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62 Cards in this Set
- Front
- Back
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T/F Is gastroesophageal reflux (GER) often associated with preemies?
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True
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What are four tests that can be used to diagnose GER in newborns?
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esophageal manometry
esophageal pH monitoring scintigraphy videofluoroscopy |
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What are two goals of the procedures used to diagnosis GER?
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1) determine the quality of musculature in the esophagus (esp. at the level of the LES)
2) determine the level of acidity within and above the level of the LES |
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Name 3 advantages of esophageal manometry (EM)
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1) can assess esophageal peristalsis during swallow and the passive tension of the LES
2) allows indirect observation of cricopharyngeas muscle 3) helpful in locating UES and LES for pH monitoring |
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Name 3 disadvantages of esophageal manometry (EM)
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1) not helpful in medical management of GER
2) must be combined with videofluoroscopy to visually identify anatomical placement of the transducers 3) its invasive |
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What pH level is considered neutral?
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7.0= neutral
<4.5=acidic |
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what is the gold standard of GER diagnoses?
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Esophageal pH monitoring
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In pH monitoring, where is the probe placed? How long is it left in?
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through nose and extended to just above the LES
24 hours |
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Name one advantage and one disadvantage of esophageal pH monitoring
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ADVANTAGE
device is portable and can be used with active infants DISADVANTAGE its invasive and long (24 hours) |
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Describe the procedure of scintigraphy
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-imaging technique
-examines passage of radioactive material (mixed in liquid) from mouth to stomach -often used to calculate gastric emptying time |
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Name an advantage and disadvantage of scintigraphy
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ADVANTAGE
can detect GER in situations where pH probe cant (if there is non-acidic refluxed material) DISADVANTAGE long procedure (1-2 hours) and radioactive material is used |
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What are some advantages and disadvantages of the barium esophagram?
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ADVANTAGE
-common test -good for evaluating esophageal anatomy and motility disorders DISADVANTAGE -uses radiation -doesn't provide lasting record of the dynamics of swallowing |
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Name the advantages of Ultrasoundography
(there are 8!) |
1) can get images of various planes by rotating the transducer without moving patient
2) images collected in real time, image can be frozen and enlarged 3) barium not required 4) noninvasive 5) can evaluate the effects of oral sensory motor stimulation 6) used to assess oral prep and oropharyngeal stages 7) its portable 8) good to use wtih children with CP or poor feeders who require frequent monitoring |
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Name 4 disadvatages of ultrasoundography
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1) does not directly determine if aspiration has occurred
2) soft areas behind larynx and hyoid cant be imaged 3) quality of image adn interpretation depend on operator **4) doesnt pass through bone |
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What are the advantages of FEES?
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1) relatively inexpensive and protable
2) gives detailed info about pharyngeal and laryngeal structures 3) do not need to administer food 4) no radiation or barium 5) can be used for biofeedback as part of therapy (some say too invasive for this) 6) good for assessing swallowing ability and structures/function of swallowing before food is intoduced 7) assists in assessing neurologic status and sensation |
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What are the disadvantages of FEES?
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1) does not assess oral or esophageal stages of swallowing
2) local anesthesia required (for tube placement through nose) 3) **invasive and may interfere with swallowing 4) doesn't comprehensively asses swallowing physiology |
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What is considered to be the gold standard in the evaluation of swallowing function?
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Videofluoroscopic Swallow Study
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What are the advantages of VSS?
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1) assesses all stages of swallowing
2) gives info on bolus transit times, motility disorders, and amount and cause of aspiration 3) and video tape recorder can be attached to teh equipment 4) strategies to improve swallow function are assessed during study 5) recordings can be used for patient and family education |
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What are the disadvantages of VSS?
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1) radiation exposure is small, but can still be a concern if patient requires frequent reassessments
2) not portable 3) need training and expertise to correctly read images 4) no sensory testing is conducted |
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What is the method called when a stethoscope is held against the neck above larynx to listen to the sounds of swallowing and respiration?
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Cervical Ausculation
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What are the advantages of Cervical Auscultation?
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1) non invasive
2) can be used to augment a clinical eval 3) provides continuous way of monitoring swallowing behaviors 4) inexpensive and portable |
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What are the disadvantages of Cervical Auscultation?
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1) may not be a valid indicator of aspiration when used alone
2) sounds may be distorted depending on what stethoscope is used |
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Should a child receive a clinical assessment or a VFSS first?
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clinical assessment
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**I have a star by this:
What are the general purposes of the clinical assessment? |
1) analyze typical feeding behavior
2) obtain social, medical, developmental, and feeding histories 3) examine structures of oral cavity 4) determine if VFSS is needed 5) determine if infant can tolerate VFSS 6) asses cranial nerve function for swallowing 7) determine factors affecting normal development of feeding skills 8) determine if they are at risk for aspiration |
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What are the general purposes of VFSS?
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1) examine structure and function of cavities (oral, nasal, and pharyngeal)
2) asses stages of swallowing and their interaction 3) measure coordination of suck, swallow, breathe sequence 4) determine maintenance of airway protection 5) determine presence of premature spillage, penetration, and aspiration 6) assess reactions to swallowing dysfunction (protective/clearing reactions) 7) assess response to compensatory strategies 8) make safe feeding recommendations and improve feeding efficiency |
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What are some signs/symptoms indicating the need for clinical assessment of feeding/swallowing?
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-FTT
-sudden weight loss -behavioral change -frequent spitting up -bottle feedings over 30 min -behavioral feeding probs -weak dysfunctional suck -coughing/choking during feeding |
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Do all infants with dysphagia require a VFSS?
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no
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When should a recommendation for a VFSS be made?
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-child has history of upper respiratory infection
-symptoms of GER present -at least 38 weeks of age |
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Name the six parts of the clinical assessment
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1) history
2) behavior/state/sensory integration 3) general postural control/tone 4) respiratory function/endurence 5) oral-motor/cranial nerve eval 6) feeding/swallow eval |
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What is the optimal stage of alertness for feeding?
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Stage 4: quiet alert
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1 pound=how many grams?
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1 pound=454 grams
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1 ounce=how many grams?
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1 ounce=28 grams
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1000 grams=how many kilograms?
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1000 grams=1kg
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What is the best feeding position for infants?
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head forward in loose chin tuck position
shoulders symmetrical and slightly depressed |
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t/f one of the most common causes of dysphagia in children is related to respiratory problems
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true
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should you assess respiratory patters before or after feeding, or both?
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both
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during the oral-motor examine, what should you look for when examining the lips?
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bilabial closure
tone of lips any scarring or clefting |
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during the oral-motor examine, what should you look for when examining the jaw?
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size (macro or micrognathia)
position (protruded or retracted) malocclusions dental bite |
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Match Class I, II, III with the following:
Distrocclusion Neutrocclusion mesiocclusion |
Neutrocclusion: I
Distrocclusion: II mesiocclusion : III |
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what is a crossbite?
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maxillary and manibular teeth are not vertically aligned
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What is it called when the upper incisors project in front of the lower incisors creating a space?
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overjet
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what is it called when the upper incisors overlap the lower incisors with a gap between?
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overbite
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T/F When conducting a feeding/swallow eval you can assess the oral prep and oral stage of swallowing and make inferences about the pharyngeal stage.
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true
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Motor:
chewing upward/anterior movement of larynx backward movement of tongue movement of tensor veli palatini palatal elevation and lowering pharyngeal constriction Sensory: sensation to deep structures of face palate tongue sensation of shape and texture in mouth |
CN 5
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Motor:
facial expression elevation of larynx lip and face muscles elevation of hyoid adn tongue Sensory: taste anterior 2/3 sensation to floor of mouth hard and soft palate |
CN 7
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Motor:
elevation of larynx adn pharynx palatal movement phayngeal and laryngeal movement eopiglottic excursion Sensory: taste posterior 2/3 sensation to tonsils upper pharynx soft palate |
CN 9
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Motor:
elevation and depression of soft palate elevation and closure of soft larynx epiglottic excursion opening of criocpharyngeal segment esophageal peristalisis Sensory: sensation to pharynx, larynx, trachea, lungs epiglottis |
CN 10
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Motor:
tongue movement elevation of hyoid bone and tongue Sensory: none |
CN 11
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In a VFSS what is the SLP responsible for?
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1) positioning the infant
2) assembling the feeding equipment 3) instruct parent 4) assuming the role of the feeder if needed 5) working with radiologist to obtain best view 6) help infant maintain midline head positioning 7) evaluate stages of swallowing 8) make suggestions for intervention/compensatory strategies |
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what are radiation limitations typically set at?
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2-5 min (book)
*Dr. Flemming said most people dont like to go over 2 minutes |
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Who should feed the child during a VFSS
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parent or caregiver
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t/f one type of nipple should be available to use during VFSS
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f: several nipples should be ready for use
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What should you have ready to use in between test swallows during a VFSS?
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formula or breast milk that is not mixed wtih barium, to continue feedings
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t/f: always start with the most difficult texture
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f: go from easiest to most difficult
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For infants receiving primary enteral feedings, you should begin with establishing a ____.
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NNS
then introduce nipple feedings using a regular or preemie nipple with regular flow rate |
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infants trigger at the vallecula by tongue pressing what?
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posterior pharyngeal wall
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t/f: some infants experience vestibular penetration during the initial suckle burst. This penetration, if normal, will clear after the first few swallows
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true
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What two major things should be looked at in the oral prep phase?
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suck(l)ing from the nipple
removing food from spoon |
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T/f: secondary peristalsis is abnormal
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true
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What things should be looked at during the oral stage?
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posterior transit of bolus
oral transit time lingual peristalsis tongue contact with hard and soft palate |
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When does the pharyngeal phase begin and end?
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begins with elicitation of swallow response and ends wtih bolus passing through CP segment
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match with cranial nerve 5, 7, 10, or 12
vf paralysis, weak cry, hypernasality, nasal regurgitation reduced tongue movements, poor suck reduced mandibular movements facial asymmetry, reduced facial movements, weak lip closure |
vf paralysis, weak cry, hypernasality, nasal regurgitation" 10
reduced tongue movements, poor suck: 12 reduced mandibular movements: 5 facial asymmetry, reduced facial movements, weak lip closure: 7 |
