Dysphagia Quiz 2: Lecture 4

Front 1

Why is an instrumental evaluation necessary?

Back 1

-pulmonary/nutritonal status may be compromised and dysphagia may be contributing
-to develop an appropriate treatment plan
-signs of symptoms of aspiration present at bedside eval did not indicate a pharyngeal problem
-anytime a pharyngeal disorder is suspected
0previous instrumental exam with diet & compensatory techniques is recommended for safe oral intake
-bedside exam is inconclusive

Front 2

This elevates speed & force of peristalsis; records pressure and contractions in the oropharynx. Placement is crucial for correct readings. A disadvantage of this is inability to view the anatomy.

Back 2

manometry

Front 3

This records oropharyngeal pressure changes, anatomic & physiologic swallow event,s and bolus transit onto a videotape. Pressure changes are viewed in analog form as +/- pressure waves.

Back 3

manoflouroscopy

Front 4

High frequency sound waves are reflected & received by a transducer and assembled onto a video image. We can measure the duration of the oropharyngeal swallow, the relationship between tongue & hyoid, abnormal lingual movement/tremor, aborted swallowing attempts, and structural deviations in the oral cavity.

Back 4

ultrasound

Front 5

What are the advantages & disadvantages to using ultrasound?

Back 5

ADVANTAGES: safe, non-invasive, biofeedback
DISADVANTAGES: can't easily see the pharynx, laryngeal penetration & aspiration cannot be seen, not widely available

Front 6

This is conucted by a radiologist, GI, or ENT. It is an imaging technique that uses radio nuclude scanning during & after ingestion of a radioactive bolus. Radioactive markers are placed externally. It measures pharyngeal transit time, number of swallows needed to clear pharynx, esophageal transit time, GI reflux, and quantity of aspirated material

Back 6

scintigraphy

Front 7

What are the advantages/disadvantages of scintigraphy?

Back 7

ADVANTAGES: detect & quantify aspiration, detect reflux
DISADVANTAGES: unable to see anatomy/phys, not typically used with kids because of radiographic material

Front 8

This records electrical activity of a muscle/muscle group. It gives information about onset & offset of activity and motor neuron firing. It gives some indication of muscle strength. Physician usually places electrodes.

Back 8

electromyogragphy (EMG)

Front 9

What are the disadvantages of EMG?

Back 9

DISADVANTAGES: invasive, can leave bruises, bleeding, swelling, and hematoma

Front 10

What is sEMG?

Back 10

surface EMG; used as a treatment technique for biofeedback; noninvasive; uses surface electrodes

Front 11

This is optimal for monitoring mild dysfunction; excellent image delination. The image is put onto film.

Back 11

cineradiography

Front 12

What are the advantages/disadvantages of cineradiography?

Back 12

ADVANTAGES: provide sharper image for slow viewing
DISADVANTAGES: increased radiation time, time & cost developing the film, difficult to obtain audio

Front 13

Describe the FEES.

Back 13

Fiberoptic Endoscopic Examination of Swallowing; a scope is inserted through the nose, and velar and laryngeal examination is performed. The endoscope is then moved above the valleculae. Clinician can color water or have them drink milk to see where the bolus goes.

Front 14

What is the SLP licensed to do regarding FEES?

Back 14

assess laryngeal function

Front 15

What can FEES detect?

Back 15

premature spillage into the hypopharynx/laryneal vestibule before swallow initiation
-adduction of VF during coughing, holding breath, or swallowing
-presence of residue
-presence of supraglottic laryngeal penetration/subglottic aspiration
-initiation delay in swallow & timing of airway closure

Front 16

What are the advantages/disadvantages of fees?

Back 16

ADVANTAGES: no radiation, secretion management, biofeedback, view benefits of postural & compensatory strategies
DISADVANTAGES: not for agitated/confused patients, may need a topical anesthetic, "white-out"

Front 17

Describe Murray's aspiration rating scale.

Back 17

0= no excess secretions
1= secretions in valleculae, pyriform sinus, lateral channels
2=transitional rating
3=secretions in laryngeal vestibule, not cleared

Front 18

What can we easily see in FEES?

Back 18

-airway closure
-among & location of secretions
-pharyngeal/laryngeal sensitivity
-residue in lateral channels, valleculae, & pyriform sinus
-coordination of breathing & swallowing
-fatigue during a meal
-altered anatomy

Front 19

What is a videoflouroscopy?

Back 19

-gold standard
-allows for longer viewing time
appropriate for more severe individuals
-most widely used

Front 20

What are other names for VFSS?

Back 20

videoflouroscopic swallow study (VFSS)
modified barium swallow study (MBS)
cookie swallow test
barium swallow study w/ SLP assistance
video swallow
deglutition study
triple phase swallowing study

Front 21

*What can clinicians determine through VFSS? (4)

Back 21

1. if the patient can continue safe oral intake
2. if the patient can progress from present method of nourishment to oral intake
3. if patients are likely to meet nutritional requirements with oral intake
4. if it is advisable to implement alternative methods of nutrition

Front 22

*What are the advantages/disadvantages of VFSS?

Back 22

ADVANTAGES: examine anat & phys, identify disorders in movement patterns in oropharyngeal structures, define treatment strategies
DISADVANTAGES: radiation exposure, transport to facility that does VFSS, gainy tape quality

Front 23

*What ar the differences between regular & modified barium swallow studies?

Back 23

REGULAR: performed by radiologist; assesses esophageal function, anatomy, peristaltic waves; patient lies on back removing gravity; large qunatities of barium; liquid only; reveals aspiration
MODIFIED BARIUM SWALLOW: performed by SLP & radiologist; evaluates safety for oropharyngeal structure & function; sitting upright (feeding position); small amounts of food coated with barium; various consistencies of food/liquid; reveals amount and reason for aspiration

Front 24

*Describe the videoflouroscopy procedure.

Back 24

1. Patient is upright & seated/standing; positioning is often the most difficult part
2. Exam begins in lateral view, can have patient say "candy" for assessment of velopharynx
3. Self feeding when appropriate
4. Procedure is videotaped, preferred for audiotaping which gives better feedback accuracy

Front 25

What does Groher suggest for VFSS?

Back 25

initial 3 swallows should view oral & pharyngeal cavities; then move focus to the pharynx to focus on pharyngeal & esophageal transfer; head neutral initialy, then moved; A/P positions

Front 26

Describe Rosenbeck's Penetration Aspiration Scale.

Back 26

1. does not enter airway
2. enters airway, remains above VF, is ejected from airway
3. enters airway, remains above VF, is not ejected
4. enters airway, contacts VF, is ejected from airway
5. enters airway, contacts VF, is not ejected from airway
6. enters airway, passes below VF, is ejected at larynx out of airway
7. enters airway, passes below VF, is not ejected despite effort
8. enters airway. passes below VF, no effort is made to eject