Ch 4 Swallowing Disorders In Patients With Neurologic Disease

Front 1

what is the frontal lobe cortex's function?

Back 1

Intent and initiation of movement
Coordination of a movement in time and space
Execution of movement in an organized and timely fashion

Front 2

what is the parietal lobe cortex?

Back 2

Interpreting sensory function
Recognizing and interpreting sensory function in reference to an appropriate motor response

Front 3

what are some factors in the extent for cortical damage in sensorimotor?

Back 3

Location of neurological deficit
Extent of deficit, larger usually means worse
Unilateral or bilateral

Front 4

what are some factors in the extent for cortical damage in cognitive?

Back 4

Left side of brain for communication impairment
Attention often afforded to inferior frontal lobe, superior temporal lobe

Front 5

what are some factors in the extent for cortical damage in swallowing?

Back 5

No observable swallow activity
Poorly coordinated motor execution
Neglect
Direct sensory loss

Front 6

Bilateral hemispheric lesions are generally less severe than unilateral T/F

Back 6

false (bilateral is more severe, dp where lesion is)

Front 7

which hemisphere are swallowing functions represented?

Back 7

both hemispheres

Front 8

if dominant hemisphere is impaired, a ________ may be available to facilitate recovery

Back 8

contralateral back up area

Front 9

________ may facilitate recovery [hemispheric damage]

Back 9

plasticity of nondominant hemisphere

Front 10

cortical-level damage to UMN system results in the same type of motor weakness as _______

Back 10

subcortical or brainsteam UMN damage

Front 11

what motor sensorimotor function is associated with the cortical part of the nervous system?

Back 11

Intent, Execution, Initiation, Programming (IEIP; I Eat Iced Pizza)

Front 12

what sensory function is associated with the cortical part of the nervous system?

Back 12

Recognition, Awareness, Motor tuning (RAM)

Front 13

what motor function is associated with the subcortical (basal ganglia) part of the nervous system?

Back 13

Refinement, Initiation, Inhibition (RII, Rice In Ice)

Front 14

what sensory function is associated with the subcortical (basal ganglia) part of the nervous system?

Back 14

Motor tuning, Awareness, Sensory conduct, Reflexes (MASR Modern Art Sucks Right)

Front 15

what motor function is associated with the brainstem of the nervous system?

Back 15

Junction box (UMN/LMN, Motor/sensory "Centers", Swallow, Respiration, Heart)

Front 16

what sensory function is associated with the brainstem of the nervous system?

Back 16

sensory conduct

Front 17

what motor function is associated with the cerebellum of the nervous system?

Back 17

Refinement, Inhibition (RI Really Irritating)

Front 18

what sensory function is associated with the cerebellum of the nervous system?

Back 18

Refinement

Front 19

what motor function is associated with the peripheral nerves of the nervous system?

Back 19

Lower motoneuron (Drive movement)

Front 20

what sensory function is associated with the peripheral nerves of the nervous system?

Back 20

Sensory conduct

Front 21

what motor function is associated with the muscles/sensory receptors of the nervous system?

Back 21

Effect movement

Front 22

what sensory function is associated with the muscles/sensory receptors of the nervous system?

Back 22

Sensation reception

Front 23

what are the sensorimotor considerations for hemisphere stroke swallowing deficits?

Back 23

volitional motor control (initiation difficulties), paresis/paralysis (transport difficulties), sensory recognition (residue, aspiration), communication deficits (inability to describe difficulties)

Front 24

what are swallowing deficits seen in patients after hemisphere strokes?

Back 24

reduced ability initiate saliva swallow
delayed trigger phyarngeal swallow
incoordination of oral movements in swallow
increased pharyngeal transit time
reduced pharngeal contraction (peristalsis)
aspiration
pharyngoesophageal segment dysfunction
impaired lower esophageal sphinter relaxation

Front 25

50% patients in acute stage with functional recovery in __-___ months for most

Back 25

1, 6

Front 26

Treatment considerations in treating swallowing disorders are______

Back 26

Expect change over time and therefore modification of treatment
Acute considerations
Chronic

Front 27

what are some acute considerations?

Back 27

Safety of oral feeding(protect airway)
Comorbidities ( ie malnutrition, dehydration, aphasia, etc)
Oral/nonoral feeding
Patient issues
Nature of swallowing deficit

Front 28

what is considered chronic for swallowing disorders?

Back 28

Beyond 6 months
Some patients may benefit from intense treatment

Front 29

list some types of dementia

Back 29

Alzheimer’s disease, multi infarct dementia, alcoholic dementia, metabolic and nutritional dementias

Front 30

list factors in progressive deterioration in cognition

Back 30

Memory
Judgment
Abstract reasoning
Personality change
Apraxia and aphasia may be present

Front 31

list oral-stage dysfunction in swallowing deficits

Back 31

Lack of initiation of the swallow, patient holds food in the mouth
Incoordinated oral control of food and liquid
Delayed initiation of the oral component of the swallow

Front 32

swallowing deficits symptoms are_____

Back 32

Persistent weight loss
Oral-stage dysfunction
Slowing of swallowing process, oral through pharyngeal
Self-feeding difficulties

Front 33

what happens when there is a slowing of swallowing process, oral through pharyngeal in swallowing deficits?

Back 33

Increased meal time
Increased risk of declining nutritional status
Reduced airway protection
Increased coughing and choking during meal time

Front 34

what can you do to improve self feeding difficulties?

Back 34

increased verbal or environmental cues

Front 35

list some Treatment Considerations in Dementia

Back 35

Special food preparation
Diet restriction
Taste and flavor enhancement
Changes in mealtime environment
Increases mealtime supervision and cueing
Behavioral/environmental changes to increase food/ liquid intake
Direct behavioral therapy to change swallowing mechanics
Feeding tubes

Front 36

Feeding tubes

Back 36

Do not reduce aspiration pneumonia
May not prevent further decline in nutritional status
May not prolong life
No impact on functional status

Front 37

Swallowing in TBI

Back 37

60% may demonstrate in acute stage
Most patients regain function within 6 months
Severity may predict recovery
Communication/cognitive problems
Physical deficits impose a degree of dependency (Self feeding, Type of food consumed)

Front 38

Treatment for TBI

Back 38

Diet modification
Postural adjustments
Feeding adaptations
Behaviorial maneuvers and compensations
Possible NG or G/J tube feedings initially

Front 39

Basal Ganglia

Back 39

Groups of cell bodies in subcortex influence quality of movement
Regulate tone, resting tension level of muscles
Steadiness of movement

Front 40

Basal Ganglia damange may

Back 40

excess tone
Delays in the initiation of movement
Slowed movements
Reduced amount of movement

Front 41

Extra unintended movements in basal ganglia

Back 41

Disrupt smooth coordinated movement attempts
Tremor, regular clonic movements, sustained postural interruptions such as dystonias

Front 42

dysphagia considerations in patients with basal ganglia deficits

Back 42

poor bolus control: involuntary movements (oral, oropharyngeal)
residue from inefficient swallow (oral, oropharyngeal, pharyngeal)
differences among swallow types
severity dependent

Front 43

Parkinson’s Disease

Back 43

Slowly progressive disease of the basal ganglia
Impairment of execution of voluntary movement
Resting tremor, bradykinesia, rigidity
Cause unknown but related to the depletion of dopamine
Impaired basal ganglia during voluntary movement
Long term use of medical treatment

Front 44

PD clinical signs

Back 44

Slowness in cognitive tasks
May display dementia
Mask-like face
Hypokenetic dysarthria
Micrographia
Changes in posture, gait, reduced movement, instability

Front 45

Swallowing Deficits in PD

Back 45

Poor bolus control 2ed involuntary movements, residue, misdirection of bolus 2ed inefficient, possibly weakened, swallow
Delayed transport through esophagus, esophageal stasis, abnormal contractions, lower esophageal abnormalities gastroparesis, defacatory dysfunctions

Front 46

Treatment in PD

Back 46

Understand underlying mechanism
Interventions will change over time
Work around time cycles of medications

Front 47

Brainstem Functions

Back 47

Junction Box for UMN and LMN, can injure both at this level
Swallowing Center (Rostral brainstem, Nucleus tractus solitarius facilitates coordination among oral, pharyngeal, esophageal components of swallowing mechanism with respiration)

Front 48

damaged brainstem can show

Back 48

severe dysphagia plus sensory and motor dysfunction

Front 49

TX ranges from monitoring to passive (oral hygiene, movement exercises) to active (postural adjustments, changing _______

Back 49

swallowing behavior) to direct and aggressive

Front 50

TX

Back 50

TX symtomatic and changes over time

Front 51

Brainstem Function, Swallowing Impairment, Treatment

Back 51

Incoordination involving disruption of swallowing center, stages of swallowing and respiration
Weakness in one or more muscle groups and sensory deficits may be present
Incomplete swallow ( Box4-7)

Front 52

Cerebellar Function

Back 52

In swallowing poorly understood
Unsteadiness (ataxia), intention tremor, hypotonia
Impairment of coordinated swallowing function

Front 53

Motor unsteadiness and weakness contributes to

Back 53

Difficulty in controlling a bolus
Difficulty in directing a bolus in a timely fashion
Residue from reduced swallowing effort

Front 54

Myoneural Junction

Back 54

Point of connection of LMN and muscle
Deficits to peripheral nerves cause flaccid weakness
Deficits at myoneural junction causes flaccid deterioration of motor function that recovers with extended rest

Front 55

Myopathies

Back 55

Motor impairment at muscle level
Severe flaccid weakness

Front 56

Sensory loss

Back 56

Tactile loss can lead to residual food and aspiration

Front 57

ALS

Back 57

Progressive, degenerative disease of unknown cause
Both LMN and UMN disease through speech, swallowing, respiratory mechanism, and entire body
Swallowing deficits progressive and widespread
Reliance on alternate feeding sources may be realized

Front 58

___% show initial presentation of corticobulbar symptoms

Back 58

25

Front 59

Limitations reflected in oral bolus control, reduced ability to transport bolus with resulting _________ and _________

Back 59

residue and reduced airway protection

Front 60

Polyneuropathy

Back 60

pathology to many nerves sensory and motor
from Diabetes or Post radiation

Front 61

Myasthenia Gravis

Back 61

Gravis-neurotransmitter substance between motor nerves and muscles is depleted, flaccid

Front 62

Polymyositis

Back 62

inflammation of striated muscle
Nasal pharyngeal regurgitation, residue in pharynx, airway compromise, cervical esophagus deficits

Front 63

Scleroderma

Back 63

inflammation of smooth muscle tissue

Front 64

Systemic Lupus Erythematosus

Back 64

proximal muscle weakness, cranial nerve abnormalities, CNS deficits, often acute deterioration with slow recovery between exacerbations
Esophageal based dysphagias

Front 65

Muscular Dystrophy

Back 65

muscle disease that affects various muscle groups
includes Oculopharyngeal MD

Front 66

Oculopharyngeal MD

Back 66

Slowly progressive disorder
Dysphagia mild to severe
Dysarthria
Ptosis
Face and Trunk Weakness

Front 67

Treatment Considerations for Muscle Diseases and Swallowing Impairment

Back 67

Dealing with progressive disease
Swallowing interventions are symptomatic
Behavioral compensations to diet modifications
Strengthening exercises are questionable
Consider ongoing medical care
Management strategies change over time
Can see a neurogenic dysphagia without overt neurologic disease