Quiz 2

know the information in the tables 6.1, 6.2, 6.3

Chart sheets

Know how each phase of swallow can be affected with nerve damage and what nerves might be affected.

• Oral phase signs/symptoms of neurogenic dysphagia:

  • weakness, paralysis, and/or incoordination of oral phase structures can result in inefficient prep and/or transit of bolus

  • by cranial nerve lesions to CN XII, VII

  • by CNS damage to cortex, periventricular white matter, or BG circuit responsible for oral coord.

  • dysphagic signs/symptoms include drooling, pocketing in labial/lateral sucli, diff manipulating the bolus, diff chewing, long oral prep time, and loss of control of bolus

• Pharyngeal phase signs/symptoms in neurogenic dysphagia:

  • any damage that affects bolus propulsive/airway protective events of pharyngeal phase of deglutition can cause dysphagia

  • increased risk of choking/aspiration

  • severely diminished laryngopharyngeal sensation = high risk of aspirating thin liquids

  • if both laryngopharyngeal sensation and pharyngeal motor function are impaired, high risk of aspiration

  • patients with neurogenic pharyngeal phase deficits aspirate silently

  • unilateral peripheral facial paralysis with intact pharyngeal and laryngeal musculature cough/choke on solids/liquids during acute stages, may result from probs with motor, sensory, tase, and parasympathetic innervation

  • common in diseases/injuries that affect large regions of brain

  • Pharyngeal phase probs may occur with peripheral nerve lesions CN X

  • delay in trigger of pharyngeal swallow, aspiration, reduced hyolaryngeal elevation, vallecular stasis, pyriform sinus stasis, pharyngeal stasis

• Esophageal phase signs and symptoms in neurogenic dysphagia:

  • esophageal motility dependent on fully func striated/smooth muscle/neural control

  • any disease that threatens this has potential to impair esophageal motility

  • if happens=dysphagia and odynophagia (pain during swallow)

Know some of the main neurologic diseases that can affect swallowing and how they affect swallowing.
(I would recommend creating a table for your own reference.)

Chart sheets made

Know some of the main connective tissue diseases that can affect swallowing and how they affect swallowing

Chart sheet made

●Mosier
Be able to describe the hypothesis, methods, results, and conclusion of this article. Do not stress about
the computations, but be able to explain why they came to the conclusion at which they arrived

Miller qs:

tables created

Movements associated with swallowing are orchestrated by:

CNS in response to sensory info provided by peripheral receptors, executed by motor nuclei

Neurogenic dysphagia most common forms

• disorders of the cerebral hemispheres and brainstem

• demyelinating diseases

• disorders of movement: extrapyramidal and cerebellar disorders

• motor unit abnormalities

• muscular dystrophies and other myopathies

• connective tissue disease

neurogenic dysphagia def:

• Any pathology in the nervous system that affects critical tissue or pathways for the neural control of swallowing can produce neurogenic dysphagia.

• The overlap of dysphagia symptoms in patients with neurological diseases and the lack of homogeneity among patients with similar neurological etiologies present a challenge for the speech-language pathologist

• Each patient exhibits different swallowing patterns (depends on lesion site, size, side, acuteness)

Difference between “signs” and “symptoms” ?

• sign: any abnormality indicative of a disease, or discoverable by examination, ex) fever, radiographic evidence of pneumonia, aspiration documented by mod. barium swallow

• symptom: something experienced by patient, ex)effortful chewing while eating, difficulty manipulating/forming bolus, reduced sensation in oral cavity reported by patient

What is silent aspiration?

• entrance of food, liquid or secretions below vocal folds w/o any outward sign of difficulty

• no choking, coughing , throat clearing - no distress

• only way to identify is MBS or FEES exam

Def of dysphonia

• Dysphonia refers to having an abnormal voice

• It is also known as hoarseness

• Changes to the voice can occur suddenly or gradually over time. The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely.

Def. of dystonia

• Dystonia is a condition where a person has uncontrollable muscle movements in some part of their body.

• uncontrolled eye blinking, spasms of neck, spasms in larynx

Botox for spasmodic dysphonia:

• botox used as a neuromuscular treatment that causes temporary paralysis in muscles by blocking presynaptic release of acetylcholine at neuromuscular junction

• used for inappropriate muscular contractions

• short term

Def. of achalasia

• failure of the lower esophageal sphincter to relax

• damaged nerves make it hard for the muscles of the esophagus to squeeze food and liquid into the stomach

• motor disorder of esophagus

• normal peristaltic waves replaced by asynchronous, low amplitude waves

• symptoms include dysphagia, chest pain, regurgitation of food in esophagus

• diagnosed by manometry

Botox treatment for achalasia:

• used when patients cannot tolerate myotomy or dilatation

• injection into 4 quadrants of the LES

Cranial nerve motor nuclei involved in swallow:

CN 5, 7, 12

NTS does ______ part of swallow to trigger response from NA which is the _____ part of the swallow.

• sensory

• motor

sensory input comes from:

• trigeminal branches

• glossopharyngeal nerve (CN IX)

• vagal branches