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100 Cards in this Set

  • Front
  • Back
the clinician begins to examine a patient from
history taking, chart review, patient descriptions, and bedside eval
the videofluoroscopy should be completed on any patient whose disordered deglutition
is not clearly limited to the oral cavity or who may be aspirating
the clinician uses info from the videofluoroscopy study to (3 things)
1. define anatomic or neuromuscular dysfunction 2. determine the recommendation as to whether or not the person should eat by mouth and the conditions under which to eat and what consistencies of food 3. plan direct or indirect treatment appropriate for the specific swallowing disorders
normal mastication requires
an intact mandible and maxilla and intact buccal and lingual musculature
when food falls from teh mouth anteriorly, it is an indication of
reduced lip closure
if a patient has reduced ability to shape the tongue around the liquid or paste, what will happen
material will immediately spread throughout the oral cavity
if the soft palate cannot or does not bulge anteriorly to contact the back fo the tongue,
food can be lost into the pharynx prematurely
inability to hold a bolus is an indication of
reduced tongue coordination.
premature loss of liquid or paste into the valleculae is an indication of
reduced anterior soft palate positioning and/or poor tongue control
if a patient has ______________, he or she will have difficulty in pulling food back together into a cohesive bolus
reduced range or coordination of tongue movement
food falling into the anterior sulcus is an indication of
reduced labial and facial muscle tone
material falling into the lateral sulcus ans the patient chews is an indication of
reduced musce tension or tone in the buccal musculature
an abnormal hold position is an indication of
reduced tongue control or tongue thrust
oral transit terminates when
the pharyngeal swallow is triggered
the swallow is triggered from sensory input to cranial nerve
IX (glossopharyngeal)
delayed oral onset of swallow is an indication of
apraxia of swallow or reduced oral sensation
when the bolus is held in the mouth with no lingual movment it could indicate
1. severe swallow apraxia, 2. reduced oral sensation 3. lack of recognition of the bolus as something to be swallowed (oral tactile agnosia)
for patients with delayed oral onset of swallow, the clinician can increase sensory stim by increasing
the pressure of the spoon on the tongue as the bolus is presented, using a cold bolus, a larger bolus, a stronger tasting bolus, or a textured bolus, which may cause the oral swallow to begin
searching tongue movements are an indication of
apraxia of swallow - good range of motion but inability to organize the front-to-back linguagl and bolus movement.
refrain from giving any _______ to __________ to the swallow apraxic
commands to swallow
tongue that moves forward to start the swallow is an indication of
tongue thrust
usually, a tongue thrust is preceded by an abnormal hold position of the bolus against the
central incisors
residue in the anterior sulcus in an indication of
reduced labial tension and tone
residue on the floor of the mouth is an indication of
reduced tongue shaping or failure of the peripheral seal of the tongue to the anterior and lateral alveolus
food that tends to lodge in a depression in the tongue's surface is an indication of
scar tissue in the tongue
the greater the lingual struggle to swallow, the _____ the effect of the scar tissue on the swallow, and the ____ the amount of food that collects in the depression created by the scar tissue
worse, greater
residue of food on the tongue is an indication of
reduced tongue range of movement or strength
if tongue range of mevemnt is very poor , food may
sit on the tongue surface or hard palate and remain there - usually occurs with thicker consistencies
if residue increases on the tongue as food becomes more viscous, it is an indication of
reduced tongue strength
if the sequential squeezing action of the tongue in the oral stage is disturbed (tongue moves in somewhat random, nonproductive motions) it is an indication of
lingual discoordination
incomplete tongue-palate contact is an indication of
reduced tongue elevation
residue of food on the hard palate is an indication of
reduced tongue elevation or strength
if increased amounts of food collect on the palate as more viscous food is presented, it is an indication
of reduced tongue strength
reduced anterior-posterior tongue movement (interrupted or broken into multiple small tongue movements with normal range of motion) is an indication of
reduced lingual coordination
repetitive lingual rocking-rolling actions is an indication of
parkinson's disease
patients with PD show a typical tongue mevement pattern characterized by a repetitive ____ and ____ movement of the central portion of the tongue. the posterior tongue fails to _____ at the appropriate time
upward and backward, lower - often lasts 10 seconds or more before a swallow
uncontrolled bolus/premature loss of liquid or pudding consistency into the pharynx is an indicaton of
reduced tongue control; reduced linguavelar seal
an uncontrolled bolus and premature loss indicate reduced lingual control and may result in aspiration _______ the swallow
before the swallow
piecemeal deglutition indicates that
rather than swallowing the bolus in a single cohesive mass, the patient swallows only one portion or piece of the bolus at a time
piecemeal deglutition may indicate a ________ of swallowing
oral transit time should lasat no longer than
1 to 1.5 seconds
most patients with delay in triggering the phayngeal swallow complain of difficulty swallowing
during the pharyngeal swallow delay, the bolus may land in the (3)
pyriform sinuses, valleculae, or the open airway
the critical symptom of delay is the location of the bolus head. the bolus head must be differentiated from
premature bolus loss
premature bolus loss is ____ a delay in triggering the pharyngeal swallow
during a delay, there is increased risk of aspiration as the pharyngeal swallow is activated because the pyriform sinuses are___
significantly shortened as the pharynx and larynx elevate. the contents are at high risk for being dumped into the airway
in patients with a delayed pharyngeal swallow, a chin-down posture may be ________
less helpful. because the posture neither changes the degree of pharyngeal shortening that occurs during swallow nor prevenets the contens of the sinuses from entering the airway
in teh pharyngeal swallow, _____________ are the first events
elevation of the larynx and hyoid
in normal young adult subjects, pharyngeal delay is
minimal (0 to .2 sec)
in normal subjects over 60, pharyngeal delay is
.4 to .5 sec
a delay of more than ___ seconds or an even shorter delay during which aspiration occurs is considered ____ delay in adults regardless of age
2 seconds, abnormal
in an infant, and abnormal delay is defined as more than ___ second between the last tongue pump and the onset of the pharyngeal swallow
1 second
normal pharyngeal transit time is a maximum of ____
1 second
pharygeal transit time _________ as volume increases
nasal penetration during a swallow is an indication of
reduced velopharyngeal closure.
pseudoepiglottis is
a fold of mucosa at the base of the tongue
a bony outgrowth from cervical vertebrae is an indication of
cervical osteophytes
cervical osteophytes can interfere with the swallow by
narrowing the pharynx or directing the bolus toward the ariway entrance
residue on one side of the pharynx in pyriform sinus is an indication of
unilateral pharyngeal wall weakness
coating on the pharyngeal walls after teh swallow is an indication of
reduced pharyngeal contraction bilaterally
older normal individuals exhibit a ____ ____ in residue on the pharynx as compared with younger adults
slight increase
it is _____ to watch for the patient's reaction to any residue left in the pharynx after the swallow
important - does patient have awareness of residue?
vallecular residue after the swallow is an indication of
reduced tongue base posterior movement
if the residue in the valleculae is a large amount -
the patient may be at risk of aspirating some or all o fthe residue during respiration after the swallow
coating in a depression on the pharyngeal wall is an indication of
scar tissue; pharyngeal pouch
if laryngeal elevation during the swallow is mildly impaired ___
some residual material will remeain on top of the larynx after the swallow.
the patient is at risk for aspiration of the food sittin gon top of the airway after the swallow, when ....
he or she opens the larynx to inhale following deglutition
as the larynx elevates, the arytenoid cartilage is brought to a level where it is ______ to the ____ of the _______ and can tilt forward to contact the _____ of the _____ and close the _______
closer to the base of teh epiglottis and can tilt forward to caontact the thickening base of the epiglottis and close the entrance to the airway
moderately reduced laryngeal elevation can result in an inability of the ________ to tilt __________ enough to make good contact with the epiglottic base
arytenoid, anteriorly - leaving the entrance to the airway slight ly open, allowing penetration of the bolus INTO the airway
some patients _____________ for reduced laryngeal elevation by tilting the arytenoid more anteriorly than normal to close the airway entrance
can compensate
laryngeal penetration and aspiration after the swallow is an indication of
reduced closure of the airway entrance (arytenoid to base of epiglottis and false vocal folds)
the bolus may enter the airway to the level of (list 3)
1. level of the middle of the arytenoid cartilage 2. level of the surface of the false vocal folds 3. level of true vocal folds
penetration can occur if (list 3)
1. larynxt lifts inadequately and leaves the airway entrance slightly open 2. arytenoid cartilage fails to tilt forward adequately to close off the airway 3. larynx lifts too slowly during the swallow.
if the larynx lifts too slowly but eventually lifts to its full range of motion, all of the penetrated material will
usually be cleared from teh ariway entrance
penetration is a problem only when
the larynx fails to lift adequately during the course of the swallow, and the penetrated material remains in the larynx after the swallow, and is then aspirated as the individual inhales following the swallow
penetration may also occur if the bolus _______the airway entrance ____ the pharyngeal swallow triggers
falls into, before
aspiration during the swallow is an indication of
reduced laryngeal closure
if the larynx does not close adequately from bottom to top ________ the swallow, material will enter the airway _________ the swallow.
during during - this is the only etiology for aspiration during the swallow
significant residue in both pyriform sinuses is an indication of
reduced anterior laryngeal motion; cricopharyngeal dysfunction; stricture
if the pharyngeal swallow has not triggered, a _______ disorder cannot be diagnosed
if residue in the pyriform sinuses is combined with residue in other parts of the pharynx (valleculae, pharyngeal walls) it is symptom of
generalized dysfunction in pharyngeal pressure generation during the swallow - includes reduced posterior movement of the tongue base and reduced pharyngeal wall movement.
normally pharyngeal transit time is
less than 1 second
if there is any question about the patient's esophageal function, an esophageal study should be performed _________ the modified barium swallow is completed
AFTER - patient's ability to swallow without aspiration is established and they can do the barium swallow safely
the esophageal stage of deglutition ___ be modified by therapy
backflow of material out of the esophagus into the pharynx requires the ___________
UES to open
the tracheoesophageal fistula is usually located at the level of the
1st to 3rd thoracic vertebrae. patients shoulders should be turned diagonallyto improve visualization of this part of the esophagus and trachea b/c sholders shadow it
aenker's diverticulum
occurs in teh area of the cricopharyngeal reagion - it is a side pocket that forms when the muscle herniates
gastroesophageal reflux disease (GERD)
backflow of food and stomach acid from the stomach to the esophagus
during the oral prep phase in the posterior-anterior view, the clinician can examine (3)
1. the ability of the tongue to lateralize material 2. the pattern of jaw motion in crushing the food during mastication 3. shape of the tongue in holding the bolus prior to initiation of swallow
unable to align teeth is an indication of
reduced mandibular movement
inability to lateralize material with the tongeu is an indication of
reduced tongue lateralization
inability to mash materials is an indication of
reduced tongue elevation to the hard palate
material falls to the floor of the mouth is an indication of
reduced tongue control - particularly in the seal of the lateral margins of the gongue to the lateral alveolus
bolus spread across mouth is an indication of
reduced lingual shaping and fine tongue control. inability to elevate one or both sides of the tongue or to form a central groove to contain food
unilateral vallecular residue is an indication of
unilateral dysfunction in posterior movement of the tongue base
residue in one pyriform sinus is an indication of
unilateral dysfunction of the pharynx
reduced vocal fold adduction may be a cause of
aspiration during the swallow
unequal height of the VF is seen in
laryngectomized patients. . airway closure is incomplete
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