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135 Cards in this Set
- Front
- Back
- 3rd side (hint)
Three types of injury
|
coup
contra coup twisting of brainstem |
4-26
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Three types of brain damage
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diffues (microscopic damage throught brain)
hypoxic-ischemic (swelling causes hypoperfusion) focal |
4-26
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Two common late secondary complications:
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hydrocephalus
chronic subdural hematoma |
4-26
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Three stages of medical tx
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acute (saving pt. life)
subacute (after stabilized) chronic (two categories) |
4-26
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Two categories of chronic tx
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community-based rehabe
tx of long-term consequences (like pain, depression, behavior) |
4-26
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Most common swallow disorder in TBI
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delay in triggering of the pharygneal swallow
|
4-26
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Always check for a _ _
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bite reflex
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4-26
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Reduced closure of the larynx and reduced cp opening are likely NOT due to neurologic damage but ARE likely due to:
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changes in laryngeal motion (usually caused by physical damage to the neck)
|
4-26
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Characteristics that make oral intake more difficult in TBI
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impulsiveness
Tendency to put too much food in mouth cognitive difficulties reduced sensation |
4-26
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Is there a relationship b/t length of coma and swallowing problems?
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Yes.
Swallowing probs worse with longer comas |
4-26
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Tx for TBI
Cognitively impaired |
compensatory strategies (postural and sensory)
Resistance and ROM Maneuvers are TOO DIFFICULT Changing diet |
4-26
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What if TBI pt has reached max. gains in treatment, but still cannot eat b/c they are aspirating or have inefficient swallowing?
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Do periodic evals - ethicially cannot continue to work with them
|
4-26
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Do back injuries, like ruptured disks, spinal stenosis, or pinched nerves lead to dysphagia?
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No
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4-26
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SCI is
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damage to the spinal cord that resultsi n a loss of function
|
4-26
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What is the leading cause of SCI?
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Motor vehicle accidents
|
4-26
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# of:
cervical vertabre thoracic lumbar sacral |
7
12 5 5 |
4-26
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Effects of SCI depend on the _ of injury and the _ of the injury.
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type
level |
4-26
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Two types of SCI injury
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complete
incomplete |
4-26
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Complete SCI injury is
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no function below the level of the injury on both sides
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4-26
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Incomplete SCI is
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some function below the primary level of injury
|
4-26
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Injury at C1 or C2
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no sensory awareness of swallowing difficulty (Silent aspiration)
|
4-26
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Injury at C4, C5, C6 (what happened to C3?)
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poor laryngeal movt and reduced cricopharyngeal opening
|
4-26
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Swallowing probs in cercial injury may be exacerbated by:
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trach w/inflated cuff
cervical brace mechanical vent |
4-26
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Always perform a _ physiologic assessment if pt complains of swallowing difficulty
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in-depth
|
4-26
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What is most likely NOT possible in pt with SCI
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postural changes
|
4-26
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What is MOST helpful in SCI tx?
|
sensory enhancement
swallow maneuvers |
4-26
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****Name the four types of cervical bracing
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soft collar
philadelphia collar Sterno-Occipital Mandibular Immobilzation Device halo |
4-26
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Swallowing worsens w/what two braces?
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SOMI
Halo |
4-26
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More swallowing difficulty with
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chin pulled back
chin/head retracted to neck pt's head is extended |
4-26
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Two types of cervical fusion
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anterior
posterior |
4-26
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Swallowing probs as a result of Anterior Cervical Fusion (incision in front of neck)
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Swelling in post pharyngeal w
red. laryn. elevation and anter movt (+ red. CP opening and red. airway closure) may see oral stage probs and delay in trigger |
4-26
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Tx for Anterior Cervical Fusion
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Significant recovery in 3 months
swallow maneuvers are most helpful |
4-26
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Brainstem problems? Try...
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TTS
Suck-swallow |
4-26
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Extent of damage in tumors from cranial nerves depends on (2)
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size of tumor
difficulty of resection |
4-26
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If CN IX (glossopharyngeal) is damaged, expect
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a delay in triggering pharyngeal swallow
|
4-26
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CN damage? Try...
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(often unilateral)
postural strategies aggressive ROM and resistance |
4-26
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Three levels of neural control:
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CNS
Autonamic System Enteric Nervous System (ENS) |
5-1
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LES seperates _ from _
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esophagus from stomach
|
5-1
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Pressure gradiate is higher/lower in the stomach than in the thoracic cavity
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higher
|
5-1
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Dx testing used for esophagus
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upper GI/Barium swallow
Endoscopy 24 hour ambulatar pH testing Esophageal Manometry |
5-1
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Upper GI looks for
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structural probs
function |
5-1
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Endoscopic allows us to see
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stomach
EGJ (esopheogastric junction) |
5-1
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Manometry shows us
|
pharynx
UES Esophageal body LES peristalsis |
5-1
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name the structural causes of dysphagia due to esophageal problems (7)
|
Schatzki's ring
Eosinophilic esophagitis peptic sticture hiatal hernia esophagial diverticula esophageal cervical web cricopharygneal bar |
5-1
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What is Schatzki's ring?
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it's at the EGJ, a thin lip of tissue b/t esophageous and stomach, "washer-like"
|
5-1
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What is the most common cause of dysphagia complaint re: esoph.
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eosinophilic esophagitis (4 of 1,000)
|
5-1
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What is eosinophilic esophagitis?
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looks like the trachea
a lot of schatzki's rings leads to food impaction squamous cells and esoinophilic cells |
5-1
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What is a peptic stricture?
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a narrowing, see ulceration and bleeding, an hourglass appearance
|
5-1
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What is a Hiatal Hernia?
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predisposes the person to reflux
usually doesn't need surgery |
5-1
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Does a Hiatal Hernia cause dysphagia?
|
No
|
5-1
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What is another name for "esophageal diverticula?"
|
Zenker's diverticulum
|
5-1
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What is a esophageal cervical web?
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like a shatzki's ring, but right below the CP muscle
Not often caused by other diseases |
5-1
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What is a cricophargyneal bar?
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it's thicker than a e.c. web, creates a funnel effect,a posterior shelf
|
5-1
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Motility is a _ problem
|
function
|
5-1
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Two motility probs
|
Achalasia
Diffuse Esophageal Spasm |
5-1
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What is achalasia?
|
Failure of LES to relax
No peristalsis a neuropathy of the ENETRIC nervous system |
5-1
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What is a Diffuse Esophageal Spasm?
|
"a corkscrew esophagus"
smooth muscle is affected |
5-1
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|
5 Iatrogenic Disorders
|
1. pill
2. radiation 3. neoplastic-esphogeal cancer 4. infections 5. congential development |
5-1
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|
what does odynaphagia mean?
|
pain w/swallowing, indicates ulcer
|
5-1
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|
What is ptosis?
|
drooping eyelids
|
5-1
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|
Another name for Schatzki's Ring
|
Steakhouse syndrome
|
5-1
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Schatzki's Ring and _ _ often coexist
|
hiatal hernia
|
5-1
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What is Boyce's sign?
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focal neck swelling that gurgles on palpation; usually on left side (mentioned with Zenker's
|
5-1
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What is the physiologic hierarchy?****
|
respiration
swallowing speech |
5-3
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|
Three aspects of respiration
|
ventilation
external respiration internal respiartion |
5-3
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|
ventilation is
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movt of air back forth b/t outside atmosphere and inner spaces of the lungs
|
5-3
|
|
external respiration is
|
exchange of gases b/t walls of the lung spaces and the transporting blood
|
5-3
|
|
internal respiration is
|
gases are exhanged bt blood cells and the body
|
5-3
|
|
two subdivisions of the respiratory system
|
conducting zone (brings air in and out)
respiratory zone (where gas exchange occurs) |
5-3
|
|
What is the Law of LaPlace?****
|
P=2T/r
|
5-3
|
|
P=2T/r
P stands for |
collapsing pressur on alveolus
|
5-3
|
|
P=2T/r
T stands for |
surface tension
|
5-3
|
|
P=2T/r
r stands for |
radius of alveous
|
5-3
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|
Large alveolus = _ collapsing pressure
|
low
|
5-3
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Small alveolus = _ collapsing pressure
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high
|
5-3
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_ alveolus are not ideal because they collapse often
|
small
|
5-3
|
|
What is surfactant?
|
A misture of phopholipids that line the alveoli and reduce their surface tension
|
5-3
|
|
Without _, Law of _ predicts that _ alveolus will collpase
|
surfactant
LaPlace small |
5-3
|
|
What is atelectasis?
|
When small alveoli collapse
|
5-3
|
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What is the space between the two pleura?
|
pleural cavity OR intrapleural space
|
5-3
|
|
What is another name for when the lungs collapse?
|
Pneumothorax
|
5-3
|
|
When elastiance goes _, compliance goes _
|
up
down |
5-3
|
|
_ is the boundary between the upper and lower airway
|
larynx
|
5-3
|
|
What is the focal point of breathing?
|
should breathe diaphragmatically (NOT clavicular or abdominal breathing)
|
5-3
|
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What is the most common pattern of respiration and swallowing?
|
inhale
start to exhale stop exhale (swallow + airway closure) return to exhalation (thought to be protective: prevents residual food in airway) |
5-3
|
|
Focal point of breathing****
|
diaphragmatically
|
5-3
|
|
What does COPD stand for?
|
Chronic Obstructive Pulmonary Disease
|
5-3
|
|
Two types of COPD
|
emphysema
chronic bronchitis |
5-3
|
|
Compare and contrast aspiration pneumonia and pneumonitis
|
asp pneumonia is an acute inflammation caused by INFECTION and is a reaction to bacteria and bacterial byproducts (SLP issue)
Pneumonitis is lung INJURY caused by acidic and particulate gastric contents (reflux, etc. a GI issue) |
5-3
|
|
Bronchospasm is caused by
|
asthma
|
5-3
|
|
Atelectasis is
|
collapse of expanded lung
|
5-3
|
|
dyspnea is
|
an unpleasant awareness/perception of shortness of breath
|
5-3
|
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hemoptysis is
|
coughing up blood tinged mucous
|
5-3
|
|
hypoxemia is
|
deficit in oxygenization of blood
|
5-3
|
|
rhonchi is
|
whistle or snoring sound upon ascultation
|
5-3
|
|
Name a the Parkinson's drug Logemann AND Nicole mentioned during lectures.
|
Halodol
|
5-3
|
|
What is another name for having no teeth?
|
edentulous
|
lab
|
|
Two risk factors for head and neck cancer
|
smoking
alcohol |
5-8
|
|
What is "the dump" according to Logemann?
|
When it is YOUR fault the pt isn't swallowing yet, when in all actuality it is the doctor's fault, because drs do everything wrong, right? They obviously have no idea what they're doing - they just follow people around for a few years...
|
5-8
|
|
What does exsanguinate mean?
|
to bleed to death
|
5-8
|
|
What does radiation cause? (5)
|
decreased blood flow
increased stiffness xerostomia fistula fibrosis |
5-8
|
|
Chemo causes?
|
mucositis (sores in mouth)
a lot of weight loss |
5-8
|
|
Dysphagia types resulting from radiation and chemo:
|
dec oral tongue motion
dec BOT motion dec ph wall motion dec laryngeal elev |
5-8
|
|
what is anastomosis?
|
reattachment
|
5-8
|
|
What is a simple resection?
|
part or all of one structure
|
5-10
|
|
What is a composite resection?
|
part or all of more than one structure (often occurs in the mouth)
|
5-10
|
|
Two most common spots for composite resection?
|
anterior floor of mouth
lateral (bot or tonsil) |
5-10
|
|
_ composite resection has the worst functional problems:
|
lateral
(results in loss of food and nasality) |
5-10
|
|
What does IMRT stand for and what is it?
|
Image Modified Radiation Therapy; I have no idea what it is...!? But the trusty internet tells me it's actually Intensity-Modulated Radiation Therapy. hmmm.
|
5-10
|
|
Two types of a partial laryngectomy
|
supraglottic
hemi |
5-10
|
|
Two types of laryngeal surgery
|
partial laryngectomy
total laryngectomy |
5-10
|
|
If the pt has a supraglottic (horizontal) laryngectomy, what can you expect to be removed?
|
epiglottis, fvf, areypiglottic folds
|
5-10
|
|
What treatment does a pt with a supraglottic/horizontal laryngectomy require?
|
since top 2/3 of larynx + hyoid are removed expect: laryngeal elevation problem and a need for airway protection
Super-supraglottic maneuver |
5-10
|
|
What to do with a hemilarygnectomy?
|
head rotation
chin down head rotation + chin down adduction exercises This is because airway closure is a big prob; |
5-10
|
|
What should you expect with a person who has had a total laryngectomy?
|
no hyoid or larynx, no CP region
1. tight closure 2. pseudoepiglottis |
5-10
|
|
Can total laryngectomees aspirate?
|
No, not phsically possible
|
5-10
|
|
Stroke occurs most often in what population?
|
African Americans, equal among gender
|
5-10
|
|
2 areas of stroke
|
hemorrhage (bursting of vessel;s lower recovery)
blockage (infarct; faster recovery) |
5-10
|
|
If a pt presents with a medullary stroke, what should you expect and how would you treat?
|
expect no swallow at first, once they have a swallow, do TTS
dec laryngeal elev (mendelsohn, falsetto, gargle, yawn) unilateral vf paralysis (head rotation) |
5-10
|
|
Most common probl in stroke pt
|
delay in trigger
|
5-10
|
|
R or L cortical lesion worse? why?
|
r, because alertness and focus decrease
|
5-15
|
|
Two types of ALS
|
bublar
spinal |
5-15
|
|
Bublar/spinal rapildy deteriates?
|
bulbar - takes 3 1/2 years
|
5-15
|
|
How long does spinal ALS take
|
10-15 years
|
5-15
|
|
No exercises will help what populations
|
postpolio
Motor neuron disease (ALS) |
5-15
|
|
Exercies to do with medullary stroke
|
TTS for delay or absent swallow
head rot to affected side adduction exercises Mendelsohn, Shaker |
|
|
Pontine stroke results in
|
hypertonicity
absent/delyaed pharyngeal swallow unilateral pharyngeal wall paresis reduced laryngeal elevation/cp opening |
|
|
What do to for pontine stroke
|
TTS for delay/absent swallow
head rotation (try both sides) Mendelsohn, Shaker |
|
|
In bulbar als, what do you expect to see and how to treat?
|
tongue later and dec strength
change their diet use compensation which won't work after a year don't over work them |
5-15
|
|
In spinal als, what do you expect to see and how do you treat?
|
mostly pharyngeal wall problems
use postural techniques |
|
|
What do you see in postpolio?
|
unilater ph w (turn head)
dec airway closure dec laryngeal elevation |
|
|
In parkinson's, what do you see?
|
tongue pumping
dec airway closure dec bot motion |
|
|
MS causes
|
delayed ph sw (TTS)
dec bot motion airway closure prob exercies help |
|
|
Guillan Barre see
|
dec ROM
Everything is weak |
|
|
Mysthenia Graves
|
hypernasality
fatigue of muscle w/use |
|