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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
Q

What can patients with CN damage benefit from?

A

aggressive ROM exercises

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26
Q

Explain pleasure feedings

A

use one or two safe consistencies and allow the patient to take in small amounts. consider alternate means of hydration and nutrition

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27
Q

What can alzheimers patients have in terms of swallowing?

A
  • agnosia for food
  • slow to open mouth
  • may hold bolus in the mouth for several minutes
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28
Q

What can alzheimers patients benefit from?

A

sensory stimulation (spoon pressure)

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29
Q

When is hydration and nutrition compromised for people with dementia?

A

when mealtime becomes prolonged

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30
Q

What are some typical symptoms of swallowing disorder for alzheimers patients?

A
  • pharyngeal delay
  • reduced LE
  • reduced BOT-R
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31
Q

Explain multi-infarct dementia

A

multiple small strokes; the location of the strokes cuts off communication between the cortex and the brain stem

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32
Q

What part of the brain controls oral phase?

A

cortex

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33
Q

what part of the brain does the pharyngeal phase?

A

brainstem

34
Q

What is often the problem with multi-infarct dementia?

A

the is a lack of connection between the voluntary and involuntary parts of swallowing

35
Q

What type of ALS is worse for swallowing?

A

the bulbar type

36
Q

When does some evidence say that sensory stimulation helps with ALS?

A

6-12 monts

37
Q

What is typical to see with a parkinson’s patient?

A
  • tongue rolling (likely cause of rigidity)
  • delay of pharyngeal swallow around 2-3 seconds
  • reduced pharyngeal wall movement
  • reduced BOT-R
38
Q

What are some symptoms of later stages of parkinson’s?

A
  • reduced LE
  • more aspiration
  • tremors (mandible, tongue, soft palate)
39
Q

What are some good techniques for Parkinson’s patients?

A

ROM exercises

40
Q

What is a common cause of death for Parkinson’s patients?

A

aspiration pneumonia

41
Q

What does MS cause?

A

demyelination of any part of the CNS

42
Q

What seems to work well for patients with MS who have swallowing problems?

A

sensory tricks

43
Q

What would happen to someone’s swallow if they had a unilateral CVA to the medulla?

A

the oral phase would probably be fine, but the pharyngeal phase would likely be absent

44
Q

Why does COPD cause problems with swallowing?

A

you must have good respiration during swallowing to have good coordination and an adequate apneic period

45
Q

What strategies are best for a patient with COPD?

A

compensatory, because other strategies may cause fatigue which will reduce respiration further

46
Q

What is a trachestomy used for?

A

upper airway obstruction

47
Q

what does the outer cannula do?

A

keeps the airway open

48
Q

what does the face plate of a trach do?

A

secures the trach against the neck

49
Q

What is the purpse of the cuff on a trach?

A

inflate or deflate to prevent aspiration

50
Q

What is the fenestration on a trach for?

A

when you are trying to wean a person off the trach

51
Q

What is the purpose of the obturator of the trach?

A

-aids in insertion of trach. opens the pathway to put the trach in

52
Q

When do you use smaller trach sizes?

A

weaning the patient off or if they are a smaller person

53
Q

What are some restrictions of inflating the cuff on the trach?

A
  • 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
Q

What are the benefits of deflatting the cough?

A

-can use a passy-muire valve (speaking valve)

55
Q

When should you place a passy-muir valve?

A

when the cuff is deflated

56
Q

List the steps for placement of the PMV

A
  • section secretions
  • deflate cuff
  • place PMV
57
Q

How can you see if the patient is aspirating if they are wearing a PMV?

A

put blue dye in the food and see if the blue is in the suctions secretions

58
Q

When should patient with PMV go for swallow study?

A

when they haven’t had blue in their secretions for 3 days in a row

59
Q

Why is a ventilator used?

A

to ensure consistent amounts of air intake and consistent breathing pattern

60
Q

What is a good indicator that someone is ready to have a trach removed?

A

tolerating a PMV for 24 hours

61
Q

What is tongue thrust?

A

when the child carries the tongue anteriorally

62
Q

what is a bilateral open bite?

A

prevents proper mastication with back teeth

63
Q

what is an anterior open bite?

A

front teeth have no contact

64
Q

what can contribute to open bites?

A

thumb sucking and pacifiers

65
Q

what are some things an SLP should screen for with tongue thrust?

A
  • 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
Q

During an SLP assessment of tongue thrust, what structures should be checked?

A

-lips
-nose
-bite/teeth
-tongue
-palate
-tonsils
-swallow
]

67
Q

What is the first the to work on in therapy for tongue thrust?

A

digit contol

68
Q

What are some things to work on in therapy with tongue thrust

A
  • start muscle training to establish new patterns
  • tongue isometrics
  • practice with mirror work
  • tongue posture
69
Q

what is the first thing to consider after assessment of swallow?

A

how will nutrition and hydration be managed?

70
Q

What are some things to consider for treatment?

A
  • patient motivation
  • patient prognosis
  • patient reaction to compensatory strategies
  • patient’s ability to follow direction
  • respiratory function
  • caregiver support
71
Q

What is the goal of swallowing therapy?

A

re-establish oral feeding while maintaining adequate nutrition and hydration and safe swallowing

72
Q

What is an example of a long term swallowing goal?

A

pt will tolerate safest, least restrictive diet without signs/symptoms of aspiration

73
Q

What is total parenteral nutrition? (TPN)

A

-a formula is delivered through a large flow vein

74
Q

Cons of TPN

A

costly and greater risk for infeciton

75
Q

what is peripheral parenteral nutrition? (PPN)

A

is patient doesn’t need all nutrition this way, they can use a smaller flow vein

76
Q

What is a nasogastric tube? (NG tube)

A

a tube that goes through the nose, pharynx, esophagus, and into the stomach to deliver formula

77
Q

What are the risks of NG tube?

A

skin erosion and GERD

78
Q

What are some precautions taken with an NG tube?

A
  • have patient up at at least 45 degrees
  • flush water through the tube after feeding
  • keep patient upright for an hour after feeding
79
Q

What is a gastrostomy/percutaneous endoscopic gastrostomy (PEG)/G-tube?

A

-a tube that is inserted externally through an opening. Goes into the stomach.

80
Q

What is a jejunostomy?

A

when the tube is externally inserted into the jejunum

81
Q

Explain fundoplication

A

the stomach is wrapped around part of the esophagus to reinforce the lower esophageal sphincter

Dysphagia (4 decks)

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