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49 Cards in this Set
- Front
- Back
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Define dysphagia.
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-difficulty moving food from mouth to stomach
-may include behavioral, sensory, and preliminary motor acts |
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What function does CN V Trigeminal serve during swallowing? Swallowing problems?
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-important for chewing
-both sensory and motor to the face |
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What function does CN VII Facial serve during swallowing? Swallowing problems?
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-both sensory and motor
-important for sensation of oropharynx and taste to anterior 2/3 of tongue |
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What function does CN IX Glossopharyngeal serve during swallowing? Swallowing problems?
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-both sensory and motor
-important for taste to posterior tongue, sensory, and motor functions of the pharynx |
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What function does CN X Vagus serve during swallowing? Swallowing problems?
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-both sensory and motor
-important for taste to oropharynx, and sensation and motor function to larynx and laryngopharynx -important for airway protection |
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What function does CN XII Hypoglossal serve during swallowing? Swallowing problems?
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-contains motor fibers that primarily innervate the tongue
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What are the 4 phases of swallowing?
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-oral prep
-oral transit -pharyngeal -esophageal |
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What is the purpose of oral prep?
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to prepare food for oral transit
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What is the purpose of oral transit?
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get bolus from mouth to pharynx
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What is the purpose of pharyngeal phase?
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get bolus from pharynx to esophagus
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What is the purpose of esophageal phase?
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get bolus from esophagus to stomach
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How long to does oral prepatory take?
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varies depending on food type
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How long does oral transit take?
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1 second
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How long does pharyngeal phase take?
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1 second
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How long does esophageal phase take?
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8-20 seconds
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What structures are involved in the pharyngeal stage?
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-soft palate
-base of tongue -pharyngeal wall -laryngeal mechanism |
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What is the difference between feeding and swallowing?
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feeding- plate to mouth
swallowing- lips to stomach |
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What structures are involved in oral preparatory?
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-lips
-tongue -jaw -cheeks -back of tongue -soft palate |
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What is the function of the soft palate in the pharyngeal transit?
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-elevates and retracts to form VP closure
-prevents nasal reflux and builds up normal pressure in the pharyngeal cavity |
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What is the function of the base of tongue in pharyngeal transit?
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retracts to pharyngeal wall
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What is the function of the pharyngeal wall in pharyngeal transit?
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shortens and stiffens
-contracts (circular) from top to bottom |
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What is the function of the laryngeal mechanism in pharyngeal transit?
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-VF adductions
-laryngeal elevation --epiglottis- desemination --cricopharyngeal opening (vagus stops firing to relax this) -arytenoids- tilt toward epiglottis (closes off laryngeal vestibule) |
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What are the structures involved in oral preparatory? and their functions?
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-lips (seal)
-tongue (lateralizes- mixes saliva + food=bolus) -jaw (rotary-grinding) -cheeks (some tension) -back of tongue (up) -soft palate (bulges down and forward) |
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What are the structures involved in oral transit? and their functions?
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-lips (seal)
-tongue (tip to alveolar ridge, forms trough, wave motion) -cheeks (compression, prevents pocketing) |
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What are the structures involved in esophageal phase? and their functions?
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-criocopharyngeal (closes, contracts to prevent reflux)
-esophagus (top to bottom contraction- peristalsis) |
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What are the boundaries of the laryngeal vestibule?
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-epiglottis (anterior)
-arytenoids (posterior) -aryepiglottic folds (sides) -true VFs (floor) |
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Where is the pyriform sinus located?
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between pharyngeal wall and arytenoids (lower in pharyngeal cavity)
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Where is the vallecula located?
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where base of tongue meets epiglottis
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What is penetration?
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when material enters below laryngeal vestibule (above VFs)
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What is aspiration?
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material enters airway (passes below VFs)
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What are the benefits of the MBS?
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-considered gold standard in clinical assessment of dysphagia
-dynamic measure, provides thorough evaluation of biomechanics -only comprehensive assessment of all 4 phases of swallowing -readily accessible in hospitals |
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What are the limitations of MBS?
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-radiation (don't want repeat trials)
-aspiration documented but not the effects -difficulty in appreciation of airway closure mechanism -limited access outside hospital setting -access based on very short period of measurement in unfamiliar environment |
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What are warning signs that a person may have swallowing problems?
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-change in voice
-weakness (facial droop, tongue pressure) -coughing, choking -repetitive swallows -regurgitation -fullness, tightness in throat -pain -weight loss -changes in salivation -appetite changes -sleep disturbances -malnurished, dehydrated -history of pneumonia -wet vocal quality post swallow -dysarthria -abnormal gag -cough post swallow |
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What is the purpose of the clinical evaluation of swallow (bedside)?
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-determine presence/absence of dysphagia (if so, how severe?)
-information regarding etiology (ALS-degenerative, stroke-recovery) -determine severity, prognosis (how likely and quickly to recover), and responsiveness to therapy (try tx approaches to see if they work) -determine dysphagia symptoms (what the disorder) -determine appropriate diagnostic tools (laryngeal and esophageal--need instrumentation, MBS, FEES, none?) -determine therapy techniques and/or strategies (plan) (need for alternative means of nutrition management) |
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What are the goals of instrumental swallowing evaluations?
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-preceded by clinical assessment
-provides info on anatomy and physiology of structures and muscles used in swallowing -evaluate the ability of patients to swallow various materials -assess secretions and the patient's reaction to them (usually done at beginning) -document adequacy of airway protection and coordination between respiration and swallowing -help evaluate the impact of compensatory therapy maneuvers on swallowing function and airway protection -look for period of normal apnea -need to be able to tell why they are aspirating |
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What are the purposes of instrumental swallowing examination?
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-image structures of upper Aero digestive tract (at-rest)
-assess movement patterns of swallowing to formulate inferences regarding physiologic integrity (e.g., speed, symmetry, range, strength, sensation, coordination) -assess swallowing related movement patterns of structures in the upper Aero digestive tract (effectiveness [ability to clear cavities] and safety [how well they maintain hydration, nutrition, and airway protection]) -identify and describe any airway compromise such as aspiration/penetration and the circumstance under which these occur -evaluate impact of compensatory maneuvers to improve swallowing safety and efficiency -identify and describe any pooled secretions within the hypopharynx and larynx. include description about patient's ability to move or clear with swallows or coughing/clearing activities -complete a cursory evaluation of esophageal anatomy and physiology to identify any esophageal contributors to dysphagia symptoms -assist in forming clinical recommendations, including type of nutrtion or hydration intake, safest and most efficient dietary level, feeding modification or therapeutic intervention |
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True or false: Feeding modification should be a last resort.
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True
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What amount of material is presented for a barium swallow? MBS?
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barium= cup
MBS= spoon trials (varies) |
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What type of consistency is presented for a barium swallow? MBS?
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barium= liquid
MBS= liquid, puree, solid |
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What position is the patient placed in for a barium swallow? MBS?
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barium= anterior/posterior or supine
MBS= AP/lateral |
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What is the purpose of a barium swallow? MBS?
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barium= assess structural abnormalities, esophageal, presence of aspiration
MBS= determine presence and specific swallowing disorder tx (identify: behavior, disorder, tx) |
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What phases does a CBE assess? MBS?
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CBE= oral prep, oral transit
MBS= all phases |
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What food items are presented for a CBE? MBS?
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CBE= real food
MBS= food with barium |
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What does the CBE tell us about penetration/aspiration? MBS?
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CBE= infer; do not know cause
MBS= can identify location, temporal events, and disorder |
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What observations during CBE indicate DEFINITE need for instrumental assessment?
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-CBE fails to address clinical questions posed by patient
-dysphagia characteristics are vague and require confirmation -nutritional or respiratory issues indicate suspicion of dysphagia -safety or efficiency of swallowing is a concern -direction for swallowing rehab is needed -help is needed to assess underlying medical problems (no confirmed dx) |
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What observations during CBE indicate POSSIBLE need for instrumental assessment?
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-patient has medical condition that has a high risk for dysphagia (e.g., brainstem damage, premature babies)
-follow function demonstrates a change -patient is unable to cooperate for a clinical exam |
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What observations during CBE indicate NO need for instrumental assessment?
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-patient no longer has dysphagia complaints
-patient's condition is too medically compromised or the patient is too uncooperative -clinician's judgment is that the exam would not alter clinical course or management plan |
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What are some highly reliable measures that assess oral function? (know 4)
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-tongue strength
-tongue range -lip strength -jaw range -oral mucosa -dentition -strength of cough -dysarthria -intelligibility |
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What are some highly reliable measures that assess laryngeal function? (know 4)
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-phonation, vocal quality (not gurgle, breathy, harsh)
-rapid alternating movements using consonant-vowel combos -hypernasal versus hyponasal -dry swallow- laryngeal elevation |
