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135 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Three types of injury
coup
contra coup
twisting of brainstem
4-26
Three types of brain damage
diffues (microscopic damage throught brain)
hypoxic-ischemic (swelling causes hypoperfusion)
focal
4-26
Two common late secondary complications:
hydrocephalus
chronic subdural hematoma
4-26
Three stages of medical tx
acute (saving pt. life)
subacute (after stabilized)
chronic (two categories)
4-26
Two categories of chronic tx
community-based rehabe
tx of long-term consequences (like pain, depression, behavior)
4-26
Most common swallow disorder in TBI
delay in triggering of the pharygneal swallow
4-26
Always check for a _ _
bite reflex
4-26
Reduced closure of the larynx and reduced cp opening are likely NOT due to neurologic damage but ARE likely due to:
changes in laryngeal motion (usually caused by physical damage to the neck)
4-26
Characteristics that make oral intake more difficult in TBI
impulsiveness
Tendency to put too much food in mouth
cognitive difficulties
reduced sensation
4-26
Is there a relationship b/t length of coma and swallowing problems?
Yes.
Swallowing probs worse with longer comas
4-26
Tx for TBI
Cognitively impaired
compensatory strategies (postural and sensory)
Resistance and ROM
Maneuvers are TOO DIFFICULT
Changing diet
4-26
What if TBI pt has reached max. gains in treatment, but still cannot eat b/c they are aspirating or have inefficient swallowing?
Do periodic evals - ethicially cannot continue to work with them
4-26
Do back injuries, like ruptured disks, spinal stenosis, or pinched nerves lead to dysphagia?
No
4-26
SCI is
damage to the spinal cord that resultsi n a loss of function
4-26
What is the leading cause of SCI?
Motor vehicle accidents
4-26
# of:
cervical vertabre
thoracic
lumbar
sacral
7
12
5
5
4-26
Effects of SCI depend on the _ of injury and the _ of the injury.
type
level
4-26
Two types of SCI injury
complete
incomplete
4-26
Complete SCI injury is
no function below the level of the injury on both sides
4-26
Incomplete SCI is
some function below the primary level of injury
4-26
Injury at C1 or C2
no sensory awareness of swallowing difficulty (Silent aspiration)
4-26
Injury at C4, C5, C6 (what happened to C3?)
poor laryngeal movt and reduced cricopharyngeal opening
4-26
Swallowing probs in cercial injury may be exacerbated by:
trach w/inflated cuff
cervical brace
mechanical vent
4-26
Always perform a _ physiologic assessment if pt complains of swallowing difficulty
in-depth
4-26
What is most likely NOT possible in pt with SCI
postural changes
4-26
What is MOST helpful in SCI tx?
sensory enhancement
swallow maneuvers
4-26
****Name the four types of cervical bracing
soft collar
philadelphia collar
Sterno-Occipital Mandibular Immobilzation Device
halo
4-26
Swallowing worsens w/what two braces?
SOMI
Halo
4-26
More swallowing difficulty with
chin pulled back
chin/head retracted to neck
pt's head is extended
4-26
Two types of cervical fusion
anterior
posterior
4-26
Swallowing probs as a result of Anterior Cervical Fusion (incision in front of neck)
Swelling in post pharyngeal w
red. laryn. elevation and anter movt (+ red. CP opening and red. airway closure)
may see oral stage probs and delay in trigger
4-26
Tx for Anterior Cervical Fusion
Significant recovery in 3 months
swallow maneuvers are most helpful
4-26
Brainstem problems? Try...
TTS
Suck-swallow
4-26
Extent of damage in tumors from cranial nerves depends on (2)
size of tumor
difficulty of resection
4-26
If CN IX (glossopharyngeal) is damaged, expect
a delay in triggering pharyngeal swallow
4-26
CN damage? Try...
(often unilateral)
postural strategies
aggressive ROM and resistance
4-26
Three levels of neural control:
CNS
Autonamic System
Enteric Nervous System (ENS)
5-1
LES seperates _ from _
esophagus from stomach
5-1
Pressure gradiate is higher/lower in the stomach than in the thoracic cavity
higher
5-1
Dx testing used for esophagus
upper GI/Barium swallow
Endoscopy
24 hour ambulatar pH testing
Esophageal Manometry
5-1
Upper GI looks for
structural probs
function
5-1
Endoscopic allows us to see
stomach
EGJ (esopheogastric junction)
5-1
Manometry shows us
pharynx
UES
Esophageal body
LES
peristalsis
5-1
name the structural causes of dysphagia due to esophageal problems (7)
Schatzki's ring
Eosinophilic esophagitis
peptic sticture
hiatal hernia
esophagial diverticula
esophageal cervical web
cricopharygneal bar
5-1
What is Schatzki's ring?
it's at the EGJ, a thin lip of tissue b/t esophageous and stomach, "washer-like"
5-1
What is the most common cause of dysphagia complaint re: esoph.
eosinophilic esophagitis (4 of 1,000)
5-1
What is eosinophilic esophagitis?
looks like the trachea
a lot of schatzki's rings
leads to food impaction
squamous cells and esoinophilic cells
5-1
What is a peptic stricture?
a narrowing, see ulceration and bleeding, an hourglass appearance
5-1
What is a Hiatal Hernia?
predisposes the person to reflux
usually doesn't need surgery
5-1
Does a Hiatal Hernia cause dysphagia?
No
5-1
What is another name for "esophageal diverticula?"
Zenker's diverticulum
5-1
What is a esophageal cervical web?
like a shatzki's ring, but right below the CP muscle
Not often caused by other diseases
5-1
What is a cricophargyneal bar?
it's thicker than a e.c. web, creates a funnel effect,a posterior shelf
5-1
Motility is a _ problem
function
5-1
Two motility probs
Achalasia
Diffuse Esophageal Spasm
5-1
What is achalasia?
Failure of LES to relax
No peristalsis
a neuropathy of the ENETRIC nervous system
5-1
What is a Diffuse Esophageal Spasm?
"a corkscrew esophagus"
smooth muscle is affected
5-1
5 Iatrogenic Disorders
1. pill
2. radiation
3. neoplastic-esphogeal cancer
4. infections
5. congential development
5-1
what does odynaphagia mean?
pain w/swallowing, indicates ulcer
5-1
What is ptosis?
drooping eyelids
5-1
Another name for Schatzki's Ring
Steakhouse syndrome
5-1
Schatzki's Ring and _ _ often coexist
hiatal hernia
5-1
What is Boyce's sign?
focal neck swelling that gurgles on palpation; usually on left side (mentioned with Zenker's
5-1
What is the physiologic hierarchy?****
respiration
swallowing
speech
5-3
Three aspects of respiration
ventilation
external respiration
internal respiartion
5-3
ventilation is
movt of air back forth b/t outside atmosphere and inner spaces of the lungs
5-3
external respiration is
exchange of gases b/t walls of the lung spaces and the transporting blood
5-3
internal respiration is
gases are exhanged bt blood cells and the body
5-3
two subdivisions of the respiratory system
conducting zone (brings air in and out)
respiratory zone (where gas exchange occurs)
5-3
What is the Law of LaPlace?****
P=2T/r
5-3
P=2T/r
P stands for
collapsing pressur on alveolus
5-3
P=2T/r
T stands for
surface tension
5-3
P=2T/r
r stands for
radius of alveous
5-3
Large alveolus = _ collapsing pressure
low
5-3
Small alveolus = _ collapsing pressure
high
5-3
_ alveolus are not ideal because they collapse often
small
5-3
What is surfactant?
A misture of phopholipids that line the alveoli and reduce their surface tension
5-3
Without _, Law of _ predicts that _ alveolus will collpase
surfactant
LaPlace
small
5-3
What is atelectasis?
When small alveoli collapse
5-3
What is the space between the two pleura?
pleural cavity OR intrapleural space
5-3
What is another name for when the lungs collapse?
Pneumothorax
5-3
When elastiance goes _, compliance goes _
up
down
5-3
_ is the boundary between the upper and lower airway
larynx
5-3
What is the focal point of breathing?
should breathe diaphragmatically (NOT clavicular or abdominal breathing)
5-3
What is the most common pattern of respiration and swallowing?
inhale
start to exhale
stop exhale (swallow + airway closure)
return to exhalation (thought to be protective: prevents residual food in airway)
5-3
Focal point of breathing****
diaphragmatically
5-3
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
5-3
Two types of COPD
emphysema
chronic bronchitis
5-3
Compare and contrast aspiration pneumonia and pneumonitis
asp pneumonia is an acute inflammation caused by INFECTION and is a reaction to bacteria and bacterial byproducts (SLP issue)

Pneumonitis is lung INJURY caused by acidic and particulate gastric contents (reflux, etc. a GI issue)
5-3
Bronchospasm is caused by
asthma
5-3
Atelectasis is
collapse of expanded lung
5-3
dyspnea is
an unpleasant awareness/perception of shortness of breath
5-3
hemoptysis is
coughing up blood tinged mucous
5-3
hypoxemia is
deficit in oxygenization of blood
5-3
rhonchi is
whistle or snoring sound upon ascultation
5-3
Name a the Parkinson's drug Logemann AND Nicole mentioned during lectures.
Halodol
5-3
What is another name for having no teeth?
edentulous
lab
Two risk factors for head and neck cancer
smoking
alcohol
5-8
What is "the dump" according to Logemann?
When it is YOUR fault the pt isn't swallowing yet, when in all actuality it is the doctor's fault, because drs do everything wrong, right? They obviously have no idea what they're doing - they just follow people around for a few years...
5-8
What does exsanguinate mean?
to bleed to death
5-8
What does radiation cause? (5)
decreased blood flow
increased stiffness
xerostomia
fistula
fibrosis
5-8
Chemo causes?
mucositis (sores in mouth)
a lot of weight loss
5-8
Dysphagia types resulting from radiation and chemo:
dec oral tongue motion
dec BOT motion
dec ph wall motion
dec laryngeal elev
5-8
what is anastomosis?
reattachment
5-8
What is a simple resection?
part or all of one structure
5-10
What is a composite resection?
part or all of more than one structure (often occurs in the mouth)
5-10
Two most common spots for composite resection?
anterior floor of mouth
lateral (bot or tonsil)
5-10
_ composite resection has the worst functional problems:
lateral
(results in loss of food and nasality)
5-10
What does IMRT stand for and what is it?
Image Modified Radiation Therapy; I have no idea what it is...!? But the trusty internet tells me it's actually Intensity-Modulated Radiation Therapy. hmmm.
5-10
Two types of a partial laryngectomy
supraglottic
hemi
5-10
Two types of laryngeal surgery
partial laryngectomy
total laryngectomy
5-10
If the pt has a supraglottic (horizontal) laryngectomy, what can you expect to be removed?
epiglottis, fvf, areypiglottic folds
5-10
What treatment does a pt with a supraglottic/horizontal laryngectomy require?
since top 2/3 of larynx + hyoid are removed expect: laryngeal elevation problem and a need for airway protection

Super-supraglottic maneuver
5-10
What to do with a hemilarygnectomy?
head rotation
chin down
head rotation + chin down
adduction exercises

This is because airway closure is a big prob;
5-10
What should you expect with a person who has had a total laryngectomy?
no hyoid or larynx, no CP region

1. tight closure
2. pseudoepiglottis
5-10
Can total laryngectomees aspirate?
No, not phsically possible
5-10
Stroke occurs most often in what population?
African Americans, equal among gender
5-10
2 areas of stroke
hemorrhage (bursting of vessel;s lower recovery)
blockage (infarct; faster recovery)
5-10
If a pt presents with a medullary stroke, what should you expect and how would you treat?
expect no swallow at first, once they have a swallow, do TTS
dec laryngeal elev (mendelsohn, falsetto, gargle, yawn)
unilateral vf paralysis (head rotation)
5-10
Most common probl in stroke pt
delay in trigger
5-10
R or L cortical lesion worse? why?
r, because alertness and focus decrease
5-15
Two types of ALS
bublar
spinal
5-15
Bublar/spinal rapildy deteriates?
bulbar - takes 3 1/2 years
5-15
How long does spinal ALS take
10-15 years
5-15
No exercises will help what populations
postpolio
Motor neuron disease (ALS)
5-15
Exercies to do with medullary stroke
TTS for delay or absent swallow
head rot to affected side
adduction exercises
Mendelsohn, Shaker
Pontine stroke results in
hypertonicity
absent/delyaed pharyngeal swallow
unilateral pharyngeal wall paresis
reduced laryngeal elevation/cp opening
What do to for pontine stroke
TTS for delay/absent swallow
head rotation (try both sides)
Mendelsohn, Shaker
In bulbar als, what do you expect to see and how to treat?
tongue later and dec strength
change their diet
use compensation which won't work after a year
don't over work them
5-15
In spinal als, what do you expect to see and how do you treat?
mostly pharyngeal wall problems
use postural techniques
What do you see in postpolio?
unilater ph w (turn head)
dec airway closure
dec laryngeal elevation
In parkinson's, what do you see?
tongue pumping
dec airway closure
dec bot motion
MS causes
delayed ph sw (TTS)
dec bot motion
airway closure prob
exercies help
Guillan Barre see
dec ROM
Everything is weak
Mysthenia Graves
hypernasality
fatigue of muscle w/use