Book Quiz 4

Front 1

Most common disorder in closed head trauma

Back 1

delay in pharyngeral swallow

Front 2

3 types of closed head trauma

Back 2

coup, contra-coup, and twisting of brainstem (but also be aware there is likely to be additional bodily trauma in an accident that might affect swallowing such as a puncture in esophogas)

Front 3

patients with closed head trauma may display which oral stage disorders?

Back 3

1) reduced lip closure
2) reduced range of tongue motion- poor bolus control
3) abnormal oral reflexes (bite reflex)
4) delay in pharyngeal swallow

Front 4

patients with closed head trauma may display which pharyngeal stage disorders?

Back 4

1) reduced laryngeal elevation (with secondary reduced vocal fold closure)
2) reduced tongue base movement
3) unilateral or bilateral pharyngeal wall paresis
4) trachesophageal fistula (secondary to puncture)
5) reduced velo-pharyngeal closure

Front 5

patients in closed head trauma may be difficult to treat because why?

Back 5

1) impulsiveness- too much food
2) cognitive difficulties- can't do maneuvers
3) reduced sensation

Front 6

patients who also have cognitive deficits need compensatory strategies. Particularly ____, and _____

Back 6

postural and enhanced sensory

Front 7

how often should nonoral patients should be re-evaluated to see if they have recovered?

Back 7

every 6 mos to 1 year

Front 8

If there is no head injury in conjunction with a cervical spinal cord injury, the problem is usually____

Back 8

pharyngeal. Particularly:
1-delayed pharyngeal swallow, 2-reduced laryngeal elevation and anterior movement,
3-reduced tongue base retraction,
4-reduced pharyngeal wall contraction.

Front 9

Injury at which cervical vertebrae results in poor laryngeal movement and consequent reduced cricopharyngeal opening?

Back 9

4,5,6,

Front 10

Injury at which cervical vertebrae results in no sensory awareness of the swallowing difficulty?

Back 10

1,2

Front 11

describe swallowing pathologies related to cervical bracing?

Back 11

may report that swallowing feels uncomfortable, but bracing is not proven to cause any disorders.

Front 12

swallowing disorders related to anterior cervical fusion will usually resove in ___ months. In the meantime you should_____

Back 12

3 months. In the interim do MBS. Mendehlson, super supra, and supra

Front 13

why are there swallowing disorders associated with cervical fusion?

Back 13

1) trauma to peripheral nerves
2) pharyngeal sweeling
3)reaction to hardware

Front 14

then what disorders do these problems caused by cervical fusion contribute to?

Back 14

-swelling of posterior pharyngeal wall
-reduced laryngeal elevation and anterior movement (which consequentially exhibit reduced cricopharyngeal closure)
-reduced unilateral or bolateral pharyngeal wall movement
-oral stage difficulties and pharygeal delay

Front 15

When Neurosurgery affects the brainstem, how can swallowing be affected and how would you treat that?

Back 15

typically significantly imparis the swallow. sometimes there is no pharyngeal swallow at all. Try thermal tactile stimulation and suck swallow

Front 16

In Neurosurgical swallowing effects, when an accoustic neuroma is removed, which nerves may be damaged?

Back 16

9
10
12
7

Front 17

What nerve are accoustic neuromas usually in

Back 17

8

Front 18

In Neurosurgical swallowing effects, when an accoustic neuroma is removed, damage to this nerve would cause unilateral delay in pharyngeal swallow.

Back 18

9

Front 19

when an accoustic neuroma is removed, and there is resulting unilateral delay in pharyngeal swallow (from damage to nerve 9) what compensatory strategies would you teach?

Back 19

postural: head rotation to damaged side, chin down

Front 20

In Neurosurgical swallowing effects, when an accoustic neuroma is removed, what types of nerve damage might you see?

Back 20

-unilateral facial weakness
-unilateral pharyngeal wall paresis
-unilateral vocal fold adductor paralysis
-unilateral soft palate weakness/tonguie paresis

Front 21

In Neurosurgical swallowing effects, when an accoustic neuroma is removed, how might you treat nerve damage?

Back 21

-Aggressive ROM: resistance to lips, oral tongue, tongue base, larynx
-Falsetto
super-supraglottic swallow
effortful breathold

Front 22

What are the oral disorders associated with poliomyelitis?

Back 22

1) reduced lingual control
2) disturbed pattern of lingual propolsion

Front 23

what are the pharyngeal disorders of poliomyelitis?

Back 23

1) reduced velopharyngeal closure
2) reduced pharyngeal contraction
3) unilateral pharyngeal paralysis

Front 24

What viral diseasecauses rapid onset of paresis which may progress to complete paralysis requiring tracheostomy? What swallowing disorders are associated with it?

Back 24

Guillian-Barre disease; weakness in oral and pharyngeal swallow; reduced range of motion oral tongue, tongue base, larynx

Front 25

What is therapy for Guillian-Barre disease

Back 25

gentle resistance and ROM; maybe mendehlson

Front 26

What are the three subgroups of Cerebral Palsy. disorders associated with these groups, and the most common of the groups.

Back 26

1) moderate-severe oral function problems (tongue thrust and innaporpriate oral reflexes, inability to hold bolus, disorganized lingual movement and discoordination from front to back, premature spillage)
2) MOST COMMON GROUP
moderate to severe oral function problems and a pharyngeal delay
3) moderate to severe oromotor problems, a pharyngeal delay, and abnormal pharyngeal swallow (reduced tongue base retraction, reduced laryngeal elevation

Front 27

What are two swallowing problems children with cerebal palsy who fall into group 2 exhibit? HOw would you treat these?

Back 27

1) oromotor difficulty with foods you chew
2) oromotor difficulty with liquid due to reduced laryngeal delay
(so diet should consist of thick liquids and purees if you cannot treat with oromotor therapy and thermal-tactile stimulation

Front 28

Is cricopharyngeal dysfunction common in kids with CP?

Back 28

no. it is rare. and you should not treat with myotomy until their larynx lowers and you know the problem would persist even after therapy.

Front 29

What is the inherited disease with widespread effects including imbalance, sensory deficits, motor coordination, and certain episodic pneumonia. can range from mild reduction in oral tongue coordination to severe oral involvement and pharyngeal delay.

Back 29

dysautonoma (riley-Day syndrome)

Front 30

Children with severe oral discoordination and pharyngeal delay may not be able to handle liquids safely and receive a _______

Back 30

gastrostomy

Front 31

what are the pharyngeal and esophageal problems associated with riley-day?

Back 31

dysfunctional LES greater on thin liquids, reduced tongue base and reduced pharyngeal contraction, difficulty opening cricopharyngeal sphincter, abnormal esophageal motility (almost a total lack of peristaltic waves)

Front 32

Children with Riley-Day benefit from what therapy

Back 32

oromotor exercises to improve oral tongue function and thermal tactile stimulation to improve triggering of the pharyngeal swallow

Front 33

medical treatments to improve specific swallowing disorders include:

Back 33

1) surgical reduction of osteophytes
2)injection into damaged vocal fold to improve bulk and assist in airway closure (glycerin, gel foam)-- limitation: denseness of tissue, must be enough tissue space)
3) vocal fold medialization procedures
4) laryngeal suspension- treats lack of laryngeal lifting ( larynx is raised and tilted under tongue base- done occasionally in head and neck patients but rarely in neurologic)
5)dialation of scar tissue in cricopharyngeal region- pass mercury filled rubber tubes (bougies) of increasing diameter. effects temporary lasting from 1- 3 months- not helpful in neurologic damage
6) cricopharyngeal myotomy- slitting fibers, permanently open sphinter.
7)botox injection into cricopharyngeus muscle- hard to find muscle, temproary

Front 34

____% or less of aspiration is caused by inadequate vocal fold closure

Back 34

10% or less

Front 35

when can patients begin eating after a myotomy? descrive effectiveness of myotomy

Back 35

can begin to at within 1 week after myotmoy. studies show 60-78% effective; but patients who had the surgery but didn't need it scewed this number. effectiveness climbs when patients
1) actually have a cricopharyngeal muscle dysfunction as the predominant problem
2)patient is able to move material through oral and pharngeal stages of the swallow up to the cricopharyngeus region
3) patient must be able to voluntarily close the airway during the swallow
** many patients beed postural or mendehlson along with it

Front 36

What are the procedures to control unremmitting aspiration?

Back 36

1) epiglottic pull-down
2)suturing th vocal folds toether
3) suturing the false vocal folds together
4) larngeal or tracheoesophageal diversion
5) tracheostomy
total laryngectgomy