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50 Cards in this Set

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Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing.
Esophageal phase
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
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
pharyngeal-phase swallowing symptoms and disorders
Esophageal-to-pharyngeal backflow due to esophageal abnormality
Tracheoesophageal fistula
Zenker diverticulum
Reflux
swallowing symptoms and disorders of the esophageal phase
________ is the passage of food or liquid through the vocal folds.
Aspiration
People who aspirate are at increased risk for________ .
pneumonia
quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms.
Several factors influence the effects of aspiration
__________ swallowing disorders are encountered more frequently in rehabilitation medicine than in most other medical specialties. functional recovery.
Neurologic
_____ is the leading cause of neurologic dysphagia.
Stroke
Approximately _____ of patients with stroke have dysphagia, which is the most significant risk factor for development of pneumonia.
51-73%
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
34%
(1) Estimate the percentage of the total bolus aspirated or (2) estimate the depth of bolus invasion into the airway
severity of aspiration can be described in 2 ways
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
Causes of feeding and swallowing problems
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)
Symptoms
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
SLP's focus of intervention
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
oropharyngeal dysphagia
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
esophageal dysphagia
has been associatedwith apnea, choking, and a history of pneumonia in the infant
Nasopharyngeal reflux
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.
_______________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
Premature babies
______ 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)
An x-ray procedure that obtains views of swallowing function that are then recorded on videotape
Modified Barium Swallow Procedure
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
SURGICAL PLACEMENT OF A FEEDING TUBE INTO THE STOMACH FOR NUTRITIONAL PURPOSES
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)
FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)
A PROCEDURE IN WHICH AN ENDOSCOPE IS PASSED TRANSNASALLY INO THE PHARYNX FOR ASSESSSMENT OF SWALLOWING
NASOGASTIC TUBE (NG TUBE)
FEEDING THROUGH A TUBE PLACED THROUGH THE NASAL PASSAGE LEADING TO THE STOMACH
MOVEMENT OF CONTENTS OF THE STOMACH UP AND OUT OF THE STOMACH INTO THE ESOPHAGUS
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
the size of a newborn's larynx
<4mm (premature <3mm
_______ dysphagia is described as being a result of inflammatory conditions such as pharyngitis or tonsilitis.
Acute
Progressive dysphagia may indicate a neuromuscular disease or a ______.
tumor
It has been estimated that as many as ___ of all children may manifest some type of nonspecified feeding difficulties.
25%
Deglutition
________ 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.
8-20
Esophageal stage lasts this long
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
Disorders of mastication include
+ Slight increase in time required to trigger reflexive
swallow (0.4 sec)
+ Oral transit time and cricopharyngeal opening time
slightly prolonged
age affects on swalling for adults
Suckle feeding: multiple tongue-pumping of small amounts of liquid from nipple which collects in posterior oral cavity and valleculae before pharyngeal swallow occurs.
age affects on swallowing for infants
*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
Differences in Adults vs Infants
50% of population needing assistance with swallowing
Percentage of elderly population with dysphagia in elderly facility
An older adult needs to take in____________________ calories per kilogram of normal" body weight.
25-30
A loss of skeletal muscle mass that is related to age is called_________________.
Sarcopenia
PASSAGE OF FOOD OR NON-FOOD MATERIAL BELOW THE LEVEL OF THE VOCAL FOLDS
ASPIRATION
IF A PERSON ASPIRATES INTO THE TRACHEA AND DOES NOT COUGH WE REFER TO THSI AS SILENT ASPIRATION
ASPIRATION SILENT
WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?
MOVEMENT OF CONTENTS OF THE STOMACH UP AND OUT OF THE STOMACH INTO THE ESOPHAGUS
FEEDING THROUGH A TUBE PLACED THROUGH THE NASAL PASSAGE LEADING TO THE STOMACH
NASOGASTIC TUBE (NG TUBE)
WHAT IS PARENTERAL NUTRITION?
A PATIENT'S TOTAL CALORIC NEEDS ARE BEING MET BY INTRAVENOUS ROUTE
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
Preparation (oral) phase problems (Sign & Symptoms)
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.
Swallowing and pharyngeal phase problems(Sign & Symptoms)
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.
Esophageal phase problems(Sign & Symptoms)