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36 Cards in this Set

  • Front
  • Back
Most common disorder in closed head trauma
delay in pharyngeral swallow
3 types of closed head trauma
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)
patients with closed head trauma may display which oral stage disorders?
1) reduced lip closure
2) reduced range of tongue motion- poor bolus control
3) abnormal oral reflexes (bite reflex)
4) delay in pharyngeal swallow
patients with closed head trauma may display which pharyngeal stage disorders?
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
patients in closed head trauma may be difficult to treat because why?
1) impulsiveness- too much food
2) cognitive difficulties- can't do maneuvers
3) reduced sensation
patients who also have cognitive deficits need compensatory strategies. Particularly ____, and _____
postural and enhanced sensory
how often should nonoral patients should be re-evaluated to see if they have recovered?
every 6 mos to 1 year
If there is no head injury in conjunction with a cervical spinal cord injury, the problem is usually____
pharyngeal. Particularly:
1-delayed pharyngeal swallow, 2-reduced laryngeal elevation and anterior movement,
3-reduced tongue base retraction,
4-reduced pharyngeal wall contraction.
Injury at which cervical vertebrae results in poor laryngeal movement and consequent reduced cricopharyngeal opening?
Injury at which cervical vertebrae results in no sensory awareness of the swallowing difficulty?
describe swallowing pathologies related to cervical bracing?
may report that swallowing feels uncomfortable, but bracing is not proven to cause any disorders.
swallowing disorders related to anterior cervical fusion will usually resove in ___ months. In the meantime you should_____
3 months. In the interim do MBS. Mendehlson, super supra, and supra
why are there swallowing disorders associated with cervical fusion?
1) trauma to peripheral nerves
2) pharyngeal sweeling
3)reaction to hardware
then what disorders do these problems caused by cervical fusion contribute to?
-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
When Neurosurgery affects the brainstem, how can swallowing be affected and how would you treat that?
typically significantly imparis the swallow. sometimes there is no pharyngeal swallow at all. Try thermal tactile stimulation and suck swallow
In Neurosurgical swallowing effects, when an accoustic neuroma is removed, which nerves may be damaged?
What nerve are accoustic neuromas usually in
In Neurosurgical swallowing effects, when an accoustic neuroma is removed, damage to this nerve would cause unilateral delay in pharyngeal swallow.
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?
postural: head rotation to damaged side, chin down
In Neurosurgical swallowing effects, when an accoustic neuroma is removed, what types of nerve damage might you see?
-unilateral facial weakness
-unilateral pharyngeal wall paresis
-unilateral vocal fold adductor paralysis
-unilateral soft palate weakness/tonguie paresis
In Neurosurgical swallowing effects, when an accoustic neuroma is removed, how might you treat nerve damage?
-Aggressive ROM: resistance to lips, oral tongue, tongue base, larynx
super-supraglottic swallow
effortful breathold
What are the oral disorders associated with poliomyelitis?
1) reduced lingual control
2) disturbed pattern of lingual propolsion
what are the pharyngeal disorders of poliomyelitis?
1) reduced velopharyngeal closure
2) reduced pharyngeal contraction
3) unilateral pharyngeal paralysis
What viral diseasecauses rapid onset of paresis which may progress to complete paralysis requiring tracheostomy? What swallowing disorders are associated with it?
Guillian-Barre disease; weakness in oral and pharyngeal swallow; reduced range of motion oral tongue, tongue base, larynx
What is therapy for Guillian-Barre disease
gentle resistance and ROM; maybe mendehlson
What are the three subgroups of Cerebral Palsy. disorders associated with these groups, and the most common of the groups.
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)
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
What are two swallowing problems children with cerebal palsy who fall into group 2 exhibit? HOw would you treat these?
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
Is cricopharyngeal dysfunction common in kids with CP?
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.
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.
dysautonoma (riley-Day syndrome)
Children with severe oral discoordination and pharyngeal delay may not be able to handle liquids safely and receive a _______
what are the pharyngeal and esophageal problems associated with riley-day?
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)
Children with Riley-Day benefit from what therapy
oromotor exercises to improve oral tongue function and thermal tactile stimulation to improve triggering of the pharyngeal swallow
medical treatments to improve specific swallowing disorders include:
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
____% or less of aspiration is caused by inadequate vocal fold closure
10% or less
when can patients begin eating after a myotomy? descrive effectiveness of myotomy
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
What are the procedures to control unremmitting aspiration?
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