The Third Big Quiz - Bleh.

Front 1

What is the most prevalent swallowing disorder in patients with closed head trauma?

Back 1

Delay triggering the pharyngeal swallow

Front 2

What is the most prevalent swallowing disorder in patients with stroke?

Back 2

Delay triggering the pharyngeal swallow

Front 3

How is the length of coma related to the severity of swallowing problems?

Back 3

The longer the coma, the more severe the swallowing problems (yeah, that one made you feel good, didn’t it?)

Front 4

Patients with closed head injury have complex swallowing problems due to the combination of _____________, ____________, and ______________.

Back 4

Closed head injury, damage to other parts of the body, and nature of emergency care.

Front 5

Neurogenic damage can be caused by what three forces?

Back 5

Direct head injury, contra-coup injury, and twisting/shearing of the brainstem

Front 6

Patients with head trauma may experience other injuries including ____________, _____________, and _______________.

Back 6

Puncture woulds to the neck, laryngeal fracture, and penetration wounds to the chest (affecting the esophagus)

Front 7

Patients receiving emergency care may be injured by ____________ or _____________.

Back 7

Tracheostomy - may be placed to high scarring the larynx. Intubation - forceful intubation can also damage the larynx.

Front 8

What are four oral swallowing disorders seen in those with closed head injury?

Back 8

Reduced lip closure, reduced tongue ROM (with poor bolus control), abnormal oral reflexes (including bite reflex), and delayed/absent pharyngeal swallow.

Front 9

What are eight pharyngeal swallowing disorders seen in those with closed head trauma?

Back 9

Reduced laryngeal elevation, reduced closure of airway entrance, reduced closure of airway throughout, reduced tongue base motion, reduced CP opening (usually related to reduced laryngeal motion), uni/bilateral pharyngeal wall weakness, tracheoesophageal fistula, reduced velopharyngeal closure.

Front 10

In patients with closed head injuries, reduced airway closure and reduced CP opening (due to poor laryngeal motion) are generally related to ______________ instead of neurologic damage.

Back 10

Physical damage to the larynx

Front 11

What are some patient characteristics which affect swallowing in those with closed head injury?

Back 11

Impulsiveness, tendency to overstuff mouth, cognitive difficulties, reduced sensation.

Front 12

True or False: The recovery of swallowing after closed head injury is well documented

Back 12

False: One study showed recovery over time but it was based on bedside evaluation (Gasp! No radiographic study?!)

Front 13

True or False: Patients of any age will develop complications from aspirating over a short period of time

Back 13

False: Younger patients can aspirate (especially on liquids) with no apparent consequences for a year or more.

Front 14

Why is it important to counsel the family regarding swallowing and dietary changes during the acute phase?

Back 14

Because if you wait until the rehabilitation stage, the patient and family may not comply with your recommendations.

Front 15

If a patient with closed head injury has cognitive deficits __________________ will be easier to use than _____________.

Back 15

Postures and sensory heightening will be easier than voluntary maneuvers.

Front 16

True or False: Most patients with closed head injury will need to use voluntary maneuvers in order to manage their swallowing disorders.

Back 16

False: Because the most common disorders are delayed pharyngeal swallow and reduced range/coordination of tongue motion and these can be addressed using other methods.

Front 17

Initial therapy tasks for patients with cognitive deficits include…

Back 17

sensory heightening strategies, resistance exercises, range of motion exercises.

Front 18

When working with family members of patients with closed head injuries, it is crucial to explain the _______________.

Back 18

Goal of each therapy task and compensatory strategy.

Front 19

True or False: If you determine that a patient has reached a plateau and dismiss them from therapy while on non-oral or limited oral feeding, that patient will not be able to return to a full oral diet.

Back 19

False: You should re-evaluate the patient every 6 mos. to 1 year. It is possible that the patient will recover swallowing function after a longer period of time.

Front 20

In patients with cervical spinal cord injuries, swallowing disorders are usually __________ in nature.

Back 20

Pharyngeal

Front 21

Common swallowing disorders in patients with cervical spinal cord injuries include (5):

Back 21

Delayed triggering of pharyngeal swallow, reduced laryngeal elevation, reduced anterior movement of the larynx (causes reduced UES opening), reduced tongue base motion, and uni/bilateral pharyngeal wall dysfunction.

Front 22

Damage to CV 4,5, or 6 will often result in…

Back 22

Poor laryngeal motion leading to poor UES opening

Front 23

Damage to CV 1 or 2 will result in…

Back 23

No sensory awareness of swallowing difficulties

Front 24

True or False: Patients with cervical spinal cord injury may have difficulty closing the airway entrance.

Back 24

True: This is usually related to poor laryngeal elevation or anterior movement

Front 25

True or False: Patients with cervical spinal injury don't generally have trouble closing the airway at the vocal folds.

Back 25

True: This is infrequent in this population. When it does occur, it is generally related to direct laryngeal damage (Intubation, trachostomy placement, prolonged trach)

Front 26

When patients have SCI damage at or above C3, they may require _______________.

Back 26

Mechanical ventilation

Front 27

Name reasons patients with cervical SCI are difficult to assess at bedside

Back 27

Patients may require mechanical ventilation (cuffed trach) and when the damage is above C5 the swallowing disorders are generall pharyngeal so you can't observe it at bedside.

Front 28

If a patient is wearing a head/neck brace, during X-Ray you may need to _________________.

Back 28

Angle the patient 15-30 degrees because the brace may shadow certain parts of the anatomy.

Front 29

With cervical SCI patients, what procedures will you use during the radiographic study?

Back 29

Postural changes are often not possible, sensory heightening and voluntary maneuvers are the most helpful.

Front 30

What are the effects of cervical bracing on the swallow?

Back 30

Not yet identified in dysphagic patients, but some studies conducted on individuals with normal swallow. These patients report a worsening of the swallow when wearing a brace but the only significant change is LONGER airway closure.

Front 31

Swallowing becomes more difficult when cervical bracing positions the head in what ways?

Back 31

If the chin is pulled back / chin or head is retracted on the neck, also if head is extended.

Front 32

Following an anterior cervical fusion, patients may suffer from what swallowing issues?

Back 32

Swelling of posterior pharyngeal wall, reduced laryngeal elevation/anterior movement (resulting in reduced closure of airway entrance and reduced CP opening), reduced uni/bilateral pharyngeal wall movement, and possible oral stage problems/delayed triggering of pharyngeal swallow.

Front 33

Swallowing problems in patients with anterior cervical fusion are caused by…

Back 33

Trauma to peripheral nerves, swelling, and reactions to hardware in the neck

Front 34

What is the recovery pattern for swallowing in patients with anterior cervical fusion?

Back 34

Patients generally recover significantly in 3 months or less. You should determine intervention strategies to allow for oral intake in the meantime.

Front 35

What are the most helpful techniques for patients with anterior cervical fusion?

Back 35

Generally compensatory techniques are useful because the swallow is likely to recover spontaneously. Most helpful are: Mendelsohn manuever, supraglottic swallow, super supraglottic swallow. (Remember, postures = ouch!)

Front 36

Damage to the [part of brainstem] will lead to significant swallowing problems including ____________________.

Back 36

Medulla / complete inability to trigger pharyngeal swallow

Front 37

Patients with damage to the medulla may benefit from what techniques?

Back 37

Sensory heightening because the issue is often a problem triggering the pharyngeal swallow. Try Thermal-Tactile Stim and/or Suck-Swallow technique.

Front 38

What is the goal of sensory heightening techniques?

Back 38

To lower the threshold of the swallowing center in the central nervous system

Front 39

Following removal or acoustic neuroma or other tumor from a cranial nerve, there may be damage to cranial nerves ____, ____, ____, ____, and possibly ____.

Back 39

VIII, IX, X, XII and VII

Front 40

Symptoms of cranial nerve damage following neurosurgical procedures will be __________ and may include…

Back 40

UNILATERAL, facial weakness, pharyngeal wall paresis/paralysis, soft palate weakness, vocal fold adductor paralysis, tongue paresis

Front 41

Damage to cranial nerve IX will often result in…

Back 41

Delayed triggering of the pharyngeal swallow

Front 42

As cranial nerve damage usually results in _________ problems, patients will often benefit from ______________________.

Back 42

Unilateral / postures: head rotated to the damaged side or chin down to protect the airway during delay.

Front 43

In addition to compensatory strategies, patients with cranial nerve damage benefit from…

Back 43

ROM and resistance exercises for lips, oral tongye, tongue base and larynx (Falsetto, effortful swallow, super-supraglottic swallow)

Front 44

Patients who are cognitively intact should practice exercises ______ times per day for ______.

Back 44

10 / 5 minutes

Front 45

Poliomyelitis may lead to disturbances in what stage of the swallow?

Back 45

Both Oral and Pharyngeal

Front 46

What oral stage swallowing disturbances may result from poliomyelitis (2)?

Back 46

Reduced lingual control of bolus, disturbed pattern of bolus propulsion

Front 47

What pharyngeal stage swallowing disturbances may result from poliomyelitis (3)?

Back 47

Reduced pharyngeal contraction, Unilateral pharyngeal paralysis, Reduced velopharyngeal closure (leading to nasal regurgitation)

Front 48

Guillan-Barre is a ____________ causing rapid onset of paresis which may progress to…

Back 48

Viral-based disease / complete paralysis requiring tracheostomy and mechanical ventilation.

Front 49

Swallowing difficulty is occasionally the first sign of __________ and is soon followed by general weakness and paralysis.

Back 49

Guillan-Barre

Front 50

What will be observed during radiographic study in patients with Guillan-Barre?

Back 50

Generalized weakness in oral and pharyngeal swallow; reduced ROM of oral tongue, tongue base, and larynx.

Front 51

Therapy for patients with Guillan-Barre should begin with…

Back 51

Gentle resistance and ROM exercises, increasing effort as the patient improves.

Front 52

Respiration is originally unstable in patients with Guillan-Barre, so ________________ should be postponed. Later on _____________ are helpful.

Back 52

Swallowing therapy or maneuvers that prolong airway closure; Supraglottic swallow or Mendelsohn.

Front 53

Patients with cerebral palsy may exhibit (4 characteristics)…

Back 53

Inappropriate oral reflexive behaviors; inability to hold cohesive bolus; disorganized lingual movements (bolus not propelled smoothly); pieces of food may spread out during chewing (premature spillage)

Front 54

Patients with cerebral palsy may be placed into which three categories of swallowing disorders?

Back 54

Moderate to severe oral function problems; oral function problems + delay triggering pharyngeal swallow; oral function problems + delayed PS + neuromuscular abnormalities during PS

Front 55

Most children with cerebral palsy fall into the category of swallowing disorders characterized by… This means which consistencies will be challenging?

Back 55

Oral function problems + Delayed PS / foods requiring chewing will be a challenge due to oral motor issues while thin liquids will also be difficult due to pharyngeal delay

Front 56

What three oral function problems are commonly observed in patients with cerebral palsy?

Back 56

Reduced lip closure, tongue thrust, reduced tongue coordination

Front 57

Patients with cerebral palsy may exhibit what 3 neuromuscular abnormalities once the pharyngeal swallow is triggered?

Back 57

Reduced tongue base retraction; reduced laryngeal elevation; significant residue after swallow leading to aspiration (this group may aspirate on every consistency)

Front 58

Management of swallowing disorders in patients with cerebral palsy commonly includes…

Back 58

Oral motor therapy; thermal tactile stim; diet change to thickened liquids and purees (LAST OPTION)

Front 59

TRUE or FALSE: Cricopharyngeal dysfunction is rarely a problem in patients with cerebral palsy

Back 59

TRUE: Myotomy should not be attempted unless other options have been exhausted. As the child grows the larynx will also drop and this may improve opening of the UES.

Front 60

Do patients with cerebral palsy generally suffer from aspiration DURING the swallow?

Back 60

No, generally laryngeal closure is adequate

Front 61

When does aspiration generally occur in patients with cerebral palsy? What causes it?

Back 61

BEFORE the swallow: reduced tongue control and delayed pharyngeal swallow / AFTER the swallow: residue left due to poor tongue base action and reduced laryngeal elevation.

Front 62

Dysautonomia is also known as ____________ and is a ____________ disease with widespread effects including…

Back 62

Riley-Day Syndrome / Inherited / autonomic inbalance, sensory deficits, motor incoordination, certain episodic phenomena

Front 63

Patients with Riley-Day syndrome suffer from what type of swallowing problems?

Back 63

Milder problems - reduction of oral tongue control and reduced tongue base and pharyngeal wall motion. More severe problems - oral involvement and delayed triggering of pharyngeal swallow.

Front 64

Patients with Riley-Day syndrome may require a G-tube because…

Back 64

1) Delayed PS - patient may not handle thin liquids and G-tube will be needed for hydration. 2) Dysfunctional LES places the patient at risk for reflux. A G-tube decreases this risk.

Front 65

Swallowing therapy for patients with Riley-Day syndrome may include…

Back 65

Oral motor therapy to improve toney function, thermal-tactile stim to help with triggering of pharyngeal swallow.

Front 66

Techniques to design to improve SPECIFIC swallowing disorders include (7):

Back 66

Surgical reduction of osteophytes; vocal fold medialization; injection of material into the vocal fold to include closure; laryngeal suspension; dilation of scar tissue in CP area; cricopharyngeal myotomy; botox injection into spastic CP

Front 67

Cervical osteophytes may cause swallowing disorders due to…

Back 67

1) Displacement of posterior pharyngeal wall which may interrupt bolus flow, 2) pressing on nerves which creates a sense of dysphagia.

Front 68

Cervical osteophytes may be surgically removed but there are two possible disadvantages

Back 68

1) Scar tissue will be created, 2) Possilbe surgical trauma to nerves innervating swallowing structures

Front 69

After a patient with insufficient airway protection attempts exercises, a surgical option to protect the airway is…

Back 69

To inject the damaged fold with material to improve closure / Vocal fold medialization surgery

Front 70

_____ % of aspiration is caused by poor vocal fold closure

Back 70

10% or less

Front 71

Laryngeal suspension is used for patients with [swallowing disorder]. It is sometimes used in patients with [medical diagnosis] but rarely in _________ patients.

Back 71

Reduced laryngeal elevation; Head and neck cancer patients; Neurologic patients

Front 72

__________ are mercury-filled soft rubber tubes used to dilate scar tissue in the CP region.

Back 72

Bougies

Front 73

The effects of scar-tissue dilation are ________, lasting __________.

Back 73

Temporary / 1-3 months

Front 74

Dilation of the CP region is generally NOT effective when the cause of the CP dysfunction is…

Back 74

Neurologic damage

Front 75

Describe the surgical procedure for a CP myotomy

Back 75

External incision made through the neck (usually left side); CP fibers are slit from top to bottom usually at posterior midline; May extend upward to inferior constrictor and downward into the upper esophageal musculature.

Front 76

Improvement of the swallow following a CP myotomy is reported in _______& of cases.

Back 76

60-78%

Front 77

What is the criteria for candidates for CP myotomy?

Back 77

1) CP dysfunction must be the predominant problem; 2) Patient must be able to move material through the oral and pharyngeal stages of the swallow; 3) Patient must be able to voluntarily close airway during the swallow.

Front 78

What effect does a CP myotomy have if performed as a preventative measure at the time of oncologic procedure?

Back 78

Study found no difference in post-operative swallowing for patients who did/did not receive a preventative myotomy.

Front 79

When a CP myotomy alone does not fix the swallowing problem, what can be used?

Back 79

Head-rotation to the unoperated side (helps with opening UES and directs food to more "open" side). Also, Mendelsohn Maneuver can be used to prolong lanrygeal elevation.

Front 80

CP Myotomy is counterindicated for patients with…

Back 80

Multiple dysfunctions of the vocal tract - reduced lingual control, delayed pharyngeal swallow, reduced pharyngeal contraction - on top of CP dysfunction.

Front 81

Complications of a CP myotomy include…

Back 81

Hemorrhage, recurrent laryngeal nerve damage, complications from surgically opening the neck.

Front 82

What are two disadvantages of Botulinum Toxin injection for relaxation of the CP?

Back 82

1) Difficult to accurately place the injection - CP is hidden behind cricoid cartilage, 2) Inaccurate injection can paralyze other muscles in the area worsening the dysphagia.

Front 83

List six procedures used to control unremitting aspiration

Back 83

Epiglottic pull-down, suturing vocal folds together, suturing false vocal folds together, laryngeal bypass / tracheoesophageal diversion, tracheostomy, total laryngectomy

Front 84

What is an advantage and disadvantage to epiglottic pull-down?

Back 84

AD: It is potentially reversible; DIS: The epiglottis commonly pulls away, making the procedure unsuccessful

Front 85

What is the procedure and disadvantages for suturing the vocal folds together?

Back 85

The epethelium is stripped and the vocal folds are sewn shut. They often tear apart making the procedure unsuccessful. Also, it is usually irreversible.

Front 86

What are some advantages to suturing the false vocal folds together to control unremitting aspiration?

Back 86

The false folds are less likely to tear apart than the true vocal folds. Also, this procesure is usually reversible.

Front 87

For a tracheoesophageal diversion, the cut is generally made at ________ and this is a ___________ procedure.

Back 87

3rd-4th tracheal ring / relatively permanent

Front 88

A total laryngectomy is only used to control aspiration when…

Back 88

There is no other solution for aspiration - it is a permanent procedure.

Front 89

All non-oral feeding types place the patient at higher risk for _______________.

Back 89

Gastroesophageal Reflux

Front 90

In patients with NG tubes, each feeding is usually followed by…

Back 90

120-240 cc of water to cleanse the tube and ensure adequate hydration

Front 91

What is the name for a smaller-diameter NG tube that can be used to help prevent irritation and reflux?

Back 91

A Dobhoff tube

Front 92

Disadvantages of NG tubes include:

Back 92

1) Physical presence of the tube is irritating; 2) Potential for reflux; and 3) Feedings usually prepared = expensive

Front 93

True or False: Data indicates that the presence of an NG tube changes the physiology of the swallow.

Back 93

FALSE

Front 94

An NG tube is generally temporary, replaced by a more permanent solution in _____ months if the patient can't transition back to oral feeding.

Back 94

3-4 months

Front 95

List six options for non-oral feeding:

Back 95

NG tube, pharyngostomy, esophagostomy, gastrostomy, jejunostomy, and fundoplication

Front 96

What are the advantages and disadvantages of pharyngostomy / esophagostomy?

Back 96

AD: No tube through the nose - less irritating and more socially acceptable. DIS: Creation of scar tissue

Front 97

What are the advantages and disadvantages of gastrostomy?

Back 97

AD: Patient can take blender-prepped foods through the tube. This is a long-term solution to severe swallowing problems. DIS: Stoma site can leak, become infected/sore.

Front 98

What are the advantages and disadvantages of jejunostomy?

Back 98

AD: It reduces the risk of reflux. DIS: Requires prepared feedings which is more expensive.

Front 99

Children with gastrostomy or jejunostomy require an additional procedure to reinforce the LES by wrapping the top of the stomach around it. What is this procedure called?

Back 99

Fundoplication

Front 100

A patient needs non-oral feeding if they aspirate more than ______ of all food consistencies or take longer than ______ seconds to swallow a single bolus of all food types despite therapeutic intervention.

Back 100

10% / 10

Front 101

The most common etiology of dysphagia of unknown origin is…

Back 101

Neurologic disease

Front 102

Which patients are most at risk for a combination of oropharyngeal and esophageal disorders?

Back 102

Those over 60 and children with congenital neurologic impairment.

Front 103

Who is responsible for esophageal assessment?

Back 103

Gastroenterologist

Front 104

The neurologic evalaluation will focus on ______________________.

Back 104

Cranial nerves innervating muscles of swallowing and symptoms of neurologic disease which may lead to dysphagia.

Front 105

Who is responsible for a structural evaluation of the head and neck as well as sensorimotor assessment ofpharynx and larynx?

Back 105

Otolaryngologist

Front 106

What team member will be enlisted if a patient has a history of recurrent or recent pneumonia?

Back 106

Pulmonologist

Front 107

Which team member is crucial for patients in rehab centers? What does this person do?

Back 107

Physiatrist - helps fit the dysphagia rehabilitation plan into the patient's overall rehab schedule.

Front 108

The Gerontologist is responsible for…

Back 108

Determining REALISTIC goals for the patient as well as monitoring whether combinations of medications are contributing to the dysphagia.

Front 109

Who makes prosthetic devices?

Back 109

The Maxillofacial Prosthodontist

Front 110

The physical therapist assists with…

Back 110

Optimal positioning of the patient during meals

Front 111

The occupational therapist can assist with…

Back 111

Providing assistive devices for eating

Front 112

What are the responsibilities of the dietician?

Back 112

Monitoring blood chemistry, weight, and ensuring adequate nutrition.

Front 113

Which team member decides when to transition the patient back to oral feeding?

Back 113

Swallowing therapist + Dietician + Attending Physician

Front 114

Provide an inservice for the respiratory and nursing staff to educate them on _________________.

Back 114

Signs and symptoms of dysphagia

Front 115

Provide an inservice for staff members responsible for feeding the patient to educate them on ___________________________.

Back 115

Complexity of normal swallowing physiology, range of swallowing disorders, and the need for INDIVIDUALIZED feeding plans.

Front 116

When establishing the radiographic procedure, be prepared to explain what three things?

Back 116

1) The necessary radiographic procedure; 2) The rationale for all aspects of the procedure; 3) The ways it differs from a standard barium swallow/upper GI exam.

Front 117

There are generally three fees to factor into the cost of the radiographic procedure. They are…

Back 117

The room fee, the radiologist's fee, and the swallowing therapist's fee

Front 118

What have studies shown about the cost and efficiency of dysphagia care using a multidisciplinary approach?

Back 118

There is not a lot of data in terms of cost OR reduced rates of pneumonia, improved nutrition, and hydration.

Front 119

Rehabilitation for laryngeal cancer patients became more common in the (decade) when _____________ was introduced as an alternative to _____________.

Back 119

1950s / partial laryngectomy / total laryngectomy

Front 120

When considering whether to use laryngeal preservation strategies in the treatment of cancer, Weiss suggests that _______________ is crucial

Back 120

The patient's perception of quality of life (so, when possible try to preserve the larynx)

Front 121

Tumors in the larynx may be managed by ____________ or ___________ with ___________ as an adjuvant therapy

Back 121

Radiation or Surgery / Chemotherapy

Front 122

For smaller tumors on the vocal folds, ___________ is often the treatment of choice. Cure rates for this treatment when compared to surgery are…

Back 122

Radiotherapy / usually equal

Front 123

The larynx is divided into three sections in which tumors may occur. What are these sections and what percentage of laryngeal tumors occur in each?

Back 123

1) Supraglottis (35% of laryngeal tumors); 2) Glottis (60% of laryngeal tumors); and 3) Subglottic area (5% of laryngeal tumors here)

Front 124

What does T1N0M0 mean?

Back 124

A small tumor with no nodal involvment or distal metastasis

Front 125

Who stages the tumor in head and neck cancer? At what point in the process?

Back 125

The primary physician (usually otolaryngologist or general surgeon). It is staged prior to treatment.

Front 126

The TMN staging system allows for comparison of ________________________

Back 126

Results of therapy across various patients suffering from the same tumor

Front 127

Will a supraglottic laryngeal tumor spread inferiorly? Why?

Back 127

Only if it is at the base of the epiglottis / Because of the pattern of lymphatic drainage in the larynx.

Front 128

True or False: There is not much known about tumors of the larynx

Back 128

False: these have been studied extensively

Front 129

In the oral cavity, a margin of 1.5 - 2 cm of normal tissue is the rule when removing tumors. Does this hold true for the larynx as well?

Back 129

No - more is known about how laryngeal tumors spread so that rule is not always followed in the larynx. A 2-cm margin of normal tissue is always left at the upper end of a laryngeal resection, though.

Front 130

Smaller supraglottic tumors may involve [list three structures] and are usually treated with ________________________.

Back 130

Epiglottis, aryepiglottic folds, or false vocal folds / Partial laryngectomy (horizontal AKA supraglottic laryngectomy)

Front 131

A supraglottic tumor which extends below the false vocal folds may require a resection that includes part or all of the _____________ and ____________ superiorly and the ___________ and ______________ inferiorly.

Back 131

Hyoid, epiglottis / aryepiglottic folds, false vocal folds

Front 132

If a supraglottic tumor extends onto the false vocal folds, will the entire ventricle be removed?

Back 132

No, only the upper half - do not need the 2-cm margin in this case because of pattern of lymphatic drainage (and supraglottic tumors tend to spread laterally not inferiorly)

Front 133

A standard supraglottic laryngectomy removes the structures which contribute to _____________. These structures are [list three]. Another structure removed is the _________. What is left as a protective mechanism?

Back 133

Airway protection / epiglottis, aryepiglottic folds, false vocal folds / hyoid bone / base of tongue, arytenoids, and true vocal folds.

Front 134

During reconstruction following supraglottic laryngectomy, the surgeon will often ________________________________.

Back 134

Elevate the remaining larynx and tuck it under the tongue base for additional protection during the swallow.

Front 135

In patients with a supraglottic laryngectomy, what will be different about the swallow? What strategy can be used for both compensation and exercise?

Back 135

The patient will now close the airway entrance by retracting the tongue base to contact the arytenoids. Laryngeal elevation will also be impaired (because hyoid bone is partially or completely removed)

Front 136

In patients with a supraglottic laryngectomy, what will happen if the tongue base does not come into complete contact with the posterior pharyngeal wall?

Back 136

There will be residue left over which will fall directly in the airway after the swallow - the patient has no valleculae anymore and pyriform sinuses will be smaller than usual.

Front 137

Patients whose supraglottic laryngectomy is extended into the base of the tongue will have what issues? What is a big concern in these patients?

Back 137

Food and liquid will tend to fall onto the closed airway entrance or on top of the vocal folds. A big concern is whether laryngeal elevation is sufficient to deflect this spillage and direct it into the esophagus.

Front 138

Patients with laryngeal suspension (following superglottic laryngectomy) may have what two problems? What can be used in rehab?

Back 138

1) Reduced lingual movement; 2) Reduced control of bolus. You can use ROM and bolus control exercises in therapy.

Front 139

What are some sensory issues in patients with supraglottic larygectomy?

Back 139

Sensation of the larynx may be reduced due to sacrifice of one superior laryngeal nerve - reduced cough reflex, patient unaware of aspiration, delayed pharyngeal swallow is also possible

Front 140

The supraglottic laryngectomy can be extended inferiorly to include _____________ and occasionally ____________. What does this mean about the patient's recovering a normal swallow?

Back 140

Part of one true vocal fold / part or all of on arytenoid cartilage / This means that the patient has even less tissue with which to protect the airway - changes of recovering normal swallow without chronic aspiration is diminished.

Front 141

Long term follow-up of patients with standard supraglottic laryngectomy showed what results?

Back 141

1) Regained normal swallowing with no aspiration during or after the swallow; 2) Able to swallow normal diet at ~ 1 month post; 3) Some patients took 3-6 months to recover oral intake.

Front 142

Long term follow-up of patients with supraglottic laryngectomy extended to include part or all of one arytenoid revealed what results?

Back 142

1) Minimum of 2 months (most often 6-12 mos.) attempting rehab; 2) Several never able to drink liquids without significant aspiration and required trach indefinitely

Front 143

Long term follow-up of patients with supraglottic laryngectomy extended into tongue base revealed what results?

Back 143

1) Significantly longer to return to oral intake (6 months or longer); 2) Larger resections of tongue may make airway protection impossible - may need to be converted to total laryngectomy

Front 144

Following supraglottic laryngectomy, patients who do not achieve complete airway entrance closure at first should be put on a program of __________________. This will geneally have an effect within _________ after initiation. Some patients will progress slower but attain airway protection _________ after surgery with continued exercise.

Back 144

Tongue base and arytenoid ROM exercise / 2-4 weeks / 3-4 months

Front 145

Following supraglottic laryngectomy, patients with good tongue base action will generally rehabilitate to a normal swallow within ________ postoperatively if they can learn instructions for _________________.

Back 145

1 month / super-supraglottic swallow

Front 146

One criteria for selecting a supraglottic laryngectomy is that the patient must __________________

Back 146

Have the capability of relearning the swallow sequence (those with mental disorders or who cannot follow a sequence of instructions are not good candidates)

Front 147

Rademaker found that during recovery after a partial laryngectomy, patients who had not attained oral intake before _____________ took significantly longer to do so.

Back 147

Beginning radiotherapy

Front 148

In patients with partial laryngectomy (if possible), the onset of radiotherapy should be delayed until _________________.

Back 148

Oral intake is reinstated

Front 149

Tumors located on the free margin of one vocal fold with only local extension are generally treated using [three options]

Back 149

Vertical laryngectomy, hemilaryngectomy, or extended laryngectomy

Front 150

The hemilaryngectomy involves physical removal of one vertical half of the larynx including [four structures]. The [three structures] are usually left intact.

Back 150

One false fold, one ventricle, one true vocal fold and a portion of the thyroid cartilage on the side of the resection / Hyoid bone, epiglottis, arytenoid

Front 151

The patient who has undergone a typical hemilaryngectomy should experience _________ swallowing difficulties because…

Back 151

Few / the unoperated side can attain normal laryngeal closure against the unoperated side because some tissue bulk is reconstructed on the side of the resection following removal of structures.

Front 152

After a typical hemilaryngectomy, the surgeon will reconstruct by adding tissue to the operated side. In order for the patient to have a normal swallow, the added tissue must be ______________.

Back 152

At the same level as the normal vocal fold (to achieve closure)

Front 153

Patients with a hemilaryngectomy sometimes have aspiration during the swallow (temporary). This can be compensated for by ______________. If there is still aspiration, __________ can be attemped or ___________________________. The patient may need to do this for [time] postoperatively.

Back 153

Chin down / head rotated to operated side / combination of chin down + head rotated which gives the best airway protection / only a few weeks

Front 154

In some patients with laryngeal tumors, the tumor is located anteriorly so that the ___[structure]____ needs to be included in the resection. In this case, the procedure is known as a ______________ and means that _________[area]________ is removed.

Back 154

Anterior commissure / frontolateral laryngectomy / Anterior 1/3 of the larynx on both sides (in addition to the entire operated side)

Front 155

How do surgeons typically reconstruct following a frontolateral laryngectomy?

Back 155

Bulk of tissue (ie. From strap muscles) placed on the operated side to give the normal side something to contact. The epiglottis, hyoid remain so that larynx can elevate. Both arytenoid cartilages are also present.

Front 156

Patients who have undergone a frontolateral laryngectomy often recover within ____[time]____ but more of them will require a ____________ initially to prevent aspiration when compared to patients with typical hemilaryngectomy.

Back 156

2-3 weeks post-operatively / chin-down posture

Front 157

In a patient needing a hemilaryngectomy, it is possible that the resection will need to include ~ 1/2 of the other side of the larynx. This is called a _____________________.

Back 157

3/4 laryngectomy

Front 158

Patients with a 3/4 laryngectomy will generally have sufficient airway protection because [three reasons] but they often need _____________ initially to make eating safe. Also, some will need ____________ to improve airway protection over time.

Back 158

1) Arytenoids are present; 2) Normal epiglottis and hyoid; 3) Tissue bulk added to the operated side during reconstruction / chin-down and head rotated postures / adduction exercises or super-supraglottic swallow

Front 159

In patients with hemilaryngectomy, chances of returning to normal swallow without aspiration are greatly decreased if the __________ is included in the resection.

Back 159

Arytenoid cartilage (ie. When lesion extends more posteriorly)

Front 160

Long-term study of patients with limited hemilaryngectomy revealed what results?

Back 160

Normal swallow generally within one week after initiation of oral feeding postoperatively

Front 161

Long term study of patients with extended hemilaryngectomy (including arytenoid) revealed what results?

Back 161

Experienced much longer rehabilitation period than those with limited hemilaryngectomy. Some were not able to manage liquids - aspiration during the swallow (needed permanent trach).

Front 162

Patients with the arytenoid resected as part of an extended hemilaryngectomy generally require _____________ as well as ______________________ to facilitate swallowing without aspiration during the swallow.

Back 162

Adduction exercises / chin-down + head rotated posture

Front 163

______________ is a major problem in any extended partial laryngectomy procedure.

Back 163

Preventing aspiration

Front 164

Larger laryngeal lesions (T3 or T4) or those involving more than one region of the larynx usually require ________________ or ________________________.

Back 164

Total laryngectomy; High-dose radiation with or without chemotherapy.

Front 165

True or False: Patients who have undergone a total laryngectomy are at risk for aspiration after the procedure.

Back 165

False: there is a physical separation of the GI tract from the respiratory tract.

Front 166

Swallowing problems following total laryngectomy are related to…

Back 166

1) Nature of closure (pseudoepiglottis); 2) Tightness of surgical closure; 3) gross anatomical differences (if pharyngectomy or esophagectomy is included)

Front 167

A pseudoepiglottis is ____________________ following total laryngectomy.

Back 167

A fold of tissue left at the base of the tongue

Front 168

What are two explanations for the appearance of a pseudoepiglottis following total laryngectomy?

Back 168

1) That it is caused by vertical closure of the defect because the base of tongue must be stretched vertically; 2) That the suture line at the base of the tongue breaks down from tension caused by tongue movement

Front 169

On lateral fluorscopy, the pseudoepiglotts appears as a ____________________________. The greater the struggle, the greater the widening of this pocket.

Back 169

Pocket at the base of the tongue which collects food and liquid during swallowing

Front 170

Some total laryngectomees are restricted to _____________ because of a pseudoepiglottis

Back 170

Liquid consistency

Front 171

Total laryngectomy patients with lesions in the pyriform sinus or hypopharynx will require extensive resection of ___________. This can lead to a tighter closure forming _________________.

Back 171

Pharyngeal mucosa / scar tissue in the esopagus

Front 172

The major treatment for tight closure following total laryngectomy is ____________ but the effects are temporary.

Back 172

Dilitation - patients asked to swallow increasingly larger mercury-filled rubber catheters to stretch the tissue.

Front 173

A surgical option for tight closure following total laryngectomy is ___________ (described by Singer and Blom) but may also impact _______________________________.

Back 173

Pharyngoesophageal myotomy / esophageal voice

Front 174

Although there are no exercises to improve stricture following total laryngectomy, ________________ may stretch and open the narrowed area if other options are not feasible.

Back 174

Changing head position (head rotation)

Front 175

Following total laryngectomy, both a pseudoepiglottis and a stricture can cause _________________ as the patient struggles to swallow.

Back 175

Backflow of food

Front 176

Greater swallowing problems will occur if _____________ or _____________ is included along with a total laryngectomy. These problems can sometimes be managed by ___________.

Back 176

Pharyngectomy / esophagestomy (ie. Backflow of food) / postural changes.

Front 177

If a patient with total laryngectomy has not returned to full diet after ________, a radiographic procedure is needed to identify _____________.

Back 177

2 months / structural abnormalities

Front 178

In terms of treatment, a pseudoepiglottis may be __________ while a stricture may be ____________.

Back 178

Surgically removed / dilated

Front 179

If a total laryngectomy patient returns after months or years with swallowing complaints (but were originally eating well) what should you do?

Back 179

Have them return to their surgeon immediately as this is a sign of possible recurrence

Front 180

In total laryngectomy patients, a number of surgical and prosthetic devices have been used to try to ______________________________. A major problem with most of these methods is ____________________.

Back 180

Reconnect the pulmonary outflow to the pharyngoesophagus (for voicing options) / aspiration of food into the trachea from the esophagus

Front 181

True or False: The Staffieri neoglottis procedure is frequently used to provide voicing options in total laryngectomy patients

Back 181

FALSE: You want to kill your patients, don't you (This procedure is not used anymore because it resulted in aspiration in most patients)

Front 182

The most successful surgical method of providing voicing options to total laryngectomees is the ___________________. What does it involve?

Back 182

Tracheoesophageal Puncture Procedure / involves placing a small prosthesis in a puncture that connects the trachea with the esophagus below vibratory portion. This is a one-way valve so air can be pushed into the esophagus for voicing but food will not flow from the esophagus to the trachea - no aspiration!

Front 183

True or False: The Panje procedure is similar to using a TEP and is a successful way of restoring voicing to patients with total laryngectomy.

Back 183

TRUE

Front 184

In the TEP procedure (Singer and Blom), what can you do if the patient IS aspirating?

Back 184

Cauterize the puncture site to narrow it and get a better fit for the prosthesis.

Front 185

Candidates for Singer and Blom's TEP procedure may need a ________________ to prevent pharyngospasm.

Back 185

Myotomy (much broader than your basic CP myotomy)

Front 186

Two options for reducing pharyngospasm in patients using a TEP are…

Back 186

1) Myotomy - pharyngeal muscles are cut which may mean diffuse residue left in the pharynx after the swallow; 2) Neurectomy - nerve supply cut to pharyngeal wall.

Front 187

After a total laryngectomy, patients may experience minor changes in swallowing including _______________

Back 187

Increased lingual pressure (to compensate for absence of larynx and reduced pharyngeal wall function)

Front 188

When treated with radiotherapy for small laryngeal tumors (T1, T2), patients may experience _________ voice change (such as _____________) and changes in _____________.

Back 188

Temporary / roughness or hoarseness / salivary flow

Front 189

The radiation field used for high-dose laryngeal exposure extends from ______________________________

Back 189

The oropharynx to the top of the esophagus

Front 190

What are the effects of high-dose laryngeal radiation therapy (6,000-7,000 cGy) w/ chemo on swallowing?

Back 190

Significantly reduced laryngeal elevation and pharyngeal wall motion (advanced laryngeal cancer patients) - laryngeal motion needed for UES opening!!

Front 191

Issues caused by radiation may not arise until years later and are thought to be caused by…

Back 191

The process of fibrosis of the tissues resulting from damage to capillaries feeding muscle fibers in the radiated area

Front 192

Pretreatment counseling is needed for laryngeal cancer patients to ensure the patient is aware of __________________________________.

Back 192

Possible changes in voice and swallowing that may occur after treatment

Front 193

For laryngeal cancer patients who will receive radiation, it is generally best for them to begin __________________ exercises before or at the beginning to radiotherapy. These should be done _______ times per day for ________ minutes each and should be continued throughout radiotherapy and after.

Back 193

ROM exercises for tongue base and laryngeal elevation / 5-10 times / 10 minutes

Front 194

Two types of neurologic disorders that affect swallowing are:

Back 194

1) Those that occur suddenly and 2) Those that are degenerative in nature

Front 195

True or False: In sudden-onset neurologic disorders causing swallowing difficulty (stroke, TBI, etc.), the patient is expected to recover

Back 195

True (at least in part)

Front 196

Degenerative neurologic conditions will cause…

Back 196

Gradual deterioration of swallowing ability over time

Front 197

In patients who are expected to improve, what three questions should you consider?

Back 197

1) What therapy should be initiated to normalize swallowing physiology? 2) Will the patient be able to eat a normal diet and when? 3) Is the patient's recovery typical of people with this type of lesion?

Front 198

For patients with degenerative neurologic conditions, what four questions should you consider?

Back 198

1) Are there typical changes in swallowing that occur with the onset of this disease? 2) Are there predictable changes in swallowing physiology characteristic of each lesion location? 3) How long can the patient continue to eat by mouth? 4) What techniques can prolong oral feeding?

Front 199

Patients with neurologic disorders have reduced sensitivity to __________ as evidenced by __________________.

Back 199

Aspiration / frequent failure to cough in response to aspiration

Front 200

Neurologic conditions affect sensory feedback regarding the __________ of food in the vocal tract and ________________.

Back 200

Position / entry of food into the airway

Front 201

Dysphagic stroke patients exhibit reduced ___________ and ___________ sensation as compared to age-matched controls

Back 201

Pharyngeal / supraglottic

Front 202

In patients with neurologic impairment, direct sensory testing is NOT possible because of ________________________.

Back 202

Cognitive and langauge problems - you can asess it indirectly

Front 203

How can you assess sensation indirectly in patients with neurologic impairment?

Back 203

Observe the patients reaction to: aspiration, residual food in the pharynx (a dry swallow to clear it indicates pharyngeal sensory awareness)

Front 204

In addition to reduced sensation, patients with neurologic impairment may fail to react to aspiration/residue because of…

Back 204

Chronic presence of aspiration/residue - the patient may have habituated to it

Front 205

How can you conduct a fatigue test for swallowing?

Back 205

Complete videofluroscopy just before and after a meal - see if there are changes in the swallow caused by use of the muscles while eating.

Front 206

What can you do for your neuro patients if fatigue is contributing to swallowing difficulties?

Back 206

Don't use maneuvers - these are more work and increase fatigue. Try smaller meals, postural changes, sensory heightening (make the swallow easier to trigger), diet changes are appropriate (thinner = easier to move).

Front 207

Studies indicate it may take up to _________ for the pharyngeal swallow to be triggered normally after extubation

Back 207

1 week

Front 208

When evaluating a neuro patient, the evaluation should be postponed if the patient is _____________.

Back 208

Intubated

Front 209

What are some techniques for evaluating patients who are comotose or have severe impairments?

Back 209

Maximize information while putting patient at minimal risk. 1) Evaluate frequency and strength of the swallow by palpating at bedside (5-10 min.); 2) Use surface EMG to assess frequency of swallow; 3) Assess how patient handles his/her own secretions

Front 210

If you aren't sure how a severely impaired patient is managing his her / own secretions, what can you do?

Back 210

Open the patients mouth and do thermal tactile stim (observe any muscle contraction that occurs in response); Then place a small amount of cold liquid at the base of the anterior arch. Assess response mechanism (patient should swallow in response)

Front 211

In the intensive care unit with neuro patients, your full bedside eval should involve giving the patient less than ____________ and should not increase the risk of _________________

Back 211

1/3 teaspoon of liquid / pulmonary complications

Front 212

Can you conduct a radiographic study with comatose/very ill patients?

Back 212

Yes, If they can be positioned on a gurney with back elevated and supported. A nurse or doctor must accompany them

Front 213

Swallowing problems caused by neurologic lesions from which some recovery can be antipated are caused by _______________________ [list some examples]

Back 213

Caused by sudden-onset neurologic conditions [stroke, closed head injury, cervical spinal cord injury, anterior cervical fusion, neurosugery affecting brainstem and cranial nerves, poliomyelitis, Guillan-Barre]

Front 214

Patients with what type of strokes will NOT experience swallowing disorders

Back 214

Infarcts limited to posterior cortex with no motor component (unless the lesion causes enough edema to affect anterior cortex)

Front 215

Do stroke patients have sensory loss in the pharynx? What evidence do we have?

Back 215

Yes, to some degree. On videoflouroscopy, stroke patients do not respond normally to oral/pharyngeal residue [will not report the residue, will not dry swallow in attempt to clear it]

Front 216

True or False: We have extensive information regarding the location of stroke and subsequent swallowing problems

Back 216

False - we have some research but there is still a lot that is unclear

Front 217

When a patient has a lesion in the lower brainstem [medulla], what can you expect from swallowing?

Back 217

1) Significant oropharyngeal swallowing impairment; 2) Major swallowing centers affected - motor and sensory in medulla (NTS, NA); 3) May include a complete inability to trigger the pharyngeal swallow

Front 218

With unilateral medullary lesions, oral control will be _____________, the pharyngeal swallow will be _________________, and neuromuscular abnormalities in the pharyngeal swallow will include [list three].

Back 218

Functional or near normal / absent or significantly delayed / 1) Reduced laryngeal elevation and anterior motion; 2) Unilateral pharyngeal weakness; and 3) Unilateral adductor VF paresis

Front 219

Patients with unilateral medullary lesions may require non-oral intake for ________ but will generally recover enough to resume oral feeding by _______________.

Back 219

1-2 weeks post-stroke / week 3

Front 220

Some patients with medullary strokes will not recover functional swallow for ___________. Helpful techniques will include [list three and their purpose].

Back 220

4-6 months post-stroke / 1) Thermal tactile stim for delayed or absent pharyngeal swallow; 2) Head rotation to compensate for pharyngeal weakness; 3) Mendelsohn and ROM exercises for laryngeal elevation

Front 221

When considering CP myotomy for patients with brainstem strokes, what are important factors?

Back 221

1) This should not be considered for at least 6 months post-stroke (give the patient sufficient time to recover spontaneously and with therapy) 2) Typically, reduction in UES opening is caused by reduced laryngeal lifting/anterior motion, NOT spasticity in the muscle itself. So, myotomy isn't going to help a whole lot.

Front 222

At 12 and 4 weeks after a medullary stroke, patients whose swallow was functional at 3 weeks post-stroke reveals that…

Back 222

Swallow is still functional but measures of pharyngeal movement during the swallow are outside the normal range for individuals of their age/gender

Front 223

A high brainstem stroke (pontine) leaves patients with _____[four characteristics]___.

Back 223

1) Severe hypertonicity; 2) Absent/delayed pharyngeal swallow; 3) Unilateral spastic pharyngeal wall paresis/paralysis; 4) Reduced laryngeal elevation with severe CP dysfunction.

Front 224

What are some treatment considerations for patients with pontine stroke?

Back 224

These patients have absent/delayed pharyngeal swallow, unilateral pharyngeal wall dysfunction and severely reduced CP opening (due to reduced laryngeal elevation) SO: They may not respond to head rotation because of hypertonicity. TTS may be helpful but can also increase oropharyngeal hypertonicity. Recovery is slow and difficult. You can try massage to reduce buccal hypertonicity.

Front 225

Subcortical strokes may affect motor and sensory pathways to and from the cortex. Swallowing difficulties are generally related to ________ and include [three problems]

Back 225

Timing / 1) Mild delay (3-5 sec) in oral transit; 2) Mild delay 93-5 sec) triggering pharyngeal swallow; 3) Mild to moderate impairment of timing of neuromuscular components of the pharyngeal swallow.

Front 226

When patients with subcortical strokes aspirate, it is generally _________ the swallow because of __________________ or ________ the swallow because of ____________.

Back 226

Before - Delayed pharyngeal swallow / After - impaired neuromuscular control

Front 227

Patients with subcortical strokes will often resume full oral intake __[when?]_____. Beneficial therapy techniques for this population include ______________________.

Back 227

3-6 weeks post-stroke if there are no other complications / Techniques to improve triggering of pharyngeal swallow (TTS) and ROM exercises for larynx and tongue base.

Front 228

Patients with anterior left hemisphere strokes tend to exhibit ____[three swallowing issues]_____.

Back 228

1) of swallow (mild to severe - usually accompanies some degree of oral apraxia; 2) Mild oral transit delays (3-5 sec); 3) Mild delays triggering pharyngeal swallow (2-3 sec).

Front 229

True or False: Patients with anterior left hemisphere strokes tend to have motorically normal pharyngeal swallows

Back 229

True

Front 230

What are some treatment techniques for patients with anterior left hemisphere strokes?

Back 230

1) Sensory enhancement - to speed the swallow; 2) May do best when feeding themselves without commands (due to swallow apraxia)

Front 231

Patients with right hemisphere strokes may exhibit _________[three swallowing issues]____.

Back 231

1) Mild oral transit delays (2-3 sec); 2) Longer pharyngeal delay (3-5 sec); 3) Laryngeal elevation delayed during swallow (can cause aspiration before or during the swallow)

Front 232

What are some treatment considerations for patients with right hemisphere strokes? [List 4]

Back 232

1) Chin down + TTS will be helpful for pharyngeal delay; 2) May use superglottic or supersupraglottic swallow during delay to prevent aspiration; 3) ROM exercises can be used to improve laryngeal elevation; 4) Patient may have attention/cognitive issues which will create difficulty using therapy and compensatory strategies.

Front 233

Who will return to oral intake faster - a patient with a left hemisphere stroke or one with a right hemisphere stroke?

Back 233

The patient with the left hemisphere stroke will return to oral intake faster (R. hemi causes more attention and cognitive issues which complicate rehabilitation)

Front 234

What effects do multiple strokes have on the swallowing in general? In the oral phase? In the pharyngeal phase?

Back 234

1) These patients will exhibit more severe swallowing problems; 2) The oral function will be slowed and patient will make repetitive tongue motions; OTT and pharyngeal delay may both be over 5 seconds; 2) Once swallow triggers, patient may have reduced laryngeal elevation, reduced airway entrance closure, and unilateral weakness of pharyngeal wall.

Front 235

What effects do multiple strokes have on swallowing therapy?

Back 235

Attention is usually affected in these patients and the ability to use therapy strategies and focus on tasks is impaired.

Front 236

True or False: Little data exists on recover of swallow post-stroke

Back 236

TRUE

Front 237

Research suggests that in patients with first-time ischemic strokes, 95% of the returned to full oral intake within _________ weeks regardless of ___________________.

Back 237

9 weeks / site of lesion (all of these patients had swallowing therapy)

Front 238

True or False: 95% of first-time ischemic stroke patients will recover a normal swallow within 9 weeks post-stroke

Back 238

False: They return to oral intake by nine weeks because their swallow is FUNCTIONAL (they don't aspirate) but timing of the swallow is still abnormal - for example they may still exhibit a pharyngeal delay. The swallowing mechanism is NEVER quite the same following a stroke.

Front 239

Following a stroke, when is recovery most rapid? What does this mean about scheduling your evaluations?

Back 239

1) Within the first two weeks / 2) You should evaluate the patient's swallow in the first week and then again at 3-4 weeks (especially if the patient is initially on non-oral feeding

Front 240

What four factors may affect swallowing function and recovery in stroke patients?

Back 240

1) Tracheostomy during acute phase; 2) Medications; 3) Long-standing insulin dependent diabetes; 4) History of TIAs, prior strokes, or other neuro damage

Front 241

How can medications affect the function and recovery of swallowing after a stoke?

Back 241

Antidepressants may slow swallowing coordination and increase the severity of the swallowing disorder. Also, some medications cause xerostomia.

Front 242

How can long-standing insulin-dependent diabetes affect swallowing function and recovery following a stroke?

Back 242

It can increase the severity of the swallowing disorder or prolong recovery because of the potential for myopathies and neuropathies. This may affect pharyngeal coordination and ROM.

Front 243

What effects does age have on swallowing function and recovery after a stroke?

Back 243

1) No age effects have been identified but remember that older patients have normal changes in swallow (60-80 year olds have longer pharyngeal delay time and older men have reduction in range of hyoid and laryngeal movement -reserve)

Front 244

In general, what treatment strategies are used for stroke patients?

Back 244

Postural changes, sensory heightening (including altering bolus characteristics) and active exercises

Front 245

What effects are seen in stroke patients when you change bolus volume?

Back 245

Many first time stroke patients have difficulty with small (1-3 ml) or large (10-20 ml) volumes. There is evidence that a larger bolus may increase the sensory input to facilitate triggering the swallow during MBS.

Front 246

What effects of bolus viscosity have been observed with stroke patients?

Back 246

Patients with delayed pharyngeal swallow will do better with puddings and purees. Patients with brainstem stroke affecting CP function will have more trouble with thicker foods.

Front 247

What effects of bolus taste have been observed with stroke patients?

Back 247

Presenting a strongly flavored (esp. SOUR) bolus may improve awareness, oral onset and pharyngeal delay. Be careful because aspiration of more acidic material may create respiratory issues.

Front 248

What are the two primary treatment modalities for malignant tumors in the oral cavity?

Back 248

Surgical resection and radiotherapy (with or without chemotherapy)

Front 249

Three means of delivering radiotherapy in the oral cavity are…

Back 249

1) Implant into gross tumor; 2) External beam methods; 3) Combination of both

Front 250

What are organ preservation protocols?

Back 250

Means of treatmeant designed to reduce the functional impact of the tumor treatment by preserving the patient's oropharyngeal structures and (hopefully) function

Front 251

If a patient has a combination of surgery and radiotherapy to eradicate an oral tumor, when is radiotherapy given?

Back 251

Usually 4-6 weeks after the surgery to allow the patient some time to heal

Front 252

A full course of radiotherapy for oral tumors usually includes a full dose of ________ spread over _______ weeks. The exposed field usually includes _____________.

Back 252

6,000-7,000 cGy / 5-6 weeks / all the lymph nodes in the area

Front 253

True or False: Chemotherapy is commonly used to eradicate tumors in head and neck cancer patients

Back 253

False: Chemo is experimental in these patients and is used as an adjuvant treatment at this time. Tumor shrinkage may occur after chemo but is usually short-lived.

Front 254

The general rule for surgical removal of tumors in the oral cavity is…

Back 254

That the tumor is removed along with a 1.5-2 cm margin of normal tissue all the way around.

Front 255

A resection is called simple when…

Back 255

Only one structure is affected

Front 256

What is a composite resection?

Back 256

When more than one structure or parts of more than one structure are included in the resection

Front 257

True or False: The rule of oral cancer surgery is that you will always remove the tumor with necessary margins without considering postoperative function.

Back 257

True - reconstruction and rehabilitation are secondary concerns

Front 258

Why do patients need dental assessment prior to initiating radiotherapy?

Back 258

Because radiotherapy disrupts salivary glands and this increases the risk of dental disease. If the patient has diseased teeth, they need to be removed prior to radiation.

Front 259

What is osteoradionecrosis of the mandible?

Back 259

A condition caused by radiotherapy in which pieces of the mandible become infected and start to break off. These pieces can then protrude through the skin and soft tissue. This condition should be avoided at all costs which is why a pretreatment dental assessment is crucial.

Front 260

Describe the TNM system

Back 260

A system of staging oral/laryngeal tumors. T stands for tumor and is followed by a number (1-4) denoting size of the tumor. N indicates the number of affected lymph nodes, and M indicates the number of sites of distant metastasis. This allows comparison of treatement outcomes across different patients with the same tumor.

Front 261

Six oral regions where tumors frequently develop are:

Back 261

1) Anterior floor of mouth or lower alveolar ridge in the anterior floor of mouth; 2) tongue (laterally or anteriorly); 3) Lateral floor of mouth or lateral alveolar ridge; 4) Tonsil (between faucial pillars); 5) Base of tongue area; 6) Hard or soft palate

Front 262

When there is a large tumor in the anterior floor of the mouth, tissues are removed as a unit because…

Back 262

This will help prevent the spread of the cancer

Front 263

What is primary closure? This is commonly done for resections of parts of what two structures?

Back 263

When smaller lesions are resected, the surgeon will simply pull the tissue back together and suture it. / Common for tongue and soft palate

Front 264

What is a flap?

Back 264

A piece of tissue that has been elevated or raised away from it's normal site. One portion is left attached to allow for continued blood supply

Front 265

What are myocutaneous flaps? When are these used? What are some typical donor sites for oral cavity reconstruction?

Back 265

A flap that is used when more amounts of tissue are needed at the surgery site. These flaps include muscle and over lying skin - generally passed under the skin to the reconstruction site. / Typical donor sites include: Pectoralis major, platysma, and trapezius m.

Front 266

What is a graft? What are the disadvantages of using a graft to reconstruct in the oral cavity?

Back 266

A graft (or Microvascular free tissue transfer) involves moving tissue from distant parts of the body to reconstruction sites. The veins and arteries are then anastamosed to those at the reconstruction site. / Disadvantages: time consuming, more difficult surgically (read: more costly), and an infection in the oral cavity is a possible complication.

Front 267

What are sensate / innervated grafts?

Back 267

These are being used more recently to attempt to bring more normal sensation to the reconstruction site. They include nerve fibers from the donor site which are attached to those at the new site. Research is still needed to determine how this will affect speech/swallowing.

Front 268

Oral cancer patients may suffer from changes in [three areas]

Back 268

Salivary flow, speech, swallowing

Front 269

Radiotherapy may lead to swallowing disorders related to [four things]

Back 269

Reduced salivary flow, intraoral sensory loss, fibrosis/reduced ROM, mucositis

Front 270

What will lead to optimal function in the oral cavity - primary closure or distal flaps?

Back 270

Primary closure appears to result in better function because no foreign material is introduced and oral sensation will be more normal (but in class, Dr. L. didn't seem like a huge fan of primary closure - check your class notes on this!)

Front 271

How does radiotherapy work AGAINST rehabilitation?

Back 271

Typically, the patient will start post-surgical rehab. Before beginning radiotherapy. The patient will start to see improvements in the swallow. Then, when radiotherapy begins swallowing will worsen again (radiation effects begin about 4 weeks in to radiotherapy) - the patient may withdraw from therapy and not return.

Front 272

Patients with resection of ________ or more of the tongue will benefit from a palatal augmentation prosthesis

Back 272

50%

Front 273

Treatment of cancer in the oropharyngeal area will affect ___________ and/or ___________ (structures).

Back 273

Tongue base / pharyngeal wall

Front 274

What techniques should be used for rehabilitation following oropharyngeal cancer treatment? What else can be useful?

Back 274

Exercises to improve tongue base function - this will improve swallow safety and efficiency / Intraoral prosthesis may also be useful to address VP deficits

Front 275

Following oral cancer surgery, you can generally begin rehabilitation once _________________. In most patients, this will be _________ after surgery.

Back 275

The patient's suture lines have healed enough to withstand aggressive exercises / 10-14 days post-op

Front 276

In H/N cancer patients, differing effects on speech and swallowing occur as a result of various extents of _____________, ____________, and _____________.

Back 276

1) Surgical resection; 2) Surgical reconstruction techniques; 3) Radiation

Front 277

Rehabilitation begins with _____________. It is necessary to identify the best way to treat the tumor while maintaining as much function as possible. The best way to accomplish this is __________________.

Back 277

Treatment planning (prior to any surgery, radiation, etc.) / A tumor conference with the entire team so that everyone can give their input.

Front 278

Who are members of the team present at a tumor conference?

Back 278

The radiation oncologist, medical oncologist, surgeon, swallowing therapist, maxillofacial prosthodontist, social worker. The patient should also be consulted on treatment decisions.

Front 279

What patient characteristics are crucial in planning treatment for H/N cancer?

Back 279

emotional status, financial resources, medical history, strong preference for a particular type of treatment

Front 280

What does swallowing pretreatment counseling involve for patients with H/N cancer?

Back 280

A swallowing screening is conducted (and then possible MBS) to identify any disorders already present. Then, the SLP will inform the patient of possible changes to speech/swallowing as a result of treatment. Rehabilitation options will also be discuss. It is important to stress the patient's responsibility in their own rehabiliation.

Front 281

When a patient has surgery for H/N cancer, you should provide ____________ with in 2-3 days.

Back 281

Post-operative counseling.

Front 282

___________ status is critical for possible prosthetic intervention. A pre-treatment consultation should be conducted to ensure that ________________ for stabilization of the prosthetic device after surgery.

Back 282

Dental / crucial teeth are spared

Front 283

The ideal case in H/N cancer swallowing rehabilitation will the that the _________________ takes place during radiographic assessment.

Back 283

First attempted swallow after surgery

Front 284

When patients undergo radiation, what should happen in terms of rehab/exercise?

Back 284

Therapy should be continued during radiation and after when possible. If therapy must be post-poned, patients should be encouraged with continue ROM/flexibility exercises on their own.

Front 285

True or False: 65% of H/N cancer patients receive speech and swallowing rehabilitation

Back 285

False: only about 50%

Front 286

________ % of patients with H/N cancer receive maxillofacial prosthetic intervention

Back 286

Less than 10%

Front 287

When planning rehabilitation for H/N cancer patients, what are the two most important pieces of information you need from the surgeon?

Back 287

1) The exact nature and extent of the resection; 2) The exact nature of reconstruction

Front 288

What swallowing problems are seen in patients with small (50% or less) resection of the tongue + primary closure?

Back 288

They are relatively temporary issues as the patient recovers: 1) Delayed triggering of Pharyngeal swallow (caused by edema, tongue mov't changes, etc); 2) Bolus control may be affected

Front 289

What treatment techniques would you use for patients with primary closure of a small tongue resection (50% or less)?

Back 289

1) TTS for delayed pharyngeal swallow (maybe only a few days of this); 2) ROM and bolus control exercises to help them adjust to changes (3-4 weeks)

Front 290

In patients with 50% or more of the tongue resected, _________________ will be affected. What consistency might work well? Is pharyngeal swallow affected? Finally, what maneuver might be useful?

Back 290

Bolus control and propulsion / liquids/thin pastes can be managed with head tilted back / Pharyngeal swallow is generally normal / May use supraglottic swallow to protect airway prior to swallow

Front 291

What rehabilitation techniques will be used in patients with 50% or more of the tongue resected?

Back 291

ROM exercises and intraoral prosthesis to allow the patient to manage all consistencies (except those requiring chewing)

Front 292

The _____ of the esophagus is smooth while the ______ is striated.

Back 292

Bottom 2/3
Top 1/3

Front 293

The inner layer of the esophagus is ______ while the outer layer is ______. What will happen if you contract each layer?

Back 293

Circular muscle (contraction will constrict the esophagus); Longitudinal muscle (contraction will shorten the esophagus)

Front 294

What are the four layers of the esophagus?

Back 294

Mucosa, submucosa, circular m., longitudinal m.

Front 295

What is the resting pressure of the LES? Why is this important?

Back 295

20-30 mm Hg (25 generally); This is crucial because it needs to be higher than the gradient between intraabdominal and intrathoracic pressure to prevent food from being sucked back up into the esophagus.

Front 296

How is the esophagus controlled?

Back 296

The top 1/3 - direct control (Vagus)
The bottom 2/3 - indirect control (Vagus via neurons in ENS)

Front 297

What is the ENS?

Back 297

The Enteric Nervous system or "second brain" consists of 100 million neurons embedded in the walls of the GI tract. It is separate from the CNS and ANS.

Front 298

The GI system is under what three levels of control?

Back 298

CNS, ANS, ENS

Front 299

Once the swallow triggers, about how long does the bolus take to get into the stomach?

Back 299

8-9 seconds

Front 300

What are seven major groups of esophageal dysfunction?

Back 300

Structural, motility, infectious, neoplastic, inflammatory, congenital, iatrogenic

Front 301

The most common cause of esophageal dysphagia is...

Back 301

Structural abnormalities

Front 302

List 4-5 structural abnormalities that cause esophageal dysphagia

Back 302

Schatzki's ring, Easinophilic esophagitis, peptic stricture, hiatal hernia, esophageal diverticula, CP bar, esophageal web, blah, blah, blah

Front 303

What is Schatzki's ring?

Back 303

A circumferential lip of tissue circling the inside junction between esophagus and stomach. It is the second most common cause of ED.

Front 304

What is the most common cause of esophageal dysphagia now?

Back 304

Easinophilic Esophagitis

Front 305

What is a peptic stricture?

Back 305

An esophageal structural abnormality which presents as an hourglass-shaped point in the esophagus due to collagen/fibrous tissue formation

Front 306

What percentage of those with esophagitis develop complcations?

Back 306

10-20%

Front 307

What is Zenker's diverticulum?

Back 307

A pocket with the opening situated above the UES - food can collect there. Mostly in older patients. May see Boyce's sign (focal, gurgly neck swelling often on the left)

Front 308

Name four esophageal motility disorders

Back 308

Achalasia
Diffuse esophageal spasm
Scleroderma
Polymyositis

Front 309

What is an esophageal motility disorder?

Back 309

Disorders arising from abnormal muscle/nerve activity which causes abnormal peristalsis or valving.

Front 310

What is achalasia

Back 310

Failure of the LES to relax (problems in Enteric NS...botox may be used!)

Front 311

What is diffuse esophageal spasm?

Back 311

Disorganized peristalsis caused by simultaneous contraction at different levels of the esophagus (AKA corkscrew esophagus or tertiary contraction)

Front 312

What is the most common GI manifestation, occuring in over 90% of cases?

Back 312

Esophageal dysmotility

Front 313

List iatrogenic causes of esophageal dysphagia

Back 313

caustic/pill, post surgery, radiation, chemotherapy, sclerotherapy, fundoplication, NG tube

Front 314

What is the clinical term for pain during swallowing?

Back 314

Odynophagia

Front 315

True or False: Neoplastic disorders are common causes of esophageal dysphagia

Back 315

False

Front 316

What are the local complications of reflux esophagtis?

Back 316

Erosive esophagitis, bleeding, esophageal ulceration, esophageal stricture, Barrett's esophagus, esophageal adenocarcinoma.

Front 317

List four infectious causes of esophageal dysphagia

Back 317

Candida, Herpes simplex virus, cytomegalovirus (CMG), HIV

Front 318

Tests for esophageal dysphagia may include:

Back 318

Barium swallow, video swallow, upper endoscopy, esophageal manometry, scintigraphy, CT scan, endoscopic ultrasound

Front 319

Treatment for esophageal dysphagia may include:

Back 319

Medical, endoscopic, and surgical treatments

Front 320

What medical treatments are used for esophageal dysphagia?

Back 320

smooth muscle relaxants, prokinetic agents, antimicrobials, steroids

Front 321

What endoscopic treatments are used for esophageal dysphagia?

Back 321

Botox, pneumatic dilation, bougie dilation, TTS balloons, PEG placement

Front 322

What surgical treatments are used for esophageal dysphagia?

Back 322

Myotomy, esophagectomy, thoracotomy, laparotomy (Latin, anyone?)

Front 323

What is ventilation?

Back 323

The movement of air back and forth between the outside atmosphere and the inner spaces of the lungs

Front 324

What is external respiration?

Back 324

The exchange of gases between walls of the lung spaces and the transporting blood

Front 325

What is internal respiration?

Back 325

Gases exchanged between blood and cells of the body

Front 326

What is the physiologic heirarchy?

Back 326

Respiration, swallowing, speech

Front 327

The _________ houses the pulmonary system which includes [3 things]

Back 327

Thorax / trachea, bronchi, lung structures

Front 328

The respiratory tract starts anteriorly with the _________ and _________. The mouth is also sometimes used to conduct air into the pharynx.

Back 328

Left nasal passage, right nasal passage (just want to make sure I get this right on the quiz, you know)

Front 329

What is the conducting zone? What structures are included?

Back 329

The parts of the respiratory system that get air in and out of the lungs. Includes: Trachea, bronchi, and bronchioles.

Front 330

What is the respiratory zone? What structures are included?

Back 330

The parts of the respiratory system that are involved in gas exchange. Includes: Respiratory bronchioles, alveolar ducts, alveolar sacs.

Front 331

Where does the trachea bifurcate?

Back 331

Around T5

Front 332

Each bronchus enters the lungs through its ______. How many divisions take place?

Back 332

Hilus / 20 divisions

Front 333

At blind ends of respiratory tubes, you will find...

Back 333

A pulmonary alveolus

Front 334

Alveoli are ____________. Each alveolus shares a wall ___________ with vascular capillaries.

Back 334

Pouch-like evaginations of the walls of respiratory bronchioles, alveolar ducts, and alveolar sacs / one-cell thick

Front 335

Alveoli have large ________ which is important because oxygen-carbon dioxide exchange occurs via _________.

Back 335

Surface area / diffusion

Front 336

What is the law of LaPlace? Why do we care?

Back 336

P = 2T/r (where p = pressure on the alveolus, T= surface tension, and r= radius of alveolus). We care because it means that alveoli are at risk of collapsing because of surface tension and their small size.

Front 337

What is the word for collapse of an alveolus? What keeps this from happening?

Back 337

Atelectasis / surfactant

Front 338

What is surfactant?

Back 338

A mixture of phospholipids that line the alveoli and reduce their surface tension

Front 339

In addition to preventng atelectasis, surfactant increases _____________

Back 339

Lung compliance - the amount the lungs can expand

Front 340

What are the two surfaces of the lungs?

Back 340

Costal (rib) and Mediastinal (medial)

Front 341

How many lobes are in the lungs?

Back 341

three right pulmonary lobes, two left pulmonary lobes

Front 342

The lungs are covered by the _________ and ________ pleura (it's not left and right, I promise!!). The pressure in he intrapleural space is usually _________.

Back 342

Pulmonary and pareital / negative

Front 343

What is lung compliance?

Back 343

Distensibility of the system, or how lung volume changes as a result of pressure change

Front 344

There is an inverse relationship between the compliance of the lungs and chest wall and their _________

Back 344

Elastic properties (Elastance)

Front 345

What happens during forced inhalation?

Back 345

Muscles are employed to enlarge the volume of the thorax and decrease pressure to draw air in

Front 346

What are two ways of decreasing thoracic air pressure?

Back 346

Thoracic (chest wall) enlargement and increasing the vertical dimension of the thorax

Front 347

Two major muscles of inspiration are __________ and __________. List three others that help...

Back 347

Diaphragm, external intercostals / scalenes, pectoralis major, pectoralis minor

Front 348

What is the major muscle of exhalation? And two others?

Back 348

Internal intercostals / transverse thoracic, quadratus lumborum

Front 349

List four abdominal muscles involved in respiration

Back 349

Rectus abdominus, external obliques, internal obliques, transverse abdominus

Front 350

What happens during active inspiration?

Back 350

Scalenes and sternocleidomastoid are employed in addition to major inspiratory muscles to help elevate the thorax. Pectoralis major and minor can also help.

Front 351

What happens during forced exhalation?

Back 351

Internal intercostals depress rib cage to decrease thoracic volume, quadratus lumborum ad transverse thoracic muscles kick in. Abdominal muscles may increase pressure on viscera to help push the diaphragm up.

Front 352

Inspiratory capacity =

Back 352

Tidal volume + inspiratory reserve volume

Front 353

Functional residual capacity =

Back 353

Expiratory reserve volume + residual volume

Front 354

Vital capacity =

Back 354

Inspiratory capacity + expiratory reserve volume

Front 355

What systems are important in swallowing?

Back 355

Neurologic, sensory, respiratory, pharyngeal/laryngeal, oral/nasal

Front 356

What is the upper airway vs. lower airway? Where is the boundary between the two?

Back 356

Upper airway = oral, nasal, pharyngeal, laryngeal areas.
Lower airway = trachea, bronchi, lungs.
LARYNX is the boundary

Front 357

What are the main valves in the upper airway?

Back 357

Oral (lip closure), nasal (VP closure), pharyngeal (only closes when tongue base contacts pharyngeal wall), laryngeal (VF and airway entrance)

Front 358

What is the setting of valves for speech breathing?

Back 358

Lips open, VP closed, larynx in rapid movement

Front 359

Wha is the setting of valves for exerted breathing?

Back 359

lips open, VP closed, glottis open

Front 360

The patient should breathe nasally and ____________ as opposed to clavicular or abdominal

Back 360

Diaphragmatically

Front 361

What are the normal respiratory rates?

Back 361

Young - 16 / min
Old - 20 / min

Front 362

Pressure in the respiratory system is dependent on _________, _________, and __________

Back 362

Muscle control, exhalatory forces, valving

Front 363

Early infants and those over 70 show what differences in respiration compared to the rest of us?

Back 363

Less consistent coordination of respiration and swallowing. More frequent interuption of inhalation to swallow - greater risk!!

Front 364

When do babies stabilize the respiratory swallowing pattern?

Back 364

By about three months

Front 365

Closing the airway for the swallow should be ______ and begins when ____________. Some patients over 60 tend to...

Back 365

Rapid
Head of bolus reaches top of airway
Close the airway entrance earlier

Front 366

A patient should NOT have _________ of swallows interrupting inhalation

Back 366

More than half

Front 367

Information about respiration that is critical for swallowing includes:

Back 367

1) Focal points of breathing
2) Rate of respiration and swallowing
3) Drooling or saliva build-up in the mouth
4) Resp-Swallow pattern
5) Efficiency of swallow
6) Coughing, gurgly voice, throat clearing
7) Pneumonia history
8) Chronic bronchial secretions (bronchorrhea)
9) Dietary intake
10) Medical Dx placing patient at risk?

Front 368

Excessive discharge of mucus form the air passages of the lungs is lovingly called _______. It is a sign of ________.

Back 368

Bronchorrhea / pneumonia

Front 369

What are some causes of respiratory disease?

Back 369

Expansion of lungs impeded - paralysis, pain, alveolar noncompliance;
airway diameters reduced - asthma
(Patient may have increase respiratory and ventilatory rates)

Front 370

List some restrictive pulmonary conditions

Back 370

pneumothorax, atelectasis, pleural effusion, pulmonary edema, asthma, sepsis (leads to Adult Respiratory Distress), paralysis, pulmonary fibrosis

Front 371

List some obstructive pulmonary conditions

Back 371

COPD - Chronic obstructive pulmonary disease: Emphysema, chronic bronchitis

Front 372

What is the difference between aspiration pneumonia and pneumonitis?

Back 372

Aspiration pneumonia is caused by foreign material entering from upper airway while pneumonitis is caused by acidic gastric contents (GERD!!)

Front 373

Aspiration pneumonia is fatal in _____ of cases

Back 373

20-50%

Front 374

What is bronchospasm?

Back 374

An abnormal contraction of smooth muscle of the bronchi (usually associated with asthma)

Front 375

What is cyanosis?

Back 375

blue-grey color - purplish discoloration of mucus membranes (occurs when you have < 5 gr. hemoglobin)

Front 376

What is dyspnea?

Back 376

The feeling of having difficulty breathing

Front 377

What is hemoptysis?

Back 377

Coughing up blood - generally GI issues!

Front 378

What is hyperpnea?

Back 378

Rapid/deep breathing

Front 379

What is hypoxemia?

Back 379

Deficient oxygenation of the blood

Front 380

What is rhonchi?

Back 380

Whistling/snoring sounds int he lungs

Front 381

If a patient has less than ________ swallows in 5 minutes, it is considered abnormal

Back 381

2-3

Front 382

What treatments should be done to improve respiratory support for swallowing?

Back 382

1) Increase length of breath hold
2) Coordination - inhale, exhale, swallow, exhale more
3) Do not work on swallows until it is rapid enough to fit in maximum comfortable breath hold.
4) Make sure paitent is holding his/her breath at the larynx!

Front 383

What is a head injury AKA?

Back 383

Acquired brain injury, traumatic brain injury

Front 384

Head injury can happen when __________ or __________

Back 384

1) When head suddenly/violently hits an object
2)When an object pierces skull and enters brain tissue

Front 385

According to the CDC, ______ people suffer TBI each year. ______ of these people die. The cost of TBI in the US is ________.

Back 385

100 out of every 100,000
52,000
$48.3 billion annually

Front 386

The risk of head injury is especially high in ________, ________, and _________

Back 386

Adolescents, young adults (esp. 15-24), those over 75 (Children under age 5 also at higher risk)

Front 387

The risk of head injury is higher in __________ in all age groups

Back 387

Males (twice as high!)

Front 388

_________ of all TBIs involve alcohol either by the victim or the person causing the injury

Back 388

Half

Front 389

The three most common causes of TBI are...

Back 389

1) Motor vehicle, bike, or vehicle-pedestrian mishaps (50%)
2) Falls (25%)
3) Violence (nearly 20%)

Front 390

Common GENERAL symptoms of TBI include:

Back 390

1) Anxiety, nervousness, depression
2)Behavioral changes - disinhibition, impulsiveness, emotional extremes
3) Blurry/double vision (diplopia)
4) Attention and memory issues
5) Aphasia, dysarthria, dysphagia
6) Balance and coordination issues
7) Muscle stiffness/spasms
8) Sleep difficulties
9) Weakness (usually hemi-paresis)

Front 391

________ is a loss of conciousness while ___________ is a brief loss of conciousness caused by a blow to the head.

Back 391

Coma / Concussion

Front 392

Post-traumatic amnesia is...

Back 392

A state following TBI in which the patient is not oriented (acute confusion)

Front 393

After TBI, recovery is characterized by...

Back 393

Progressive improvement in cognitive and behavioral functions (usually rapid at first and then slows to a plateau after months/years)

Front 394

The Glascow Coma Scale can be used to assess...

Back 394

Degree of conciousness

Front 395

The difference between a closed-HI and open-HI is...

Back 395

In an open HI, the skull is penetrated and the brain is exposed to air

Front 396

What are diffuse injuries?

Back 396

Microscopic damage throughout many areas of the brain. Shearing of large nerve fibers ad stretching of blood vessels in many areas (frontal and temporal lobes are particulary susceptible)

Front 397

What are hypoxic-ischemic injuries?

Back 397

They cause swelling in the brain which restricts the flow of blood-borne oxygen, glucose, and other nutrients

Front 398

What is a focal brain injury?

Back 398

One confined to a specific area of the brain that causes localized damage that can often be detectd on CT or X-ray

Front 399

What are contusions?

Back 399

Bruises that cause swelling, bleeding, and destruction of brain tissue. (Frontal and temporal lobes!!)

Front 400

A small amount of bleeding that spreads thinly over the surface of the brain is characteristic of...

Back 400

A subarachnoid hemotoma

Front 401

The most common late secondary complications fo TBI are...

Back 401

Hydrocephalus and chronic subdural hemotoma

Front 402

What is chronic subdural hemotoma?

Back 402

A focal brain injury characterized by an accumulation of blood or spinal fluid on the surface of the brain that exerts pressure on brain tissue

Front 403

A slow bleeding that occurs outside the brain (usually over surface of frontal or parietal lobe)

Back 403

Subdural hemotoma

Front 404

Bleeding outside the brain generally caused by damaged artery

Back 404

Epidural hemotoma

Front 405

The three stages of medical treatment for TBI are...

Back 405

Acute, subacute, chronic

Front 406

Acute treatment focuses on...

Back 406

Saving the victims life. Airway, breathing, blood supply. Surgery may be needed within days (ie. to decrease cranial pressure). Seizures may occur. Monitor swelling in the brain.