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50 Cards in this Set

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disorders affecting the oral preparatory and oral propulsive phases usually result from impaired control of the tongue.
Oral phase
If pharyngeal clearance is impaired severely, a patient may be unable to ingest sufficient amounts of food and drink to sustain life.
Pharyngeal phase
Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing.
Esophageal phase
Oral phase, Pharyngeal phase, Esophageal phase
3 phases of Swallowing
This happens when food enters the airway below the true vocal folds.
Aspiration
600 times a day
Approximately how may times do we swallow per day
People who aspirate are at risk for this.
pneumonia
percentage of patients with strokes have Dysphagia
51-73%
quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms.
factors influence the effects of aspiration
(1) Estimate the percentage of the total bolus aspirated (2) estimate the depth of bolus invasion into the airway.
aspiration described in 2 ways
PASSAGE OF FOOD OR NON-FOOD MATERIAL BELOW THE LEVEL OF THE VOCAL FOLDS
ASPIRATION
Pneumonia accounts for about __% of all stroke-related deaths and represents the third highest cause of death during the first month after a stroke
34%
IF A PERSON ASPIRATES INTO THE TRACHEA AND DOES NOT COUGH WE REFER TO THSI AS SILENT ASPIRATION
ASPIRATION SILENT
Among elderly patients, dysphagia may have particularly serious consequences, particularly in terms of ___________and ________ diseases.
Malnutrition and Respiratory Diseases
Difficulty in swallowing liquids is often suggestive of a ________ disorder or a sign of age-related swallowing difficulties.
Neurological
It has been estimated that as many as ___% of all children may manifest some type of nonspecified feeding difficulties.
25%
The first two stages are under ____________ control, whereas the second two stages are ___________ being under ________ control
voluntary, involuntary, reflexive
include a multitude of "conservative" measures, focused pharmacotherapies, and surgical interventions
therapeutic interventions
if it is because of disordered function, the dysfunction may have roots in neurosensory, neuromotor, or central processing functions
behavioral
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
Symptoms
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
Causes of feeding and swallowing problems
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.
What is the long-term outlook for a child with dysphagia?
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
treatment
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
intervention strategies for the SLP
The _____, ______, and ______ (superior cartilage of the larynx) lie at a higher level than in the adult
hyoid, larynx, and epiglottis
has been associatedwith apnea, choking, and a history of pneumonia inthe infant
Nasopharyngeal reflux
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
Diagnostic procedures
Disorders of the smooth muscle esophagus in children vary from those in adults to a lesser degree than the _______disorders; these pediatric lower
______________disorders
deglutitive & esophageal
_____,__________, 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
Drooling, sialorrhea
_________ _______during swallowing is an abnormal oral motor pattern that may contribute to abnormalities of deglutition, speech, and orofacial development
Tongue thrusting
_______ (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
Dysphagia
When esophageal dysmotility prevents the appropriate caudal movement of ingested material, the material's retrograde movement may result in ____________
regurgitation
Cardinal signs of oropharyngoesophageal dysmotility are signs of misdirection of swallowed material into the airway
Symptoms of Misdirection of Swallows into Airway
Palatal dysfunction can allow material into the nasopharynx.
Nasopharyngeal Regurgitation
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.
causes of chronic dysphagia
The wave-like motion that moves the bolus down the esophagus
peristalsis
Poor feeding, Difficulty chewing, Gagging, Vomiting during meals, etc.
symtoms of Feeding and Swallowing disorders in children and infants
<4mm (premature <3mm)
the size of a newborn's larynx
MOVEMENT OF CONTENTS OF THE STOMACH UP AND OUT OF THE STOMACH INTO THE ESOPHAGUS
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
A PROCEDURE IN WHICH AN ENDOSCOPE IS PASSED TRANSNASALLY INO THE PHARYNX FOR ASSESSSMENT OF SWALLOWING
FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)
FEEDING THROUGH A TUBE PLACED THROUGH THE NASAL PASSAGE LEADING TO THE STOMACH
NASOGASTIC TUBE (NG TUBE)
SURGICAL PLACEMENT OF A FEEDING TUBE INTO THE STOMACH FOR NUTRITIONAL PURPOSES
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)
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
PARENTERAL NUTRITION
AS WE AGE (PRESBY-) THE CONTRACTIONS OF THE ESOPHAGEAL MUSCLES MAY SLOW DOWN
PRESBYESOPHAGUS
An x-ray procedure that obtains views of swallowing function that are then recorded on videotape
Modified Barium Swallow Procedure
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
Modified Barium Swallow procedure is useful for this
A complete blockage of the upper airway by food or other objects, preventing a person from breathing effectively
choking
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
Videofluoroscopic Swallowing Study (VFSS)
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
Who is diagnosed with Pediatric dysphagia
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
Intervention for infants with swallowing disorders.