Slpa 966 - Swallowing - Exam 2

Front 1

What is the best EBP for dysarthria?

Back 1

Lee Silverman Voice Treatment (LSVT)

Front 2

What pharyngeal symptoms does someone with parkinsons display?

Back 2

-vallecular retention
-piriform sinus retention
-impaired laryngeal elevation
-penetration
-aspiration
-UES dysfunction

Front 3

What pharyngeal symptoms are present with brainstem stroke?

Back 3

-absent/delayed pharyngeal response
-reduced hyolaryngeal elevation
-reduced oropharyngeal constriction
-reduced pharyngeal constriction
-reduced laryngeal closure
-reduced pharyngoesophageal segment opening
-generalized incoordination

Front 4

What oral stage symptoms are present for ALS?

Back 4

-leakage
-mastication
-bolus formation
-bolus transport
-residual pooling

Front 5

What pharyngeal symptoms are present for ALS?

Back 5

-nasopharyngeal regurgitation
-vallecular pooling
-piriform sinus pooling
-airway spillage
-ineffective airway clearance (ventilators)
-shortness of breath

Front 6

What swallowing problems do people with dementia display?

Back 6

-oral stage dysfunction (and pharyngeal dysfunction)
-feeding limitations
-slow/delayed oral and pharyngeal movements

Front 7

rapid respiratory rate = what predicted swallowing dysfunction?

Back 7

-no airway protection during spillage
-aspiration before, during, or after

Front 8

weak cough = what predicted swallowing dysfunction?

Back 8

-aspiration during swallow
-ineffective clearance if aspiration

Front 9

coughs immediately after swallow = what predicted swallowing dysfunction?

Back 9

-spillage before swallow
-residue in vestibule (after the swallow aspirates)
-delay

Front 10

coughs after swallow (after 2-3 secs) = what predicted swallowing dysfunction?

Back 10

-reduced sensation
-GERDS (redness, edema)
-sensitivity issue

Front 11

food sticks = what predicted swallowing dysfunction?

Back 11

incomplete bolus clearance
(esophageal disorder)

Front 12

food backing up in throat = what predicted swallowing dysfunction?

Back 12

esophageal or gastro reflux
(esophageal disorder)

Front 13

hypernasal voice = what predicted swallowing dysfunction?

Back 13

-incomplete VP closure
-nasal reflux
(pharyngeal disorder)

Front 14

hoarse, breathy voice = what predicted swallowing dysfunction?

Back 14

-penetration/aspiration before or during the swallow
*breathy is only time you can get aspiration during the swallow
(pharyngeal disorder)

Front 15

wet vocal quality = what predicted swallowing dysfunction?

Back 15

aspiration of food, liquid, secretions after the swallow
(pharyngeal disorder)

Front 16

reduced pitch range = what predicted swallowing dysfunction?

Back 16

reduced sensitivity to aspiration
(pharyngeal disorder)

Front 17

What oral symptoms are present with parkinsons?

Back 17

-lingual tremor
*-repetitive tongue pumping (spillage)
-prolonged ramplike posture
-piecemeal (don't put all in 1 bolus)
-velar tremor
-buccal retention

Front 18

What are some considerations for subcortical damage for swallowing?

Back 18

-poor bolus transportation/control
-residue (oral, pharyngeal)
-severity dependent

Front 19

What are some esophageal disorders?

Back 19

-esophageal to pharyngeal backflow
-tracheoesophageal fistula (hole in wall between trachea and esophagus)
-stricture (narrowing of esophagus)
-diverticulum (pockets)
-zenker diverticulum (right below level of cricopharyngeus-- caused by weakness in lining of esophagus)

Front 20

What swallowing symptoms are present from hemispheric strokes?

Back 20

-initiation
-incoordination of oral movements
-delayed triggering of pharyngeal swallow
-increased pharyngeal transit time
-reduced pharyngeal contraction
-aspiration
-UES dysfunction

Front 21

What strategy should be used to prevent spillage?

Back 21

a chin tuck to widen valliculae to avoid aspiration

Front 22

Describe delayed/mistimed pharyngeal transit.

Back 22

-not oral-control issue
-sensory issue (late trigger, normal til epiglottis)

Front 23

What are some pharyngeal transit disorders?

Back 23

-nasal reflux/penetration
-bony spurs/outgrowth on posterior pharyngeal wall (calcifications)
-reduced pharyngeal contraction (will see residue)
-vallecular residue (decreased base of tongue retraction)
-residue at top of airway (decreased laryngeal elevation)
-laryngeal penetration and aspiration (reduced closure of airway entrance/laryngeal closure)
-residue in pyriform sinus
-residue throughout pharynx
-pharyngeal transit (over 1 sec)

Front 24

Describe spillage.

Back 24

-before the swallow (anterior or posterior)
-drooling (anterior)
-repeat tongue pumping (oral prep is complete, yet no or struggle to swallow)
-premature loss (tongue pumping involved chewing and lose it)
-long latency (swallow delay; can also have absent swallow response)

Front 25

Describe residue.

Back 25

-after the swallow
-nasal reflux/penetration (VP not working)
-reduced pharyngeal contraction (bilateral vs. unilateral)
-decreased base of tongue retraction, and/or inadequate hyoid elevation (vallecular residue)
-decreased laryngeal elevation (residue at top of airway)
-reduced closure of airway entrance/laryngeal closure (laryngeal penetration and aspiration)

Front 26

What are some oral prep disorders?

Back 26

-reduce lip closure (leakage)
-reduced range of tongue motion (cannot form bolus)
-reduced tongue shaping and coordination
-material in anterior/lateral sulcus (pocketing)
-abnormal hold position (tongue thrust)
-lack of initiation
-incoordination of oral movements (apraxia)
-slow oral movements
-lack of rotary jaw movements (primative, can't grind food)

Front 27

What are some oral transit disorders?

Back 27

-delayed oral onset (apraxia)
-reduced oral sensation (don't notice drooling or pocketing)
-residue in anterior (reduced labial tension/tone)/lateral (decreased buccal muscle tention) sulci
-tongue pumping
-residue on floor of mouth (reduced tongue shaping)
-residue on tongue (reduced tongue range/strength)
-disturbed lingual peristalsis (not smooth "wave")
-incomplete tongue to palate contact (decreased tongue elevation)

Front 28

cannot hold barium in mouth anteriorly = what impairment?

Back 28

reduced lip closure
(oral issue)

Front 29

cannot form bolus = what impairment?

Back 29

reduced tongue range/coordination
(oral issue)

Front 30

cannot chew = what impairment?

Back 30

reduced tongue lateralization
(oral issue)

Front 31

hesitancy initiating swallow = what impairment?

Back 31

impaired cognitive/neural function or oral sensation
(oral issue)

Front 32

stasis (residue) in buccal sulci = what impairment?

Back 32

reduced labial or buccal tension
(oral issue)

Front 33

premature spillage of bolus = what impairment?

Back 33

reduced tongue or palatal control
(oral issue)

Front 34

slow oral transit time = what impairment?

Back 34

impaired tongue movement
(oral issue)

Front 35

What type of issue is spillage?

Back 35

timing issue

Front 36

What type of issue is residue?

Back 36

strength issue

Front 37

Explain compensatory techniques.

Back 37

compensate for lost function
-goal: eliminate symptoms without changing the physiology of swallow
-use during meals (posture, food placement, presentation, rate, size of bolus,....)

Front 38

Explain facilitation/therapeutic techniques.

Back 38

improve function
-goal: change the swallowing physiology
-used during tx (oral-motor exercises, laryngeal elevation exercises, pharyngeal strengthening,....)

Front 39

List oral prep disorder.

Back 39

-bolus control issues

Front 40

List and describe bolus control issues (oral prep disorder).

Back 40

-reduced labial seal/tension (anterior spillage)
-reduced oral sensation (unaware of spillage/residue)
-diminished buccal tension (pocketing)
-decreased strength or range of tongue movement
-decreased oral coordination
-apraxia of swallow (struggle initiating and organizing swallow)

Front 41

List impaired tongue movement patterns (oral prep disorder).

Back 41

-minimal-diminished
-disorganized
-anterior tongue thrust (CP)
-lingual-rocking (parkinsons)
-piecemeal deglutition (small bits back, not full bolus)
-decreased back of tongue control

Front 42

List indirect approaches/activities for oral prep/oral phase.

Back 42

-oral motor exercises
-range of motion and resistance exercises
-IOPI (isometric tongue exercises)
-bolus control exercises (work on manipulation different bolus textures)
-sensory stimulation (taste, temp, pressure)

Front 43

List oral transit disorders.

Back 43

-impaired tongue movement patterns
-reduced oral coordination
-reduced oral sensation

Front 44

Name compensatory approaches for oral prep/transit.

Back 44

-heighten sensory awareness
-food placement (midline, stronger side)
-external buccal pressures/labial and chin support (compensates for decreased muscle tone)

Front 45

Name modified feeding activities.

Back 45

-appropriate seating (90 degrees)
-rate
-bolus placement
-downward pressure on tongue w/ spoon
-alternate liquids/solids
-multiple swallows
-tongue sweep
-larger volumes
-pre-swallow hydration
-self-feeding
-feeding aides
-educate family
-time meals (meds, fatigue)
-minimize distractions

Front 46

List pharyngeal disorders.

Back 46

-delayed onset of swallow
-inadequate VP closure
-reduced tongue base movement
-reduced laryngeal closure
-reduced laryngeal elevation (residue in pyriform sinus)
-cricopharyngeal dysfunction
-reduced pharyngeal contraction (residue in pharynx)
-generalized reduction in pharyngeal pressure (residue in pharynx)

Front 47

Name indirect/direct therapy approaches for delayed onset of pharyngeal swallow.

Back 47

-thermal-tactile stimulation
-thermogustatory stimulation (sour bolus)
-suck-swallow
-supraglottic swallow (hold breath during swallow)
-postural variations (chin down)
-diet modifications

Front 48

What approach would you use to improve swallow of pharyngeal disorders?

Back 48

effortful swallow

Front 49

What approaches would you use for decreased laryngeal closure?

Back 49

-vocal fold adduction exercises
-supraglottic swallow (hold breath during swallow)
-chin down (increase vallecular space, epiglottic protection)
-diet modifications

Front 50

What approaches would you use for laryngeal elevation/cricopharyngeal disorders?

Back 50

-shaker exercises (head bobs)
-mendelsohn maneuver (hold squeeze at top of swallow)
-mytomy (surgery, remove tissue on cricopharyngeus muscle)

Front 51

What approach would you use for decreased pharyngeal contraction?

Back 51

masako maneuver (tongue between teeth)

Front 52

What approaches would you use for decreased pharyngeal pressure?

Back 52

-posture changes
-positioning strategies to better side
-alternating liquid/solid
-multiple swallows
-small portions

Front 53

Name thickened liquids from most to least restrictive.

Back 53

-spoon-thick
-honey
-nectar
-thin

Front 54

List national dysphagia diet levels.

Back 54

-level 1: dysphagia pureed (cohesive food w/ little mastication)
-level 2: mechanically altered (semi-solid moist foods--oatmeal, soft veggies, wet-chopped meat)
-level 3: dysphagia advanced (bite-sized, require more mastication--well-moistened, not dry)
-level 4: regular diet

Front 55

Name short-term, non-surgical non-oral alternatives.

Back 55

-nasogastric tube (NG tube)
-dobhoff (nasojejunal tube--larger, short-term nasal tube)

Front 56

Name long-term or chronic need non-oral alternatives.

Back 56

-gastrostomy tube (G tube)
-percutaneous endoscopic gastrostomy (PEG tube--directly into stomach)
-jejunostomy (J tube--if patient is at-risk for reflux)

Front 57

What are possible concerns for non-oral alternatives?

Back 57

-nutritional needs being met?
-aspiration of tube feeding due to reflux
-aspiration of saliva/bacteria in mouth due to poor hygiene
-prone to infection or irritation
-gastric leakage

Front 58

What are the ASHA preferred practice guidelines for our role in esophageal stage?

Back 58

-swallowing assessment refers to esophageal stage
-collaborate between SLP and radiologists observations, impressions, and recommendations
-obligated to document observation of swallowing continuum in upright position
-play a key role in early detection
-facilitation and appropriate medical referrals for further eval
-can't diagnose but can describe what we see

Front 59

Describe GERD.

Back 59

Gastroesophageal reflux disease
-backflow from lower esophageal sphincter to UES
-relux of gastic contents from stomach to esophagus (to pharynx)