognition in deficits)

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12
Q

When is spontaneous recovery the best with a stroke?

A

first three weeks

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13
Q

How far apart should you space MBSSs?

A

no sooner than two weeks together

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14
Q

define trismus

A

inadequate jaw movement

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15
Q

what is mucositus?

A

thick ropey secretions

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16
Q

What causes mucositis?

A

dry mouth

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17
Q

Why is kyphosis?

A

stooped posture

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18
Q

define passive aspiration

A

aspiration that occurs after the swallow (likely during dry swallows to clear bolus)

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19
Q

What are some symptoms of cervical spinal cord injury for swallow?

A
  • pharyngeal delay
  • reduced LE
  • reduced BOT-R
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20
Q

When will someone with a cervical spinal cord injury have reduced sensation?

A

if the injury is as high as c1 or c2

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21
Q

what might you have to do if a patient is wearing a collar during MBSS?

A

tilt the patient to one hip

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22
Q

What can you do if patient can’t do postural techniques because of a collar?

A

sensory techniques or manuevers

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23
Q

Where does the metal plate go for a cervical spine fusion?

A

directly behind the pharynx

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24
Q

What will patients with cranial nerve injury to 9 have problems with?

A

the trigger of the swallow

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25
What can patients with CN damage benefit from?
aggressive ROM exercises
26
Explain pleasure feedings
use one or two safe consistencies and allow the patient to take in small amounts. consider alternate means of hydration and nutrition
27
What can alzheimers patients have in terms of swallowing?
- agnosia for food - slow to open mouth - may hold bolus in the mouth for several minutes
28
What can alzheimers patients benefit from?
sensory stimulation (spoon pressure)
29
When is hydration and nutrition compromised for people with dementia?
when mealtime becomes prolonged
30
What are some typical symptoms of swallowing disorder for alzheimers patients?
- pharyngeal delay - reduced LE - reduced BOT-R
31
Explain multi-infarct dementia
multiple small strokes; the location of the strokes cuts off communication between the cortex and the brain stem
32
What part of the brain controls oral phase?
cortex
33
what part of the brain does the pharyngeal phase?
brainstem
34
What is often the problem with multi-infarct dementia?
the is a lack of connection between the voluntary and involuntary parts of swallowing
35
What type of ALS is worse for swallowing?
the bulbar type
36
When does some evidence say that sensory stimulation helps with ALS?
6-12 monts
37
What is typical to see with a parkinson's patient?
- tongue rolling (likely cause of rigidity) - delay of pharyngeal swallow around 2-3 seconds - reduced pharyngeal wall movement - reduced BOT-R
38
What are some symptoms of later stages of parkinson's?
- reduced LE - more aspiration - tremors (mandible, tongue, soft palate)
39
What are some good techniques for Parkinson's patients?
ROM exercises
40
What is a common cause of death for Parkinson's patients?
aspiration pneumonia
41
What does MS cause?
demyelination of any part of the CNS
42
What seems to work well for patients with MS who have swallowing problems?
sensory tricks
43
What would happen to someone's swallow if they had a unilateral CVA to the medulla?
the oral phase would probably be fine, but the pharyngeal phase would likely be absent
44
Why does COPD cause problems with swallowing?
you must have good respiration during swallowing to have good coordination and an adequate apneic period
45
What strategies are best for a patient with COPD?
compensatory, because other strategies may cause fatigue which will reduce respiration further
46
What is a trachestomy used for?
upper airway obstruction
47
what does the outer cannula do?
keeps the airway open
48
what does the face plate of a trach do?
secures the trach against the neck
49
What is the purpse of the cuff on a trach?
inflate or deflate to prevent aspiration
50
What is the fenestration on a trach for?
when you are trying to wean a person off the trach
51
What is the purpose of the obturator of the trach?
-aids in insertion of trach. opens the pathway to put the trach in
52
When do you use smaller trach sizes?
weaning the patient off or if they are a smaller person
53
What are some restrictions of inflating the cuff on the trach?
- reduces LE (anchors the larynx down) - inflated cuff for more than 6 months can cause scar tissue and fistulas - can reduced VF closure after long use
54
What are the benefits of deflatting the cough?
-can use a passy-muire valve (speaking valve)
55
When should you place a passy-muir valve?
when the cuff is deflated
56
List the steps for placement of the PMV
- section secretions - deflate cuff - place PMV
57
How can you see if the patient is aspirating if they are wearing a PMV?
put blue dye in the food and see if the blue is in the suctions secretions
58
When should patient with PMV go for swallow study?
when they haven't had blue in their secretions for 3 days in a row
59
Why is a ventilator used?
to ensure consistent amounts of air intake and consistent breathing pattern
60
What is a good indicator that someone is ready to have a trach removed?
tolerating a PMV for 24 hours
61
What is tongue thrust?
when the child carries the tongue anteriorally
62
what is a bilateral open bite?
prevents proper mastication with back teeth
63
what is an anterior open bite?
front teeth have no contact
64
what can contribute to open bites?
thumb sucking and pacifiers
65
what are some things an SLP should screen for with tongue thrust?
- rest posture of lips and tongue - oral habits (nail biting, lip licking, etc) - occlusion - tongue mobility - articulation - swallow pattern (watch for tongue to protrude through the teeth
66
During an SLP assessment of tongue thrust, what structures should be checked?
-lips -nose -bite/teeth -tongue -palate -tonsils -swallow ]
67
What is the first the to work on in therapy for tongue thrust?
digit contol
68
What are some things to work on in therapy with tongue thrust
- start muscle training to establish new patterns - tongue isometrics - practice with mirror work - tongue posture
69
what is the first thing to consider after assessment of swallow?
how will nutrition and hydration be managed?
70
What are some things to consider for treatment?
- patient motivation - patient prognosis - patient reaction to compensatory strategies - patient's ability to follow direction - respiratory function - caregiver support
71
What is the goal of swallowing therapy?
re-establish oral feeding while maintaining adequate nutrition and hydration and safe swallowing
72
What is an example of a long term swallowing goal?
pt will tolerate safest, least restrictive diet without signs/symptoms of aspiration
73
What is total parenteral nutrition? (TPN)
-a formula is delivered through a large flow vein
74
Cons of TPN
costly and greater risk for infeciton
75
what is peripheral parenteral nutrition? (PPN)
is patient doesn't need all nutrition this way, they can use a smaller flow vein
76
What is a nasogastric tube? (NG tube)
a tube that goes through the nose, pharynx, esophagus, and into the stomach to deliver formula
77
What are the risks of NG tube?
skin erosion and GERD
78
What are some precautions taken with an NG tube?
- have patient up at at least 45 degrees - flush water through the tube after feeding - keep patient upright for an hour after feeding
79
What is a gastrostomy/percutaneous endoscopic gastrostomy (PEG)/G-tube?
-a tube that is inserted externally through an opening. Goes into the stomach.
80
What is a jejunostomy?
when the tube is externally inserted into the jejunum
81
Explain fundoplication
the stomach is wrapped around part of the esophagus to reinforce the lower esophageal sphincter

Dysphagia (4 decks)

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