Week 4

Question 1

What are UMN lesions associated with?

Answer 1

Normal increased reflexes
late and mild atrophy
Normal or increased tone

Question 2

What are LMN lesions associated with?

Answer 2

Decreased or absent reflexes
Rapid and severe atrophy
Decreased or absent tone

Question 3

What are the types of stroke?

Answer 3

Ischemic - clot/block
Hemorrhagic - bleed/burst
TIA- smaller blockage

Question 4

Dysphagia in ______ of acute stroke cases

Answer 4

29-80%

Question 5

How is improvement of dysphagia in strokes?

Answer 5

50-90% show rapid improvement to near baseline function

Persistent dysphagia continues in 20-50%

Of the persistent, 50% aspirate and 35% develop AP

AP is the leading cause of re-hospitalization in acute stroke

AP contributes to >50% of deaths in the first 30 days post stroke

Question 6

What is silent aspiration?

Answer 6

aspiration w/o sensation (no awareness, no coughing, no throat clearing)
CN X damage (sensory)

Question 7

Silent aspiration is present in _____ of post stroke dysphagia cases and commonly causes AP

Answer 7

2-66%

Question 8

What are indications for instrumental assessment?

Answer 8

AP
cough
wet voice
diff w/ hydration/nutrition

Question 9

Which is more detrimental to swallowing: cortical or brainstem stroke?

Answer 9

Brainstem

Location of many CNs

Question 10

What are primary characteristics of GERD?

Answer 10

heartburn and esophagitis

Nightime, supine reflux

Associated with obesity

LES dysfunction and poor motility

Esophagus is protected against acid

Question 11

What are primary characteristics of LPR?

Answer 11

70% of pt deny heartburn (silent); only 25% have esophagitis

Daytime, upright reflux

No Rx with BMI

UES dysfunction and seemingly good motility

Laryngeal/pharyngeal region is poorly protected from acid

Question 12

What are GERD lifestyle modifications?

Answer 12

Elevate HOB 6 in.
Smoking cessation
Low-fat diet
Weight loss
Avoid lying down w/i 3 hrs of eating
Eat frequent small meals
Avoid refluxogenic foods: alcohol, chocolate, spicy, citrus

Question 13

what are causes of esophagitis?

Answer 13

GERD - most common
Infection (ex. candida)
Foreign bodies (ex. pills)
Chemo and radiation
Eosinophilic esophagitis)

Question 14

Eosinophilic esophagus

Answer 14

used to be rare, more common now

Allergic inflammation of esophagus

Cause unknown

referral to allergist

Question 15

What is treatment for LPR?

Answer 15

Standard GERD reccomendations

Meds-h2 receptor antagonists and/or PPI

Question 16

Which is more common to cause solid food dysphagia: A or B ring?

Answer 16

B ring - Tx: dilation

If A ring tx needed: botox

Question 17

What are common findings in TBI?

Answer 17

residue, bolus spill, delay swallowing

Question 18

What is the presenting complaint of myasthenia gravis?

Answer 18

Dysphagia

high risk of AP, aspiration typically silent

not good to repeat trials and exercises, can deplete ACh

Question 19

How do you decide if there is a presence of presbyphagia or dysphagia?

Answer 19

1. overt safety issue

2. case Hx

Question 20

What are typical signs of presbyphagia

Answer 20

longer swallowing
muscle atrophy
increase in pharyngeal movement
decrease in pharyngeal muscle mass
loss of sensation
longer swallow trigger
increased cortical activity

increased or reduced kinematic output? Literature is controversial