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230 Cards in this Set

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  • Back
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True or False

Oropharyngeal and esophageal dysphagia often co-occur.
Yup
The top ___ percent of the esophagus is ____ muscle, while the bottom ____ percent is ____ muscle.
33%
striated
66%
smooth
The inner layer of muscle in the espophagus is ____ serving to _____ the esophagus
circular
squeeze/constrict
The outer layer ofmuscle in the esophagus is ____ serving to _____ the esophagus
longitudinal
shorten
The UES opens and closes ____, whereas the LES opens and closes ____. Why?
quickly
slowly
The LES has to remain open until the esophagus is clear
How long for food to travel (typically) from the mouth to the cervical esophagus? At what rate does it travel from the cervical esophagus to the stomach?
1 sec
3-4 cm/sec (slow)
Ennervation of the upper esophagus by the CNX...
goes directly to the muscle fiber (excitatory-Ach)
Ennervation of the lower esophagus by the CNX...
is via the ENS (enteric), CNX to ENS (excitatory, Ach); then ENS to muscle fiber (both excitatory Ach and inhibiting N0, VIP)
Things like to flow...
...from high to low.

Pressure, that is.
Intra-abdominal resting pressure?
+5mm Hg
Intra-thoracic resting pressure?
-5mm Hg
LES resting pressure?
+25mm Hg
The esophagus enters the stomach through the diaphragm at the ____
esophageal hiatus
True or False

The enteric nervous sytem is embedded in the wall of the GI and is part of the ANS.
False

It is separate from both the CNS and ANS, lining the intestinal tract and has over 100M neurons.
Name me some general categories of causes of oropharyngeal dysphagia, say 6:

MINIMS
Muscular
Iatrogenic
Metabolic
Infectious
Neurologic
Structural
Name me some general categories of esophageal dysphagia

SIMINIC
Structural
Iatrogenic
Motility
Infectious
Neoplastic
Inflammatory
Congenital
Patient N has an esophageal dysphagia problem that is structural. What are five possibilities?

SHEEP
Schatzki's Ring
Hiatal Hernia
Esophageal Diverticula
Eosinophilic esophagitis
Peptic stricture
Patient Q comes in saying things are sticking in her throat right here (pointing to the notch at the base of her throat). Is this more likely to be esphageal or pharyngeal dysphagia?
Your guess is as good as mine
Patient O is complaining of things getting stuck right there (pointing to his chest). Where's the problem likely to be located if it's esophageal dysphagia?
At or below where he's pointing.
How often is food impaction seen at NUH?
3-4 times a week
My stomach is protruding above the diaphragm. I have a/an
hiatal hernia
Your stomach has got a web of tissue localized to the esophageal squamocolumnar junction that's coexisting (almost invariably) with a hiatal hernia. You don't have an LES. What do you have?
Schatzki's ring
Is schatzki's ring common? If so, how so (percent) and are there any populations it is more common in? If it's acquired, how is it acquired?
Yup. 4-15% of radiographic studies show it.
More prevalent with age
resulting from chemical injury of eg
Clinical presentation of schatzki's ring?
intermittent dysphagia for solids
What's steakhouse syndrome and what disorder is it related to?
Schatzki's ring and it's a food impaction.
Esophageal dysphagia is most common with esophageal rings of what size?
<13 mm
Dude! Your esophagus looks like a trachea! What's wrong with you?
Eosiniphilic Esophagitis (allergy induced)
What foods cause the most impactions?
Bread. And meat.
What's the likelihood of an impaction with an esophageal diameter (at the point of constriction) of less than 13mm
about 100%
What's the likelihood of an impaction with an esophageal diameter (at the point of constriction) of about 13-20mm?
about 33%
What's an esophageal complication of GERD (a type of stenosis)?
Peptic stricture
What is a peptic stricture?
scar tissue forming at the esophageal juncture (collagen and fibrous tissue) as a result of GERD
____ of people seeking medical attention for symptoms of GERD have esophagitis.
1/3
Most common causes of ED?
Eosiniphilic Eg
Schatzki's ring
Does reflux esophagitis have any complications and if so, what are they?

ABBUSE
Adenocarcinoma
Barrett's Esophagus
Bleeding
Ulceration
Stricture
Erosive esophagitis
____ percent of people with esophagitis have a peptic stricture
8-20%
How to treat a peptic stricture...
dilation
lifelong acid suppression
True or False

Agh! Hiatal hernia! Well, at least it's not very common so I don't have to worry too much about it.
False

It's super common, with 60% of elderly enjoying it, especially int he West. Axial type can predispose one to GERD
Patient Q presents with dysphagia, regurgitation, aspiration, halitosis and hoarseness, as well as a focal neck swelling that gurgles on palpation (Boyce's sign). What does Patient Q have?
A Zenker's diverticulum
Patient Ohm has a mucosal outpouching of the hyopharyngeal wall proximal to the cricopharyngeus muscle. What does patient ohm have? Will a myotomy help?
Zenker's diverticulum?
They seem to.
There's this semilunar fibrotic narrowing of the esophagus right below the UES. What is it, and are they common?
Esophageal web
6-12% of radiographic studies
Due to poor compliance of the cricopharyngeus there's this constriction that is causing elevation in intrabolus pressure and regurgitation. What is it?
Cricopharyngeal bar. It's thick, whereas a web is thin.
What are some esophageal motility disorders?

PADS
Polymyositis
Achalasia
Diffuse Esophageal Spasm
Scleroderma
What's motility anyway? What does esophageal motility disorder mean?
Function, to do with muscle and nerve. Abnormal peristalsis!
If it takes my esophagus 5 minutes to move food down through the GE junction, what's a probable cause?
Achalasia (failure to relax)
Normal esophageal transit time is..
about 8 seconds
Oh gosh, ENS neuropathy, resulting in loss of ganglion cells within the esophagus and LES and degeneration of vagal fibers. What's gonna happen?
Achalasia
Some therapies for achalasia?
botox (not so great)
pneumatic dilation (3-4 cm)
Laproscopy
Simultaneous contractions along the the esophagus causes a characteristic pattern called a _____ esophagus, aka ____. Does it affect the smooth or striated portion of the eg?
corkscrew esophagus
diffuse esophageal spasm.
smooth
Pain with swallowing is called:
It's associated with?
odynophagia
ulcerations
What are some iatrogenic esophagial dysphagias?

CRaPS FuNC
Caustic (pill)
Radiation
Post surgical
Sclerotherapy
Fundoplication
Nasogastric tube
Chemotherapy
How to avoid pill esophagitis?
at least 1/2 glass water minimum when taking a pill and please don't lie down immediately.
Most common site of injury with pill esophagitis is at the level of __. Why?
the aortic arch, not the GE junction.
1. aorta causes extrinsic compression
2. zone of low pressure, at the junction of the smooth and striated muscle
True or False

Chronic sequellae from radiation can occur years after exposure and can include stricture, fistula and even complete obstruction.
True
What's a cutoff sign?
A ratty irregular "cut off" in the esophagus leading to a stenosis. It indicates a neoplastic growth.
Neoplastic types of esophageal dysphagia?

SALLy Met FiliP
Squamous Cell carcinoma
Adenocarcinoma
Leiomyoma
Lymphoma
Metastatic ca
Fibrovascular polyp
Lipoma
squamous Papiloma
infectious types of esophageal dysphagia?

CHeCHi
Candida
Herpes simplex (HSV)
Cytomegalovirus (CMV)
HIV
Some congenital problems that cause esophageal dysphagia

SAAD
Stenosis
Atresia
Aortic Arch anomalies
Duplication
The clinical approach to swallowing disorders (esophageal) includes:

HETT
History
Exam
Tests
Treatment
Three broad categories of medical treatment for esophageal dysphagia?

MES
Medical therapy
Endoscopic therapy
Surgical therapy
What are three diagnostic procedures used in the diagnosis of esophageal dysphagia?
UGI/Esophagram/TBS
UEE (Endoscopic exam)
Esophageal Manometry (Hi res)
True or false

In hi resolution esophageal manometry the x axis is distance down the UES, the y-axis is time, and color indicates pressure.
False

x axis is time
y axis is distance
What's the esophagus lined with?
Squamous epithelium
There's one pharynx to serve several functions, some more important than others. What's the heirarchy?
1. respiration
2. swallowing
3. speech
Three general aspects of respiration are:
ventilation (air in and out)
external respiration (gas exchange in lungs)
internal respiration (gas exchange in body)
The ___ and ___ (body structures) function as a respiratory unit
thorax
abdomen
Which zone (subdivision of the respiratory system) brings air into and out of the lungs?
conducting zone
Which zone (subdivision of the respiratory system) is where gas exchange occurs?
respiratory zone
The trachea is a tube located within the _____. The tube is lined with ____ and supported by _____ made of _____. It extends from the _____ at the ___ (level of the spine) and bifurcates at about ____ (level of the spine), where it divides into two ____
The trachea is a tube located within the THORAX. The tube is lined with MUCOUS MEMBRANE and supported by CARTILAGINOUS RINGS made of HYELIN. It extends from the LOWER BORDER OF THE CRICOID at C6 (level of the spine) and bifurcates at about T5 (level of the spine), where it divides into two BRONCHI
The right and left bronchi differ in ____, ____, and ____.
angulation, diameter, and length
Each bronchus enters the lung through its ____
hilus
True or False

Respiratory bronchioles are still ciliated and cartilaginous but have alveoli budding off them.
True
How many bronchial divisions take place?
20
What's the final bronchial termination called (at the blind ends of the tube)
pulmonary alveolus
The respiratory tract begins superiorly with the _____ and _____. From there, air is conducted into and out of the ____, through the ___ and into the ____ from which it moves into the ____.
The respiratory tract begins superiorly with the TWO NASAL PASSAGES and MOUTH. From there, air is conducted into and out of the PHARYNX, through the LARYNX and into the TRACHEA from which it moves into the LUNGS.
The ____, ____, and ____ belong to the respiratory conducting zone
trachea, bronchi, bronchioles
The ___, ___ and ___ belong to the respiratory zone
respiratory bronchioles, alveolar ducts, alveolar sacs
True or False

An alveolar sac is a pouch-like evagination of the walls of the respiratory broncholes and alveolar ducts.
False

An alveolus (pl alveoli) is a pouch-like evagination of the walls of the respiratory bronchioles, alveolar ducts and alveolar sacs
O2-CO2 exchange occurs by ____ in the alveoli. Why (ish)?
diffusion
alveoli have large surface areas
Each alveous shares a wall that is ____ thick with ______ through which _____ takes place
one cell thick
vascular capillaries
external respiration
Without ____, the Law of LaPlace predicts that a small alveolus will _____ (called ____)
surfactant
collapse
atelectasis
True or False

Surfactant decreases lung compliance
False

increases it.
True or False

A small alveolus has a higher collapsing pressure than a larger alveolus.
True
______ generates a pressure that can collapse alveoli.
surface tension
P=2T/r

What is it?
The Law of LaPlace
P=pressure
T=surface tension
r=radius of alveolus
____ is a mixture of phospholipids that line ____ and do what?
surfactant
alveoli
reduce their surface tension
Lungs have 2 surfaces, right?
Sure, costal (rib) and mediastinal
True or False

There are four right and three left pulmonary lobes
False

Three right and two left
Lungs are covered by 2 ____, the ____ and the ____, which are fused together at the ___. Space between them is called ____ or ____.
pleurae
pulmonary pleura
parietal pleura
hilus
pleural cavity or intrapleural space
Is pressure in the intrapleural space positive or negative?
negative
The change in lung volume for a given change in pressure is called?
lung compliance
There exists an inverse relationship between _____ of lungs and chest wall and their ______.
compliance
elastance (elastic properties)
If the pressure of the intrapleural space is equivalent to the outside air pressure (and pressure w/in the lungs), what happens
A pneumothorax (lung will collapse)
Is respiration a pumping action?
yup
with ____ inhalation, few muscles are used.
quiet
with ____ inhalation, muscles enlarge the volume of the thorax and decrease pressure within the thorax so air will flow into the lungs.
forced
with ____, compressive pumping action decreases the volume of the thorax and increases pressure on air within the lungs.
exhalation
2 ways to decrease thoracic air pressure
thoracic (chest wall) enlargement
increase vertical dimension of the thorax (diaphragm)
2 major muscles of inspiration
diaphragm
external intercostals
3 minor muscles of inspiration
scalenae
pectoralis majoris et minoris
major muscle of expiration
internal intercoastals
2 minor muscles of expiration
transverse thoracic
quadratus lumborum
4 Abdominal muscles involved in respiration
rectus abdominus
oblique externis
oblique internis
abdominus transversus
What's happening?

Active musculature expands thoracic volume to decrease internal pressure
quiet inhalation
What's happening?

Relaxation of muscles of inhalation, so ribs and/or diaphragm muscle return to their rest positions, decreasing thoracic volume and increasing thoracic pressure
quiet exhalation
What muscle groups help during active inhalation?
scalenes, sternocleidomastoid (elevate thorax)
also pecs
What muscle groups aid in forced exhalation?
internal intercostals
quadratus lumborum, transverse thoracic
Which lung volume includes the volume that fills alveoli plus the volume that fills the airways during quiet breathing?
tidal volume
The additional volume that can be inspired above tidal volume is ___, whereas the additional volume that can expired below tidal volume is ___
inspiratory reserve volume
expiratory reserve volume
Volume of gas in lungs after maximal forced expiration is called
residual volume
Each ____ includes two or more lung volumes.
lung capacity
Tidal volume + IRV =
Inspiratory capacity
Tidal volume + ERV + IRV =
vital capacity
total of all lung volumes
total lung capacity
ERV + RV, The amount of air left in the lungs after a tidal breath out.
functional residual capacity
Systems important in swallowing

SPORN!
Sensory
Pharyngeal/Laryngeal
Oral/Nasal
Respiratory
Neurologic
What's the boundary between the upper and lower airway
larynx
The primary airway is through the
nose
Four main valves in the upper airway
oral
nasal
pharyngeal tube
laryngeal tube
Normal respiratory rate:
Young:
Old:
Young: 16/min
Elderly: 20/min
Maintaining airflow pressure is dependent on ___, ____, and ___
muscle control, exhalatory forces, and adequate valving
What's the most common pattern coordination of respiration and swallowing and what percentage of people use it?
Inhale
start to exhale
stop and swallow
exhale some more
60-80%
How long does one normally stop breathing (pause) while swallowing?
What's the pause called?
1/3-2/3 of a second depending on bolus size.
Apneic pause (apnea)
At what age is coordination of respiration and swallowing less consistent.
Under 3 months and over 70 years
When the _______ of the bolus reaches the _____, the airway closes. It remains closed until _____
leading edge
top of the airway
the tail of the bolus passes the AE
Which types of patients might close the AE earlier during a swallow
older patients, (60+)
Information about respiration critical for swallowing:

BASE
B3 BREATHING
Focal point of breathing
rate of respiration
pneumonia history (last year)

S3 SWALLOW
rate of swallowing
efficiency of swallow
no more than 1/2 of swallows interrupted by inhalation

A3 ASPIRATION/penetration
drooling/buildup of saliva
no coughing/gurgly voice/throat clearing
chronic bronchial secretions/bronchorrhea

E2 EXTRANEOUS
dietary intake
risky diagnoses
Curvature of the spine aka
kyphosis (inhibits respiration)
4 things that can restrict expansion of the lungs, limiting the ability of the lungs to draw in air:
paralysis
kyphosis
pain (e.g. pleursy)
alveolar noncompliance
Some Restrictive pulmonary conditions. Say, 8.

SAFE PAPP
Pneumothorax
Atelectasis
Pleural Effusion
Edema (pulmonary)
Asthma
Sepsis (leading to Ad Resp Distress Syn)
Paralysis
Fibrosis (pulmonary)
____is defined as a state in which the lung, in whole or in part, is collapsed or without air. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.
atelectasis

The most common cause is post-surgical atelectasis, characterized by splinting, restricted breathing after abdominal surgery. Smokers and the elderly are at an increased risk. Outside of this context, atelectasis implies some blockage of a bronchiole or bronchus, which can be within the airway (foreign body, mucus plug), from the wall (tumor, usually SCC) or compressing from the outside (tumor, lymph node, tubercle). Another cause is poor surfactant spreading during inspiration, causing an increase in surface tension which tends to collapse smaller alveoli.
perforated pleurae aka
pneumothorax
Obstructive Pulmonary Conditions aka (2 types)
Chronic obstructive pulmonary disease
emphysema
chronic bronchitis
Acute lung injury caused by acidic and particulate gastric contents (GERD)
Pneumonitis
acute pulmonary inflammation caused by infection: reaction to bacteria and bacterial byproducts. Is it fatal?
aspiration pneumonia
Yup, in 20-50% of cases
___ is a difficulty in breathing caused by a sudden constriction of the muscles in the walls of the bronchioles (as in asthma)
bronchospasm
the production of more than 100 mL per day of watery sputum
bronchorrhea
____ refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. It occurs when the oxygen saturation of arterial blood falls below 85%.
cyanosis
____ or short of breath (SOB) is perceived difficulty breathing or pain on breathing.
dyspnea
___ is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g. in tuberculosis or other respiratory infections).
hemoptysis
An abnormal deficiency in the concentration of oxygen in arterial blood. A frequent error is made when the term is used to describe poor tissue diffusion.
Hypoxemia

Hypoxia is poor tissue diffusion
the state of breathing faster and/or deeper than necessary, thereby reducing the carbon dioxide concentration of the blood below normal.
Hyperpnea
an abnormal or adventitious sound heard when listening to the chest as the person breathes, a coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways
Rhonchi
Assessment of Respiration for Swallowing (4 parts)

HOSP
History taking (+chart review)
Observations
Specific Tasks
Planning treatment using assessment
Is this abnormal? Greater than 2-3 saliva swallows in 5 minutes.
Nope. Less than 2-3 saliva swallows in 5 minutes is, though.
Specific tasks to check respiration include:

BCMN ahasa
Breath hold Cough Maneuvers Name repetition

Prolonged voluntary breath hold (1, 3, 5, 10 seconds)
Cough and throat clear with and without abdominal support AND with and without shoulder girdle stabilization
SG and SSG maneuvers
Prolong vowel /a/ (1, 2, 5 sec)
repeat name soft, loud, medium
Sustain /s/
Repeat /ha/
Sustain /a/ while changing pitch
If respiratory status is severe, plan to work on:
respiration first (not nec. your job); may decide not to work on speech or swallowing immediately
If less than half the swallows have ____ between swallowing and respiration, consider working on ____
normal coordination

swallow-respiratory coordination
True or False

Timing of swallow: oral onset and transit should be no more than 2 seconds, otherwise it can be a strain on the respiratory system
True
What should the focus of therapy be?
Improving the underlying respiratory problem?
Improve the speed of the swallow?
Improving respiratory control?
the risk of head injury is especially high among__, __, & __
15-25 year-olds, persons over 75, kids under 5
True or False

For persons of all ages, the risk of head injury among males and females is roughly equivalent.
False

twice as high for males
3 most common causes of TBI
vehicle-related accident (>50%)
falls (25%)
violence (20%)
3 common successive stages of TBI:
Coma
Post-traumatic amnesia
Recovery
An injury that causes swelling in the brain that restricts the flow of blood-borne oxygen,glucose, and other nutrients.
hypoxic-ischemic injury
Brain damage characterized by microscopic damage throughout many areas of the brain. Shearing of large nerve fibers and stretching of blood vessels in many areas of the brain. The ___ and ___ lobes are particulary susceptible.
Diffuse injuries
frontal and temporal
Brain damage confined to a specific area of the brain and causing localized damage that can often be detected by CT or x-ray
Focal brain injury
Bruises that cause swelling, bleeding, and destruction of brain tissue. _____ typically affect the ____ and ___ lobes.
contusions
frontal & temporal
Cerebral or intracranial blood leak from damaged vessel in brain tissue.
Hemorrhage
Occurs in TBI when an artery to the brain is compressed by swelling of surrounding tissues, preventing flow of blood-borne oxygen to the brain.
a macroscopic area of necrotic tissue in some organ caused by loss of blood supply. Supplying arteries may be blocked from within by some obstruction (e.g. a blood clot or cholesterol deposit), or may be mechanically compressed or ruptured by trauma.
infarction

Infarctions are commonly associated with atherosclerosis, where an atherosclerotic plaque ruptures, a thrombus forms on the surface occluding the blood flow and occasionally forming an embolus that occludes other blood vessels downstream.
80% of ___ are due to infarction.
Strokes/CVAs
a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). This bleeding often separates the dura and the arachnoid layers.
Subdural hematoma

Unlike in epidural hematomas, which are usually caused by tears in arteries, subdural bleeding usually results from tears in veins that cross the subdural space. Subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue.
a buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space and compress delicate brain tissue.
Epidural or extradural hematoma
bleeding into the subarachnoid space surrounding the brain, i.e., the area between the arachnoid membrane and the pia mater. It may arise due to trauma or spontaneously, and is a medical emergency which can lead to death or severe disability even if recognized and treated in an early stage.
subarachnoid hemorrhage
True or False

Complications from TBI can develop weeks or months after the initial injury
True
a condition in which abnormal accumulation of cerebrospinal fluid (CSF) in the brain causes increased intracranial pressure inside the skull. This is usually due to blockage of CSF outflow in the brain ventricles or in the subarachnoid space at the base of the brain.
hydrocephalus
A Focal brain injury characterized by an accumulation or blood or spinal fluid on the surface of the brain, exerting pressure. Symptoms of this chronic secondary complication have a slower onset than those of epidural hemorrhages because the lower pressure veins bleed more slowly than arteries. Thus, signs and symptoms may show up within 24 hours but can be delayed as much as 2 weeks
chronic subdural hematoma
3 stages of medical treatment for TBI
Acute
Subacute
Chronic
Stage of medical treatment wherein the patient is stabilized immediately after the TBI
acute
Stage of medical treatment wherein the TBI patient is rehabilitated and returned to the community
Subacute
Stage of medical treatment wherein the TBI patient continues rehabilitation and treats long-term impairments
chronic
What is...

In cases of hydrocephalus, a one-way valve that is used to drain excess cerebrospinal fluid from the brain and carry it to the peritoneal cavity. This valve usually sits outside the skull, but beneath the skin, somewhere behind the ear.
ventriculo-peritoneal shunt
Two categories of chronic treatment:
community based (rehab & return to work/school)
treatment of long-term consequences
The most common swallowing disorder in TBI cases with brainstem damage
DTriPS

cortex is modulation....not sure what that means...
The ____ during the swallow can cause stress in a compromised respiratory system
apneic pause
Some oral disorders seen in TBI (3)
Rd Lip closure
Rd ROM of OT w/ poor bolus control
Abn oral reflexes
8 "neuromuscular abnormalities" aka swallow disorders associated with TBI during the pharyngeal stage of the swallow

L AE TB AC UES PW VP F
L AE TB AC UES PW VP F

Rd Lg Elev
Rd AE closure
Rd TB retraction
Rd AC
Rd UES opening
Rd VP closure
Uni/Bi PW paresis/paralysis
Rd VP closure
Tracheoesophageal fistula
Any other reasons for dysphagia in a TBI patient other than the TBI itself?

TIPPL
Tracheostomy too high
Intubation
Penetration wounds
Puncture wounds
Laryngeal fracture
About ___ of patients with SCI also have a head injury
1/3
A/An _____ SCI shows no function below the level of the injury, no sensation, and no voluntary movement. (bilateral)
complete
A/An ____ SCI shows some function below the primary level of the injury
incomplete
Swallowing problems in SCI patients may be exacerbated by (3)
trach
cervical brace
mechanical vent
Injury at C1 or C2 (nature of swallowing difficulty)
no sensory awareness of difficulty
Injury at C4, 5 and/or 6 (nature of swallowing difficulty)
poor laryngeal movment and reduced UES opening, occasional AE closure (not TVF) problems
What treatments are typically most helpful for patients with SCI?
swallow maneuvers (if no TBI/cognition ok)
sensory enhancement
postures not so much bec. of brace etc
Types of CSI braces? (4)

SHoPS
Soft collar
Philadelphia collar
SOMI (sterno-occipital mandibular immobilization)
Halo
What treatment is most helpful for dysphagia in patients with ACF (anterior cervical fusion)
swallow maneuvers such as mendelsohn supraglottic, super-supraglottic
True or False

duration of recovery reflects the number of complications with ACF
Troo
If the medulla is affected...
What swallowing disorders?
What sorts of symptoms?
What to try?
DTriPS and APS
OT, TB, Lg struggling
Try TTS and SS
What's A and how much is it?
Total Lung Capacity (6.0L)
What's B?
Inspiratory Capacity (3.0L)
What's C?
Functional Residual Capacity
What are D & E? Together they make up what?
Inspiratory reserve volume and tidal volume.
Inspiratory capacity
What's F & G?
What do they make up?
Expiratory Reserve Volume and Residual Volume
Functional Residual Capacity
What's H?
What's it made of?
Vital Capacity
IRV + TV + ERV
Jones et al (1985) argue that simultaneous disorders of the pharynx and esophagus are:
so frequent that the complete swallowing chain should be examined in all patients with dysphagia.
Jones et al, (1985) Pharyngoesophageal interrelationships: observations and working concepts
According to Jones et al (1985) a cricopharyngeal prominence:
may be a clue to esophageal disease
Jones et al, (1985) Pharyngoesophageal interrelationships: observations and working concepts
In Logemann & Bytell (1979), the authors argue that anterior floor of mouth resection patients (HN Ca) have problems with:
preparation for the swallow and oral transit
Logemann & Bytell (1979) Swallowing Disorders in three types of head and neck surgical patients.
Logemann & Bytell (1979) demonstrate that HN Ca pts with tonsil/base of tongue resection have:
slowing in preparation for the swallow and in oral and pharyngeal stages of the swallow
Logemann & Bytell (1979) Swallowing Disorders in three types of head and neck surgical patients.`
Logemann & Bytell (1979) examined HN Ca pts and found that after supraglottic laryngectomy, patients:
show only slight slowing in oral transit and pharyngeal transit (as compared to other types of surgical patients)
Logemann & Bytell (1979) Swallowing Disorders in three types of head and neck surgical patients.
According to Logemann & Bytell (1979) what factors other than the amount of tongue resected may be important in determining the extent of postoperative dysfunction in HN Ca pts?
oral sensitivity
nature of closure/reconstruction
Logemann & Bytell (1979) Swallowing Disorders in three types of head and neck surgical patients.
What procedure did McConnel et al (1986) find useful in examining laryngectomy patients
Manofluorography
McConnel et al (1986) Examination of swallowing after total alryngectomy using manofluorography
According to McConnel et al (1986) which laryngectomy group showed the longest pharyngeal transit times?
total laryngectomies with tongue impairment
McConnel et al (1986) Examination of swallowing after total alryngectomy using manofluorography
What, according to McConnel et al (1986) offered greater resistance to bolus flow?
The postlaryngectomy pharynx
McConnel et al (1986) Examination of swallowing after total alryngectomy using manofluorography
What did manofluorography of laryngectomy patients show, according to McConnel et al (1986)?
the importance of the tongue in bolus propulsion in the pharynx
McConnel et al (1986) Examination of swallowing after total alryngectomy using manofluorography
According to Logemann, et al (1994), what should the focus of swallowign therapy be after supraglottic laryngectomy? What therapy approaches were used?
improvement of posterior movment of the tongue base and anterior tilting of the arytenoid to close the airway entrance and improve bolus propulsion. SG & SSG
Logemann et al (1994) Mechanisms of recovery of swallow after supraglottic laryngectomy.
Robbins & Levine (1988) determined that left cortical stroke dysphagia was characterized by
impaired oral stage function,
difficulty initiating coordinated motor activity
apraxia
Robbins & Levine (1988) Swallowing after unilateral stroke of the cerebral cortex: preliminary experience
Robbins & Levine (1988) determined that right cortical stroke dysphatia was characterized by
pharyngeal pooling
penetration
aspiration
Robbins & Levine (1988) Swallowing after unilateral stroke of the cerebral cortex: preliminary experience
Robbins & Levine (1988) argue that distinct patterns of dysphagia after unilateral cortical stroke challenge what:
the traditional classification of swallowign as a bilateral and brainstem-mediated activity
Robbins & Levine (1988) Swallowing after unilateral stroke of the cerebral cortex: preliminary experience
According to Horner et al (1988) what's a common clinical characteristic of aspirating patients (following stroke)
dysphonia
Horner et al (1988) Aspiration following stroke: clinical correlates and outcome
In the study conducted by Horner et al (1988), of the stroke patients studied, ___ aspirated. Which were at greatest risk?
1/2
Those with combined cerebral-brainstem strokes with bilateral cranial nerve signs
Horner et al (1988) Aspiration following stroke: clinical correlates and outcome.
True or False

Horner et al (1988) found that compensatory feeding approaches did not prevent aspiration pneumonia
False

It did. They argue it's just as effective as indirect swallowing therapy, though I'd like to see you enjoy your dinner in mouthfuls of less than a teaspoon.
Horner et al (1988) Aspiration following stroke: clinical correlates and outcome.
According to Lazarus (1993) what can result in immediate and long term changes in swallow functioning in HN Ca pts?
Radiation therapy
Lazarus (1993) Effects of radiation therapy and voluntary maneuvers on swallow functioning in head and neck cancer patients.
According to Lazarus (1993) what was effective in improving extent and duration of tongue base retraction, laryngeal elevation, and laryngeal vestibule and true vocal cord closure?
SSG & MM
Lazarus (1993) Effects of radiation therapy and voluntary maneuvers on swallow functioning in head and neck cancer patients.
Martin et al (1994) found that ____ was usually maintained at the onset of deglutition and ___ before the onset of _____.
respiration
halted
laryngeal elevation
Martin et al (1994) Coordination between respiration and swallowing: respiratory phase relationships and temporal integration.
According to Martin et al (1994), what respiratory phase brackets small volume liquid swallowing activity?
expiration
Martin et al (1994) Coordination between respiration and swallowing: respiratory phase relationships and temporal integration.
True or False

According to Martin et al (1994), Discoordination between swallowing and respiration may increase the potential for aspiration
True
Martin et al (1994) Coordination between respiration and swallowing: respiratory phase relationships and temporal integration.
According to Lazarus et al (1996), oral and pharyngeal motility for swallow can become compromised if what is provided to either what or what?
external-beam radiation treatment
larynx or tongue base regions
Lazarus (1996) Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy.
In Lazarus et al (1996), what sordts of swallow disorders were seen in HN Ca pts treated with radiation and chemo?
reduced coordination and abnormal timing of pharyngeal events
Lazarus (1996) Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy.
Logemann et al (1994) found that postural techniques were successful in eliminating aspiration ____ in ____ of patients.
on at least one volume of liquid in 81%
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Delay in triggering the pharyngeal swallow. What postural change?
Head down
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Delayed oral transit time. What postural change?
Head lifted
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Reduced laryngeal elevation (liquid enters laryngeal vestibule and is inhaled after swallow)
And the posture recommended by Logemann et all (1994) is?
But...
Head down

other research shows head rotated... right?
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Reduced laryngeal closure (Bolus passes through larynx and into trachea during pharyngeal phase of swallow)
Head rotated to damaged side, SGS
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Unilateral pharyngeal weakness

And the posture suggested by Logemann et al (1994) is?
Head rotated to damaged side
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
According to Logemann et al (1994), what posture best helps impaired cricopharyngeal opening/reduced anterior laryngeal movement?
head rotated
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Reduced pharyngeal clearance

And the correct posture, according to Logemann et al (1994), is?
lying on side
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
According to Logemann et al (1994) patients receiving the least benefit from postures tended to be those:
with resections involving more than one structure.
Logemann et al (1994) Effects of postural change on aspiration in head and neck surgical patients
Sharp & Genesen (1996) advocate the use of a _____ for identifying and negotiating ethical dilemmas.
systematic framework
Sharp & Genesen (1996) Ethical decision-making in dysphagia management.
True and False

In the clinical ethics model, according Sharp & Genesen (1996), patient preferences and medical indications take precedence over quality of life and contextual features.
True
Sharp & Genesen (1996) Ethical decision-making in dysphagia management.