Pathophysiological Of Swallowing In Infants & Adults

Front 1

disorders affecting the oral preparatory and oral propulsive phases usually result from impaired control of the tongue.

Back 1

Oral phase

Front 2

If pharyngeal clearance is impaired severely, a patient may be unable to ingest sufficient amounts of food and drink to sustain life.

Back 2

Pharyngeal phase

Front 3

Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing.

Back 3

Esophageal phase

Front 4

Oral phase, Pharyngeal phase, Esophageal phase

Back 4

3 phases of Swallowing

Front 5

This happens when food enters the airway below the true vocal folds.

Back 5

Aspiration

Front 6

600 times a day

Back 6

Approximately how may times do we swallow per day

Front 7

People who aspirate are at risk for this.

Back 7

pneumonia

Front 8

percentage of patients with strokes have Dysphagia

Back 8

51-73%

Front 9

quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms.

Back 9

factors influence the effects of aspiration

Front 10

(1) Estimate the percentage of the total bolus aspirated (2) estimate the depth of bolus invasion into the airway.

Back 10

aspiration described in 2 ways

Front 11

PASSAGE OF FOOD OR NON-FOOD MATERIAL BELOW THE LEVEL OF THE VOCAL FOLDS

Back 11

ASPIRATION

Front 12

Pneumonia accounts for about __% of all stroke-related deaths and represents the third highest cause of death during the first month after a stroke

Back 12

34%

Front 13

IF A PERSON ASPIRATES INTO THE TRACHEA AND DOES NOT COUGH WE REFER TO THSI AS SILENT ASPIRATION

Back 13

ASPIRATION SILENT

Front 14

Among elderly patients, dysphagia may have particularly serious consequences, particularly in terms of ___________and ________ diseases.

Back 14

Malnutrition and Respiratory Diseases

Front 15

Difficulty in swallowing liquids is often suggestive of a ________ disorder or a sign of age-related swallowing difficulties.

Back 15

Neurological

Front 16

It has been estimated that as many as ___% of all children may manifest some type of nonspecified feeding difficulties.

Back 16

25%

Front 17

The first two stages are under ____________ control, whereas the second two stages are ___________ being under ________ control

Back 17

voluntary, involuntary, reflexive

Front 18

include a multitude of "conservative" measures, focused pharmacotherapies, and surgical interventions

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therapeutic interventions

Front 19

if it is because of disordered function, the dysfunction may have roots in neurosensory, neuromotor, or central processing functions

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behavioral

Front 20

Poor feeding; Difficulty chewing; Difficulty drinking from a bottle or cup; Difficulty breast feeding; Refusing food or liquid; Coughing or choking while eating or drinking; Excessive drooling and food spilling from the mouth

Back 20

Symptoms

Front 21

Prematurity Cerebral palsy Autism Head and neck abnormalities Muscle weakness in the face and neck Gastroesophageal reflux Multiple medical problems Respiratory difficulties Medications that may cause lethargy or decreased appetite Problems with parent-child interactions at

Back 21

Causes of feeding and swallowing problems

Front 22

Some children with dysphagia will have long-term problems. Children who have other health problems, especially those that affect the nerves and muscles (such as muscular dystrophy and brain injury), may not be able to experience much improvement with their swallowing difficulties. Other children may learn to eat and drink successfully.

Back 22

What is the long-term outlook for a child with dysphagia?

Front 23

Medical intervention, as needed Direct feeding therapy designed to meet your child's individual needs Nutritional changes Postural or positioning changes (different seating, etc.) Behavior management techniques Desensitization to new foods or textures Food temperature and texture changes Referral to other disciplines, such as psychology or a dentist

Back 23

treatment

Front 24

Strengthening the muscles of the mouth Increasing tongue movement Improving chewing patterns Increasing tolerance of different foods or liquids Improving sucking /drinking ability Coordinating the suck-swallow-breathe pattern (for infants) Altering food textures and liquid viscosity to ensure safe swallowing Other interventions depending on your child's specific needs

Back 24

intervention strategies for the SLP

Front 25

The _____, ______, and ______ (superior cartilage of the larynx) lie at a higher level than in the adult

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hyoid, larynx, and epiglottis

Front 26

has been associatedwith apnea, choking, and a history of pneumonia inthe infant

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Nasopharyngeal reflux

Front 27

used in children suspected of oral, pharyngeal, or esophageal motor disorders may include radiography (particularly esophagram or videofluoroscopic swallowing study), manometry, endoscopy of the esophagus or airway (including fiberoptic endoscopic evaluation of swallowing with sensory testing), scintigraphy, esophageal pH-metry or impedance, or central nervous system imaging

Back 27

Diagnostic procedures

Front 28

Disorders of the smooth muscle esophagus in children vary from those in adults to a lesser degree than the _______disorders; these pediatric lower
______________disorders

Back 28

deglutitive & esophageal

Front 29

_____,__________, the unintentional loss of saliva and other oral contents from the mouth, is generally a sign of oral dysmotility involving striated musculature, and often occurs in the context of more general neurologic disability

Back 29

Drooling, sialorrhea

Front 30

_________ _______during swallowing is an abnormal oral motor pattern that may contribute to abnormalities of deglutition, speech, and orofacial development

Back 30

Tongue thrusting

Front 31

_______ (difficulty swallowing) may be a specific complaint in the older child, but in the less verbal child (either younger or developmentally delayed) it may be represented by refusal by a hungry child of offered nutrients, by regurgitation of undigested ingested food, or even by drooling in a child unable to handle oral secretions appropriat

Back 31

Dysphagia

Front 32

When esophageal dysmotility prevents the appropriate caudal movement of ingested material, the material's retrograde movement may result in ____________

Back 32

regurgitation

Front 33

Cardinal signs of oropharyngoesophageal dysmotility are signs of misdirection of swallowed material into the airway

Back 33

Symptoms of Misdirection of Swallows into Airway

Front 34

Palatal dysfunction can allow material into the nasopharynx.

Back 34

Nasopharyngeal Regurgitation

Front 35

structural abnormalities such as head and neck tumours, thyroid enlargement, benign strictures
infections such as HIV, candida or herpes
iatrogenic causes, such as perforation of the oesophagus during intubation
gastro-oesophageal reflux disease (GERD), in which stomach acid irritates and damages the lining of the oesophagus
poisoning and/or burns that result from, for instance, swallowing household cleaning agents.

Back 35

causes of chronic dysphagia

Front 36

The wave-like motion that moves the bolus down the esophagus

Back 36

peristalsis

Front 37

Poor feeding, Difficulty chewing, Gagging, Vomiting during meals, etc.

Back 37

symtoms of Feeding and Swallowing disorders in children and infants

Front 38

<4mm (premature <3mm)

Back 38

the size of a newborn's larynx

Front 39

MOVEMENT OF CONTENTS OF THE STOMACH UP AND OUT OF THE STOMACH INTO THE ESOPHAGUS

Back 39

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Front 40

A PROCEDURE IN WHICH AN ENDOSCOPE IS PASSED TRANSNASALLY INO THE PHARYNX FOR ASSESSSMENT OF SWALLOWING

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FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)

Front 41

FEEDING THROUGH A TUBE PLACED THROUGH THE NASAL PASSAGE LEADING TO THE STOMACH

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NASOGASTIC TUBE (NG TUBE)

Front 42

SURGICAL PLACEMENT OF A FEEDING TUBE INTO THE STOMACH FOR NUTRITIONAL PURPOSES

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PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

Front 43

A DEEP LINE IS SURGICALLY PLACED INTO THE SUBCLAVIAN ARTERY AND NUTRITION IN A CLEAR SOLUTION IS DELIVERED DIRECTLY INTO THE CHAMBER OF THE HEART; SOMETIMES CALLED TOTAL PARENTERAL NUTRITION (TPN) OR PARENTERAL HYPERALIMANTATION

Back 43

PARENTERAL NUTRITION

Front 44

AS WE AGE (PRESBY-) THE CONTRACTIONS OF THE ESOPHAGEAL MUSCLES MAY SLOW DOWN

Back 44

PRESBYESOPHAGUS

Front 45

An x-ray procedure that obtains views of swallowing function that are then recorded on videotape

Back 45

Modified Barium Swallow Procedure

Front 46

determining the presence or absence of aspiration of material into the airway and assessing the movement of material into and through the upper portion of the esophagus

Back 46

Modified Barium Swallow procedure is useful for this

Front 47

A complete blockage of the upper airway by food or other objects, preventing a person from breathing effectively

Back 47

choking

Front 48

VFSS is used to document occurrence of aspiration, reasons for aspiration, and possible therapies for aspiration. In this study the infant is given breastmilk or formula mixed with liquid barium. The infant is placed in a feeding seat and the fluoroscope table is tilted so that the response of the pharyngeal area during feeding can be captured as a permanent video image

Back 48

Videofluoroscopic Swallowing Study (VFSS)

Front 49

Premature babies may be diagnosed with pediatric dysphagia if they develop irregular suck patterns during nursing. Toddlers and infants with cerebral palsy or a correctable cleft plate may also be diagnosed with pediatric dysphagia

Back 49

Who is diagnosed with Pediatric dysphagia

Front 50

Adding a small amount of rice cereal to infant formula or pumped breast milk may help dysphagia. Blending the formula/cereal mixture before adding it to a baby bottle can remove the lumps and make the mixture easier to suck through a nipple, as well as easier to swallow.
Do not cut holes in nipples, since this can increase the risk for choking and aspiration, as well as interfere with the baby's oral development. Future feeding and speech skills may be affected.
Baby foods should not be offered to infants from a spoon until they are at least 4 months old, since they do not have the proper coordination to swallow foods from a spoon until this age.
Your child's speech or occupational therapist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow

Back 50

Intervention for infants with swallowing disorders.