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50 Cards in this Set

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The Normal Swallow
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.
Swallowing involves:
...voluntary and involuntary neuromuscular contractions proceeding from the mouth to the stomach and is commonly divided into oropharyngeal and esophageal stages
Oropharyngeal Stage
The oropharyngeal stage of deglutition begins with contractions of the tongue and striated muscles of mastication. The muscles work in a coordinated fashion to mix the food bolus with saliva and propel it from the anterior oral cavity into the oropharynyx, where the involuntary swallowing reflex is triggeredThe cerebellum controls output for the motor nuclei of cranial nerves V, VII and XII. The entire sequence lasts about one second.
What cranial nerves are involved in swallowing in the oropharyngeal stage?
The cerebellum controls output for the motor nuclei of cranial nerves V, VII and XII.
In the oropharyngeal stage the soft palate_____________.
The cerebellum controls output for the motor nuclei of cranial nerves V, VII and XII. The entire sequence lasts about one second.The epiglottis moves downward to cover the airway while striated pharyngeal muscles contract to move the food bolus past the cricopharyngeus muscle (the physiologic upper esophageal sphincter and into the proximal esophagus (Figure 1C).
How long does the swallowing ___________ last in the orolaryngeal phase?
This swallowing reflex lasts approximately one second and involves the motor and sensory tracts from cranial nerves IX and X.
Esophageal Stage
As food is propelled from the pharynx into the esophagus, involuntary contractions of the skeletal muscles of the upper esophagus force the bolus through the mid and distal esophagus. The medulla controls this involuntary swallowing reflex, although voluntary swallowing may be initiated by the cerebral cortex. The lower esophageal sphincter relaxes at the initiation of the swallow, and this relaxation persists until the food bolus is propelled into the stomach. It may take eight to 20 seconds for the contractions to drive the bolus into the stomach.
Etiology/Causes of Dysphagia
The causes of dysphagia vary from neurological factors, illness, brainstem/trauma to the head/injuries, etc...

stroke
traumatic brain injury
cerebral palsy
dementia (including Alzheimer's disease )
Parkinson's disease
progressive supranuclear palsy
Huntington's disease
Wilson's disease
torticollis
motor neuron disease
multiple sclerosis
neoplasms and other structural disorders
poliomyelitis and postpolio syndrome
infectious disorders
Guillain-Barre syndrome and other polyneuropathies
myasthenia gravis
myopathy
iatrogenic oral/pharyngeal dysphagia
Conditions/Symtems of Dysphagia
- difficulty swallowing
3- hoarsness
Dysphagia in the Elderly
Age-related changes in intestinal innervation may contribute to gastrointestinal disorders that are seen with increased incidence in the elderly. These include dysphagia, gastroesophageal reflux disease and constipation.
Contributing factors of dysphagia in the elderly.
Immobility, comorbidity, and medication side effects also contribute to these conditions
The most common __________________ disorder in the elder is dysphagia.
Dysphagia, the most common esophageal disorder in the elderly, may be described as the subjective awareness of difficulty in swallowing, caused by impaired progression of matter from the pharynx to the stomach.3
Symptoms of Dysphagia in the elderly can include:
- coughing or choking
- change in voice
- repetitive swallowing or need to clear voice
- regurgitation
- weakness in head and/or neck
oropharyngeal dysphagia (OD) - What is it?
Difficulty in initiating swallowing or transferring food from the oropharynx to the upper esophagus.
esophageal dysphagia (ED) - What is it?
difficulty in swallowing that occurs when ingested material cannot be transported from the hypopharynx through the esophagus into the stomach.4 In people older than 60, the prevalence of dysphagia is 15% to 40%.
What do motor responses in the elderly have to do with dysphagia?
The elderly experience a slowing of performance of fine and gross motor tasks. That is, in older people, healthy swallowing occurs more slowly, while remaining coordinated and effective. A decline in the reaction time to sensory stimuli and a relatively asymptomatic decline in oropharyngeal motor performance are observed in seniors.3,6 They also have more pharyngeal residue, indicating longer exposure of the glottis to the swallowed bolus in the elderly
Dysphagia can be considered a _______________________ disorder of ___________ flow.
biomechanical & bolus

Dysphagia is a biomechanical disorder of bolus flow that occurs when organic lesions or functional impairment of the nervous system or musculature impedes the transport of liquids and solids
OD/ ______________ results from abnormal function of the _________________.
_______________ & esophagus


OD results from abnormal function proximal to the esophagus and usually occurs in those with neurologic or muscular disorders that affect the skeletal muscles (e.g., stroke, Parkinson's disease, Alzheimer's disease, muscular dystrophy).
Patient Evaluation and Diagnostic Testing
look for evidence of a systemic neurological disorder and evaluate speech and swallowing function to identify the aspiration risk in patients with OD
Misconceptions about the gag reflex test concerning dysphagia.
Although commonly performed, the gag reflex test, which evaluates the afferent activity of the glossopharyngeal nerve, is a poor predictor for aspiration.
What should be done when the cause of dysphagia is not apparent?
When the cause of dysphagia is not apparent, clinicians should consider benign (e.g., peptic strictures) or malignant (e.g., esophageal carcinomas) structural diseases.9 Initially, a patient may be referred for a barium swallow (barium solution or barium-coated food), along with videofluoroscopy, which uses continuous x-rays to view the barium as it passes through the pharynx, esophagus, and stomach.4,10 An upper endoscopy allows biopsies and inspection of the mucosa of the esophagus. Esophageal manometry allows documentation of abnormal motility (e.g., esophageal spasm) as a cause of dysphagia
Treatment
After identifying causes of dysphagia, the goals are to identify and maintain safe swallowing techniques, prevent aspiration, and provide adequate nutritional support.
Why is dealing with Alzheimer's disease a difficult task for family members and caretakers which may involve dysphagia?
Patients with Alzheimer's disease may not be able to swallow food and fluids when they reach the final stages of dementia and dysphagia; thus, their families are faced with difficult decisions surrounding artificial nutrition and hydration, and gastrostomy tube placement may be needed in those with severe dysphagia and recurrent aspiration.4
In the elderly neurological causes of dysphagia may include: ___________________.....
stroke, neurodegenerative disorders, dementia,
How do certain medications impact the onset of dysphagia?
Medications such as bisphoshinets,
potassium chloride, NDAIDS, aspirins, quinidine, ferrous compounds
Why are medications linked to a greater propensisty for dysphagia in the elderly?
Because the elderly take more medications, spend more time in recumbent positions, and have reduced salivary productions, they are more likely to be adversely affected by dysphagia then other age groups.
What is one simple/basic reason for increaed risk in the elderly for dysphagia?
One basic reason for increased risk is that the elderly do not drink enough water when they take medication.
What should those who prescribe and administer medication to the elderly be sure to inform patients and/or avoid?
If a patient in a recumbent position ingests a tablet or capsule with less than 15 mL of water, the medication's passage through the esophagus is hampered.8 Patients should be discouraged from taking medications at bedtime with small sips of water.
Which medicatiion are most likely to cause injury to the esophagous?
Potassium chloride and quinidine and tetracycline preparations are the agents most likely to cause esophageal injury resulting in strictures.
Feeding and Swallowing Disorders in Infants and Children
Esophageal-to-pharyngeal backflow due to esophageal abnormality
Tracheoesophageal fistula
Zenker diverticulum
Reflux
Coordination in the brainstem, cortex, and periphery is necessary to facilitate the highly complex and intricately related breathing and swallowing processes in terms of central control and function
True
No age-related differences exist in breathing and swallowing coordination.
False
The time of apnea onset may vary with the swallowing tasks, but it is obligatory at the initiation of the pharyngeal swallow.
True
The nasal cavity, pharyngeal cavity, velopharyngeal port, and the tongue base demonstrate dual roles during breathing and swallowing.
True
Causes of feeding and swallowing problems in infants and/or children.
premature birth,
cerapalsy,
autism,
face and neck weaknesses,
multiple medical problems,
respriatory problems, and more
Symptoms of dysphagia in children and infants.
Symptoms of dysphagia in children can include, but are not limited to poor feeding, difficulty chewing, coughing or choking while feeding or drinking, gagging, difficulty breast feeding, excessive drooling, vomiting during meals, liquid leaking from nose, inceased congestion during feeding, accepting only certain types of food, weigh loss and more.
Dysphagia is only organic in nature.
False

The cause of dysphagia may be organic or behavioral; if organic, it may be because of disordered anatomy or function; if it is because of disordered function, the dysfunction may have roots in neurosensory, neuromotor, or central
Why is it necessary for the SLP to develop an accurate and thorough medical history?
A general medical history is crucial. It may disclose, for example, predispositions to secondary esophageal motor disorders (e.g., esophageal atresia, collagen vascular disorders, caustic ingestions, sclerotherapy, allergic esophageal dysmotility); suggestions of more diffuse gut motility (e.g., slowed stooling in early botulism); a travel history permitting exposure (e.g., to Chagas' disease); trauma to the head and neck (including the iatrogenic "trauma" of tracheotomy); potentially pertinent medications (e.g., benzodiazepines such as nitrazepam); and so forth
Assessing oral, pharyngeal, and esophageal motor disorders in infants and children is complicated because...
Because the symptoms of dysphagia can without thorough assessment can be misdiagnosed for some other illness or disorder and because dysphagia can be connected with many other illnesses or disorders.
Etiologies of pediatric dysphagia
Dysphagia or swallowing dysfunction with children occurs more frequently with neurological, respiratory, or anatomical problems
Can dysphagia occur during the oral stage of swallowing?
Yes

Dysphagia can occur during the oral stage of swallowing that involves moving the food from the front to the back of the mouth before swallowing.
Present an example of one whay children may demonstrate/have dysphagai during the oral stage of swallowing.
Children with low muscle tone may have weak or uncoordinated tongue movements resulting in prolonged mealtimes or even choking with liquids because food spills in the airway before the swallow has been initiated.
Describe dysphagia in an infant/child during the pharyngeal stage of swallowing.
Dysphagia can also occur during the pharyngeal stage of swallowing as food is transiting from the hypopharynx to the upper esophageal sphincter. There are many components of the pharyngeal stage that can potentially be disrupted and result in risk for aspiration. For example, while the larynx is elevating, the vocal cords are closing to protect the airway, or the pharyngeal muscles are moving in a wave like motion to move food into the esophagus. Low muscle tone can impact the muscles in the pharynx (pharyngeal constrictors) creating weak peristalsis and solid foods may be more difficult to clear from the throat.
Is dysphagia associated with infants/children with respiratory prolems? Explain
Yes.

Dysphagia can also occur during the pharyngeal stage of swallowing as food is transiting from the hypopharynx to the upper esophageal sphincter. There are many components of the pharyngeal stage that can potentially be disrupted and result in risk for aspiration. For example, while the larynx is elevating, the vocal cords are closing to protect the airway, or the pharyngeal muscles are moving in a wave like motion to move food into the esophagus. Low muscle tone can impact the muscles in the pharynx (pharyngeal constrictors) creating weak peristalsis and solid foods may be more difficult to clear from the throat.
List some red flags for sensory-based feeding problems:
No problems with taking liquids
Gag on foods that require chewing
Will separate textures from smooth food and pocket or expel them
Able to bite and chew solid foods, but not swallow them
May try to swallow foods whole to avoid contact for chewing
Hypersensitive gag only with solids and not with liquids
Intervention for sensory-based feeding problems
In many instances therapy is helpful. A speech-language pathologist or occupational therapist that is trained in pediatric feeding problems can implement an oral-sensory treatment program to help desensitize the infant and reduce the sensitive gag response to textures. Also, the therapist can assist the parent with activities to transition the child to age-appropriate textures and tastes of food.
What is the speech therapist have a role in dysphagia?
Yes
Are feeding disorders in children associated with dysphagia?
Yes, in many instances because a child has dysphagia he/she will demonstrate difficulty with feeding as a sypmptom of dysphagia.
Common intervention strategies for SLPs in addressing pediatric feeding difficulties.
oral motor therapy focused on maintaining and developing the infant or child's feeding skills.
As an SLP what would be some possible recommendations you would make to a parent for a child with dysphagia and feeding is a problem. The parent is concerned about their child's weight.
I would inform the parent that pureed foods, thicken liquids, nutritional supplements, dysphagia cups are some of the alternaltives to aide their child in feeding. I would further inform the parent that force feeding should NOT BE DONE.