Pathophysiology Of Swallowing In Infants And Adults

Front 1

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

Back 1

Esophageal phase

Front 2

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

Back 2

Oral phase

Front 3

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

Back 3

Pharyngeal phase

Front 4

Residue at top of airway due to reduced laryngeal elevation
Laryngeal penetration and aspiration due to reduced closure of the airway entrance (arytenoid to base of epiglottis)
Aspiration during swallow due to reduced laryngeal closure
Stasis of residue in pyriform sinuses due to reduced anterior laryngeal pressure
Delayed pharyngeal transit time

Back 4

pharyngeal-phase swallowing symptoms and disorders

Front 5

Esophageal-to-pharyngeal backflow due to esophageal abnormality
Tracheoesophageal fistula
Zenker diverticulum
Reflux

Back 5

swallowing symptoms and disorders of the esophageal phase

Front 6

________ is the passage of food or liquid through the vocal folds.

Back 6

Aspiration

Front 7

People who aspirate are at increased risk for________ .

Back 7

pneumonia

Front 8

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

Back 8

Several factors influence the effects of aspiration

Front 9

__________ swallowing disorders are encountered more frequently in rehabilitation medicine than in most other medical specialties. functional recovery.

Back 9

Neurologic

Front 10

_____ is the leading cause of neurologic dysphagia.

Back 10

Stroke

Front 11

Approximately _____ of patients with stroke have dysphagia, which is the most significant risk factor for development of pneumonia.

Back 11

51-73%

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, although not all these cases of pneumonia are attributable to aspiration of food

Back 12

34%

Front 13

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

Back 13

severity of aspiration can be described in 2 ways

Front 14

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 mealtime

Back 14

Causes of feeding and swallowing problems

Front 15

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 Liquid leaking out the nose Gagging Vomiting during meals Increased congestion during meals Increased fussiness or crying during meals Accepting only certain types of food (only pureed foods or only crunchy foods) Poor weight gain Frequent respiratory infections or pneumonia (may occur when food or liquid is aspirated into the airway, rather than swallowed effectively)

Back 15

Symptoms

Front 16

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 16

Treatment

Front 17

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 17

SLP's focus of intervention

Front 18

difficulty trying to swallow
choking or breathing saliva into your lungs while swallowing
coughing while swallowing
regurgitating liquid through your nose
breathing in food while swallowing
weak voice
weight loss

Back 18

oropharyngeal dysphagia

Front 19

pressure sensation in your mid-chest area
sensation of food stuck in your throat
weight loss
chest pain
pain with swallowing
belching
chronic cough
sore throat
bad breath

Back 19

esophageal dysphagia

Front 20

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

Back 20

Nasopharyngeal reflux

Front 21

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 21

Intervention for infants with swallowing disorders.

Front 22

_______________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 22

Premature babies

Front 23

______ 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 23

Videofluoroscopic Swallowing Study (VFSS)

Front 24

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

Back 24

Modified Barium Swallow Procedure

Front 25

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 25

PARENTERAL NUTRITION

Front 26

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

Back 26

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

Front 27

FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)

Back 27

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

Front 28

NASOGASTIC TUBE (NG TUBE)

Back 28

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

Front 29

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

Back 29

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Front 30

the size of a newborn's larynx

Back 30

<4mm (premature <3mm

Front 31

_______ dysphagia is described as being a result of inflammatory conditions such as pharyngitis or tonsilitis.

Back 31

Acute

Front 32

Progressive dysphagia may indicate a neuromuscular disease or a ______.

Back 32

tumor

Front 33

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

Back 33

25%

Front 34

Deglutition

Back 34

________ is the act of swallowing in which a food or liquid bolus is transported from the mouth through the pharynx and esophagus into the stomach.

Front 35

8-20

Back 35

Esophageal stage lasts this long

Front 36

1. reduced range of tongue motion
2. reduced buccal tension/buccal scarring
3. poor maxillary/mandibular alignment
4. poor dentition/mandibular defects
5. disorders involved in muscles of mastication

Back 36

Disorders of mastication include

Front 37

+ Slight increase in time required to trigger reflexive
swallow (0.4 sec)
+ Oral transit time and cricopharyngeal opening time
slightly prolonged

Back 37

age affects on swalling for adults

Front 38

Suckle feeding: multiple tongue-pumping of small amounts of liquid from nipple which collects in posterior oral cavity and valleculae before pharyngeal swallow occurs.

Back 38

age affects on swallowing for infants

Front 39

*1/3 size at birth
*Narrow dimensions of subglottisand glottis
*subglottisis the narrowest (4-5mm in diameter)
*Higher in the neck
*C4 at birth vsC6-7 at 15 y/o
*Epiglottis is narrower

Back 39

Differences in Adults vs Infants

Front 40

50% of population needing assistance with swallowing

Back 40

Percentage of elderly population with dysphagia in elderly facility

Front 41

An older adult needs to take in____________________ calories per kilogram of normal" body weight.

Back 41

25-30

Front 42

A loss of skeletal muscle mass that is related to age is called_________________.

Back 42

Sarcopenia

Front 43

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

Back 43

ASPIRATION

Front 44

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

Back 44

ASPIRATION SILENT

Front 45

WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

Back 45

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

Front 46

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

Back 46

NASOGASTIC TUBE (NG TUBE)

Front 47

WHAT IS PARENTERAL NUTRITION?

Back 47

A PATIENT'S TOTAL CALORIC NEEDS ARE BEING MET BY INTRAVENOUS ROUTE

Front 48

Signs-Leakage of food or liquid from the mouth, food collecting between the gums and the cheek, reduced or poorly coordinated tongue movements preventing food from forming a bolus and moving food from the front to the back of the mouth, prolonged chewing due to pain in the mouth, reduced sensation or muscular weakness.
Symptoms-Difficulty moving food or liquids to the back of the tongue or pain in the mouth on chewing

Back 48

Preparation (oral) phase problems (Sign & Symptoms)

Front 49

Signs-Delayed swallowing phase, choking and coughing before, during or after the swallow, ‘gurgly’ quality to the voice after drinking due to material entering the larynx, nasal regurgitation or copious sputum.
Symptoms-A sensation of food ‘sticking’ at the mouth or throat, feeling of choking or pain in the throat on swallowing.

Back 49

Swallowing and pharyngeal phase problems(Sign & Symptoms)

Front 50

Signs-Usually none unless aspiration is causing repeated chest infections.
Symptoms-Sensation of food sticking in the chest or abdomen that is worse with solid food (the level of the sensation invariably matches the site of the blockage), pain on swallowing or heartburn due to reflux of stomach contents into the esophagus.

Back 50

Esophageal phase problems(Sign & Symptoms)