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67 Cards in this Set
- Front
- Back
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Superior
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above
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inferior
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below
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lateral
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extending from side to side
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Anterior
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in front of
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Posterior
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in back of
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Supine
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face up
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Prone
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face down
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Bolus
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collected and shaped body of food which has been chewed and chemically processed by enzymes prior to being swallowed
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peristalis
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the wave like motion which conducts the bolus through the esophageal structure
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transit
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movement which moves the bolus through the oral and pharyngeal structures
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Patent tube
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a tube which collapses against itself, does not remain open but opens to receive a substance such as food, esophagus is a patent tube
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esophagus
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the food tube conducting food to the stomach
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trachea
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the windpipe, formed of cartilage and leading to the lungs; intended to let air in and out of lungs
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anterior and lateral sulci
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furrow or groove btw. the gum and lip; bolus can pocket in these areas
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valleculae
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base of tongue and top of epiglottis;food can pool or collect here
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Pyriform Sinuses
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spaces between muscle fiber joining with the sides of the thyroid cartilage; sacs on either side of larynx where food can collect
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Penetration
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a process in which food or liquids enter the larynx but does not become inhaled into the trachea; foreign substances are ejected from the laryngeal area; remains above the level of the vocal folds
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Aspiration
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the inhalation of food, liquid or other foreign matter into the lungs; it moves below the level of the vocal folds
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Aspiration Pneumonia
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a particular type of pneumonia that results from food, liquid, or other foreign matter entering the lungs, this type often causes death of patients with dysphagia
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Normal Adult Swallow stages
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Oral preparatory stage(no time)
Oral stage (one second in time) Pharyngeal Stage (one second in time) Esophageal Stage (8-20 seconds in time) |
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Oral Preparatory Stage
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food is broken down by chewing, mashing w/tongue and exposure to enzymes in saliva to form bolus; its the pleasurable stage of swallowing taste and smell provided the pleasurable aspects
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Oral Stage (last 1sec.)
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bolus propelled posteriorly toward the pharynx, tongue makes rolling, squeezing action agaings the palate forcing food backward; ends when bolus passes the anterior faucial pillars or arches; involuntary process
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Pocketing or Squirreling
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patients store food in the lateral or anterial suclus deliberately
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Pharyngeal Stage (1sec.)
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starts when swallow reflex is initiated; stimulation of anterior faucial arches, causes series of simultaneous physiological reactions designed to protect the airway from foreign matter
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What is the biological purpose of larynx?
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to protect the airway from foreign matter
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How is nasal passage sealed?
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its sealed off by raising the soft palate; food/liquid cannot enter the nose
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Protected Airway
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laryngeal elevation: larynx moves as a unit up and anteriorly to provide more posterior space for the bolus to move into the esophagus; as same time larynx rises, vf close and epiglottis lowers over the top of the larynx to act as a protective lid
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Types of Dysphagia
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Neurogenic
Psychogenic Mechanical or anatomical dysphagis |
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Neurogenic Dysphagisa
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CVA
MS CP Tumor Head Trauma ALS Parkinson's Dementia |
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Mechanical or anatomical
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inability to chew and or swallow bc of damage to anatomical structures which prevent the mechanical processing of food
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Types of mechanical or anatomical dysphagia
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physical damage-trauma to throat
chemical damage-destruction or scarring; include damage from radiation exposure cancer, fistula in trachea or esophagus, allergy |
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Psychogenic Dysphagia
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caused by mental disorders; include anorexia secondary to other diseases like psychosis, neurosis, or anxiety disorders
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Neurogenic dysphagia
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caused by damage to the nervous system that interferes with the process of chewing and/or swallowing
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Esophageal Stage (8-20sec.)
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the UES opens to receive the bolus (start of esopageal stage) closes around it and the bolus is moved by peristalsis unitl it reaches a sphincter at its lower end called the LES;it connects to esophagus with stomach and intestinal tract and then relaxes allowing bolus to pass from the esophagus
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Enteral Oral Nutrition
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taken by mouth
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Enteral Tube Feeding
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provided through a tube or catheter that delivers nutrients distal to the oral cavity
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Combined Enteral Nutrition
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provided by mouth and tube feeding simultaneously
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Tube feeding (non surgical)
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oragastric-mouth/esohagus
nasogastric- nose/stomach nasojujunal-nose/jejunum |
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Tube feeding (surgical)
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Pharyngostomy-pharyngeal stoma/stomach
Esophagostomy-esophageal stoma/stomach Gastrostomy(PEG,PEJ)-stomach stoma/stomach Jejunostomy (PEJ)-jejunum stoma/stomach |
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Reflux
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stomach contents move up the esophagus which can result in aspiratio of gastrointestinal fluids and acids; usual signs are gagging when lying down; bad taste in mouth; burning in chest/pharynx
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Backflow
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condition when food already in the esophagus backs up through the UES w/out ever entering the stomach and does not contain harmful acids
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V Trigeminal
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sensation of anterior 2/3 of tongue; motor: mouth opening, mandible, floor of mouth, velopharyngeal closure
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VII Facial
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sensation posterior 1/3 tongue; motor: lip, larynx, pharynx
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IX Glossopharyngeal
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taste, Motor: pharynx and larynx
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X - Vagus
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sensory for pharynx, larynx; motor for velum, palate
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XI – Spinal Accessory
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motor for pharynx and palate
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XII – Hypoglossal
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motor for tongue, larynx
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Screening
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identify patients who may be candidates fro dysphagia evaluation and treatment, hands off process, take 15 minutes, and does not require doctors orders
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Red flag for evaluations
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recurrent pneumonia
unplanned weight loss cough with meds or meals ENT consult/vocal cord paralysis labored breathing report of wet vocal quality dehydration, change in eating |
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Swallow Evaluation (Bedside Swallow Eval)
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Pre-feeding Assessment
Feeding Assessment Judging type and severity of level of dyspahgia recommendations |
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Bolus Control Techniques
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3 sec. prep
Lingual sweep cyclic ingestion dry swallow thermal gustatory stimulation bolus placement modifications of bolus |
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Airway Protection Strategies
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Supraglottic swallow
Super-Supraglottic swallow Pharyngeal expectoration Vocal quality checks |
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Recommend Videofluoroscopy
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any symptoms of pharyngeal disorder (coughing, wet voice, delayed pharyngeal swallow)
Dx suggest risk for aspiration oral pharyngeal transport time is over 10 sec. |
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Reccommend NPO
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patient cannot maintain nutrition and hydration orally
symptoms indicate pharyngeal involvement with severe risk of aspiration |
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MBS
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allow objective measuremnt of oral pharyngeal transit time, verifies or rules out aspiration
localization of the site of the swallowing disorder in the pharynx and esophagus and helps to lead to DX, looks at anatomy and physiology of swallow |
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Barium Swallow Study
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used to examine the anatomy and physiology of esophagus
lies down or stands up larger amount of material used often very thick liquid carries barium |
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FEES/FEEST
(Fiber Endoscopic Evaluation of the Swallow) |
flexible scope inserted nasally and positioned to visualize the velopharynx, oralpharynx, and pharynx before and after swallow occurs
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Blue Dye Test
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use with tracheostomized patients, to color secretions, food and liquid the patient consumes
tracheal suctioning used to test for the blue dye, if dye found in suctioned secretions, there is a confirmation of aspiration |
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Scintigraphy
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small dose of radioactive sulfur colloid mixed with various consistencies which the patient swallows, placed under scintigraphy counter which quantifies the % of aspirated material
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Ultrasound
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can visualize the movement of the larynx(excursion) but not generally the action of the vocal folds
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Electromyography
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measures electrical impulses generated by muscles of the neck, larynx and pharynx, will not specify location of difficulty
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Accelerometry
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use of surface microphone that picks up contractions of muscles
CLA- computerized laryngeal analyzer newly developed |
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Cervical Ausculation
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use stethoscope to listen to sounds in the cervical region as swallow occurs
must be trained to id sounds that are associated w/laryngeal protection and swallow |
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Indirect Treatment
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designed to facilitate and improve neuromuscluar function and control
prepare pt. for safe introduction of food for a later time, no food introduced |
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Examples of indirect tx
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oral/pharyngeal/laryngeal motor stimulation/exercises
neuromuscluar electrical stimulation thermal gustatory stimulation deep pharyngeal neuromuscular stimulation |
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Direct treatment
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oral presentation of food
may include logistics related to physical characteristics of the food being presented (consistency, amount, hot/cold, flavors, rate of presentation) compensatory techniques, strategies, and adaptation develop and individual plan of treatment program for the pt. |
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Compensations/Facilitations
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Strategies that impose alteration in behavior
Bolus characteristics |
