Groher Chapter 6

Front 1

According to Bosma, "the suckle action" is a coordination of what four anatomical entities?

Back 1

Tongue
Hyoid bone
Mandibular muscles
Lower lip

Front 2

Bosma refers to this group of four anatomic entities collectively as the...

Back 2

Suckle Motor Organ

Front 3

Does anyone besides Bosma really use the term "Suckle Motor organ"?

Back 3

No

Front 4

True or False:
The structures of the suckle motor organ move upward and backward and then downward and forward.

Back 4

True

Front 5

If an infant demonstrates a suckle-suckle-swallow pattern does the first suckled bolus accumulate in the oral cavity or posterior to the faucial isthmus?

Back 5

The first bolus will accumulate posterior to the faucial pillars (at the junction of the hard and soft palate and in the valleculae)

Front 6

Is it more important that an infant demonstrate a suckle-swallow pattern as opposed to a suckle-suckle-swallow pattern or that the swallow pattern be rhythmic?

Back 6

rhythmic pattern is more important

Front 7

True or false?
The forward movement of the cricoid cartilage does not assist in opening the cricoesophageal sphincter

Back 7

False. Along with peristalsis, the forward movement of the cricoid cartilage assists in opening the Cricoesophageal sphincter

Front 8

During dyspnea, (as in crying), does the pharynx expand or constrict to assist with inspiration?

Back 8

The pharynx expands

Front 9

During expiration activities such as phonation, grunts, or coughs what does the pharynx do?

Back 9

It constricts

Front 10

What do clinicians need to do when using cervical auscultation to evaluate feeding?

Back 10

Put a stethoscope or microphone over the larynx and listen

Front 11

What two types of sounds can be heard during cervical auscultation?

Back 11

1. bolus transit sounds
2. discrete sounds of the larynx and pharynx before and after bolus transit

Front 12

What sounds might be heard (or not heard) during cervical auscultation of a dysphagic infant?

Back 12

Absent or only occasional pharyngeal swallow sounds, bubbling, wheezing, stridor.

Front 13

True or False?
Neural control of the esophagogastric junction is is complete in an infant.

Back 13

False. It is incomplete.

Front 14

True or False?
In comparison to the esophagogastric junction, the pharyngoesopageal segment is stable in infants.

Back 14

True.

Front 15

The causes and mechanisms of feeding failure lie in:
1.
2.

Back 15

1. development of the oral and pharyngeal cavities
2. the patterning of oral and pharyngeal functions in the brain

Front 16

What do the sensory input from the mouth and pharynx and the brain regions representing feeding movements work together to do?

Back 16

These peripheral and central aspects develop reciprocally to improve suckle feeding and the coordination of swallowing and respiration.

Front 17

True or False?
Early abnormal feeding, respiratory, and positional performances can affect the structure and form of the muscles and skeleton of the mouth, pharynx, and larynx.

Back 17

True

Front 18

The pharyngeal and oral areas are innervated by the following five cranial nerves:

Back 18

1. Trigeminal
2. Facial
3. Glossopharyngeal
4. Vagus
5. Hypoglossal

Front 19

True or false?
The oral and pharyngeal areas are only innervated by cranial nerves.

Back 19

False. They are also innervated by upper cervical nerves.

Front 20

In order to achieve adequate suckle feeding, infants with hypoplasia of what organ may compensate with their pharyngeal constrictor wall, soft palate, palatine folds, and hyoid suspensory muscles?

Back 20

Hypoplasia of the tongue

Front 21

An infant with what other oral anomaly may compensate using his soft palate muscles, pharyngeal constrictors, and tongue?

Back 21

Cleft palate, but the compensations will depend on the individual cleft.

Front 22

What are the most common embryopathies of the medullla and the pons?
(embryopathy = developmental disorder in an embryo)

Back 22

1. Aplasia (defective development) of the motor nuclei
2. Syringobulbia

Front 23

What is syringobulbia?

Back 23

Expansion of the central canal in the bulbar area. (May be associated with hypoplasia of primary nuclei or impaired coordination and regulation.

Front 24

Aplasia of the hypoglossal or trigeminal nuclei may cause what to be impaired?

Back 24

Suckle actions

Front 25

Aplasia of facial innervation may cause weakness in what muscle?

Back 25

Orbicularis oris. Weakness in this muscle results in a poor lip seal around the nipple.

Front 26

Aplasia of the vagal striated motor innervations may cause weakness in which muscles?

Back 26

Laryngeal and pharyngeal muscles.

Front 27

Dysphagia in infants is most commonly caused by what?

Back 27

Acquired neurological impairment (acquired either in fetal or early postnatal life)

Front 28

What types of problems, shared by mother and fetus, may be responsible for acquired neurological impairment?

Back 28

Respiratory, Vascular, Metabolic

Front 29

True or False?
Upper respiratory infections and thrush usually greatly impair an infants suckle.

Back 29

False. The greater risk of an upper respiratory infection is nasal obstruction.

Front 30

Herpes Simplex lesions in the oral and pharyngeal cavities of an infant may result in what?

Back 30

Feeding related pain

Front 31

The repeated stress of intubation may cause an infant to become what?

Back 31

Orally defensive

Front 32

What are two situations that may may delay oral feeding and result in dysphagia with an iatrogenic etiology?

Back 32

1. Extended parenteral or enteral intubation
2. Early postnatal surgery in or around the route of feeding

Front 33

When oral feeding is impaired, what two things should the clinician be concerned about?

Back 33

1. Nutrition
2. Oral feeding experience

Front 34

When should intubation feeding (nasogastric or gastroma) be considered?

Back 34

When an infant is malnouished despite feeding attempts and suckling abilities

Front 35

What should a clinician do before attempting to feed an infant in a feeding evaluation?

Back 35

-Observe in the state of calmly awake or light sleep
-attempt to elicit the rooting reflex by touching the infant on the cheeks or lips

Front 36

What should a clinician do during a feeding evaluation while feeding the infant (or eliciting suckle behaviors)?

Back 36

-evaluate lip closure and tongue activity, by stimulating the lips and then pushing a gloved finger down on the middle of the tongue
-listen to multiple pharyngeal swallows using cervical auscultation

Front 37

What should a clinician do during therapeutic stimulation?

Back 37

Use the same methods of oral stimulation and observation that are used in a feeding evaluation.

Front 38

Is it more advantageous to have few feeders or many feeders?

Back 38

Few feeders, their expertise will benefit the infant's feeding

Front 39

Does a nasogastric tube impede suckle feeding?

Back 39

No, but it does interfere with swallowing. A PEG is a more likely alternative to an NG tube.

Front 40

What should a clinician do if an infant can suckle but has no pharyngeal swallow?

Back 40

- be particularly concerned
-evaluate other laryngeal and pharyngeal activities (e.g. respiration, cry)
-use cervical auscultation to listen for bubbles, choke, cough, clearing, or stridor
-Use radiography to see if thickening liquids improve pharyngeal performance
-attempt to use suckling to encourage swallowing (e.g. inject milk in the side of mouth while suckling on a pacifier)

Front 41

Colic has been attributed to...

Back 41

esophagogpharyngeal regurgitation, secondary to inadequate burping, irritable bowel, or protein hypersensitivity, or GERD

Front 42

The fetus has been swallowing since...

Back 42

the twelfth week in utero or earlier

Front 43

True or False?
Small, unimpaired infants are usually able to swallow their own secretions, participate in respiration, and maintain and airway.

Back 43

True

Front 44

What are some ways non-nutritive suckling can benefit an infant?

Back 44

-less restlessness
-earlier achievement of bottle feeding
-increased polypeptide hormone release (encourages earlier gastric emptying)

Front 45

Bosma's group demonstrated what progression of separate components of suckle-feeding at bottle?

Back 45

-stabilization of individual suckle
-swallow sequences
-stabilization of suckling rhythm
-interposition of breaths between swallows in suckle-feeding runs

Front 46

Which type of feeding tube is associated with fewer lung function problems in preterm infants under 2000 grams?
Orogastric or Nasogastric?

Back 46

Orogastric

Front 47

True or false?
Premature infants as young as 32 weeks gestational age have been graduated directly to breast feeding.

Back 47

True

Front 48

During what age range does transitional feeding occur?

Back 48

6 months to two years

Front 49

At 4-6 months of age, what feeding behavior does spoon-feeding elicit?

Back 49

Mouth opening

Front 50

What other motor development (useful for feeding) occurs around 4-6 months?

Back 50

hand can bring food to the mouth

Front 51

True or false?
There is no difference between biting and chewing.

Back 51

False

Front 52

Describe "chewing"

Back 52

A lateralized mastication skill that is oriented around the molar area. The tongue plays a major role.

Front 53

How should a clinician conduct a chewing evaluation?

Back 53

With patience, small bits of crackers or softened candy, and frequent inspections using passive openings of the mouth

Front 54

What adverse chewing behaviors may be observed in a feeding eval?

Back 54

-anterior spillage
-food remains in middle of the tongue
-squirreling in the sides of mouth
-oral dyspraxia

Front 55

What happens during "biting"?

Back 55

mandible closes and opens vertically so that interincisor approximation is achieved

Front 56

When is biting first noticed?

Back 56

During oral play at the end of suckle feeding (infant bites the nipple)

Front 57

What is tongue mashing?

Back 57

using the tongue to mash food
(duh), may look similar to the vertical motions of early chewing

Front 58

True or false?
Tongue mashed food may be effectively swallowed.

Back 58

True

Front 59

The maturation of which muscles is important for mature feeding?

Back 59

facial muscles around the mouth (e.g. buccinator and orbicularis oris)

Front 60

Why are these muscles important?

Back 60

So that lip seal can be achieved

Front 61

The sensory resources of the oral area (important for chewing and biting) are increased by what developmental event?

Back 61

Eruption of teeth

Front 62

Is the relationship between motor performance and sensory input and anatomic development reciprocal?

Back 62

Yes

Front 63

What other anatomic change occurs in the "suckle motor organ"?

Back 63

Tongue, hyoid, and larynx descend

Front 64

True or false?
In normal individuals, rooting and nipple latching reflexes are not lost.

Back 64

False. Rooting and nipple latching are normally lost.

Front 65

What types of circumstances may influence a family or individual to not use optimal feeding resources?

Back 65

Social or environmental

Front 66

What standardized instrument describes the oral/pharyngeal anatomy, feeding particulars, and respiratory performance of bulbar dyskineticchildren?

Back 66

Multidisciplinary Feeding Profile

Front 67

True or False?
The feeding competence, routines, and nutritional status of feeding impaired children should be frequently assessed.

Back 67

True

Front 68

True or false?
Feeding would never interfere with seizures.

Back 68

False. e.g. a laryngospasm reacting to aspirated material could induce a grand mal seizure

Front 69

In neurologically impaired individuals, the pattern and severity of feeding impairment can indicate what?

Back 69

Bulbar involvement/impairment

Front 70

Why could a neurological impairment acquired in childhood affect feeding?

Back 70

-brain has less plasticity
-oral and pharyngeal musculoskeletal structures have not adapted to the impaired feeding/swallowing function (however, they may adapt)

Front 71

Community-based centers that offer specialized feeding care are usually created by who?

Back 71

Parents

Front 72

What public law has increased federal and state sponsorship of such centers?

Back 72

PL 99-457 An act for Care of Handicapped Infants and Toddlers