SLP 536 midterm

What is a sign of dysphagia related to food recognition? s/s

Inability to recognize food

What symptom of dysphagia involves difficulty controlling food or saliva in the mouth? s/s

Inability to control food/saliva in the mouth

What symptom of dysphagia may occur during any part of the swallow? s/s

Coughing during any part of the swallow

What is a potential consequence of dysphagia that involves weight? s/s

Unexplained weight loss

What symptom of dysphagia can result in a gurgly voice after eating? s/s

Gurgly voice after a meal

What symptom of dysphagia can lead to prolonged meal duration? s/s

Prolonged meal duration

What sensation might a patient with dysphagia experience regarding food? s/s

A sense of food sticking in the throat

What complaint might a patient with dysphagia express? s/s

Patient complaining of swallowing difficulties

What serious condition can recur in patients with dysphagia? s/s

Recurring pneumonia

phases of swallowing: oral Prep

LIPS SEALED TIGHT TO PREVENT ANTERIOR SPILLAGE OF WHATEVER WE ARE EATING AND DRINKING

cranial nerves involved in swallowing

Trigeminal V, facial VII, glossopharyngeal IX, vagus X, hypoglossal XII

purpose of a swallow screening

Purpose is to determine whether further evaluation is needed.

What is the first step in a Bedside Swallow Evaluation?

Have the patient ingest a variety of textured foods and drinks.

What is evaluated during a Bedside Swallow Evaluation?

How the patient is swallowing the ingested foods and drinks.

What additional assessments may be performed if needed after a Bedside Swallow Evaluation?

MBSS, FEES, or VFSS.

swallow maneuvers for oropharyngeal dysphagia

Super suprasubglottic swallow

Mendelsohn maneuver

Effortful swallow

diet consistencies

liquids, thick liquids, purees, minced

head and neck cancer staging

TNM approach

tumor, nodal status and metastasis

glossectomy (tumor of the tongue)

Partial glossectomy

Hemiglossectomy

Subtotoal glossectomy

Total glossectomy

Phase of Swallowing: Oral Transit

WE PERFORM A ROTARY (SEMI CIRCULAR) MOTION OF OUR MANDIBLE/JAW WHEN WE ARE CHEWING

Phases of Swallowing: Pharyngeal

is triggered when the bolus reaches the anterior faucial arch (remember this is that area right above the palatine tonsils)

Phases of Swallowing: Esophageal

UES opens then closes, peristalsis, LES opens then closes

When does the bolus enter the UES?

Esophageal Stage

Super Suprasubglottic Swallow

It involves closing the airway at the level of the vocal cords before and during the swallow, and then clearing any residue with a cough.

Mendelsohn Maneuver

For: reduced laryngeal elevation plus reduced UES opening

How: Swallow normal, feel larynx lift; swallow, feel and hold larynx up after it lifts, finish swallow

(longer elevation of larynx normalizes timing of pharyngeal swallow)

effortful swallow maneuver

It involves squeezing all swallowing muscles very hard while swallowing. This can be done with or without food, and it often involves imagining swallowing a grape or a stuck object.

TNM staging

classifies cancer according to tumor size, node involvement, metastasis

Partial glossectomy

Removes less than 50% of tongue

Difficulty holding and preparing bolus

Anterior tissue removal increases difficulties

Hemiglossectomy

removal of half the tongue

subtotal glossectomy

Removing more than half the tongue but not the entire tongue

Total Glossectomy

Removal of entire tongue

IDDSI

International Dysphagia Diet Standardization Initiative

IDDSI Framework

0- thin

1- slightly thin

2- mildly thin

3- moderately thick

4- extremely thick

5- minced and moist

6- soft and bite sized

7- regular

genioglossus muscle

protrudes tongue

Styloglossus

elevates and retracts tongue

Hyoglossus

depresses tongue

Palatoglossus

elevates posterior part of tongue

superior longitudinal muscle

shortens tongue, turns tip upward, assists in turning lateral margins upward

Inferior longitudinal muscle

shortens tongue, pulls tip downward, assists in retraction

Transverse muscle of tongue

narrows tongue

vertical muscle of tongue

flattens the tongue, and pulls tongue down into floor of mouth

What does VFSS stand for?

Videofluoroscopic swallow study

What type of study is a VFSS?

A radiographic study using fluoroscopy

What does VFSS examine during swallowing?

The movement patterns of the oral cavity, pharynx, and esophagus

What type of radiation is used in a VFSS?

Ionized radiation

What contrast agent is used in a VFSS?

Barium

What does FEES stand for?

Fiberoptic Endoscopic Evaluation of Swallowing

What is the purpose of inserting a thin, flexible endoscope through the nasal passage in FEES?

To visualize the pharynx and larynx during swallowing.

What does FEES allow healthcare providers to assess?

How the patient handles various food and liquid consistencies.

signs and symptoms of dysphagia

inability to control food/liquid in the mouth, coughing during any part of the swallow, unexplained weight loss, gurgly voice after swallow, prolonged meal duration, sense of food sticking in the throat

importance of a swallowing screen

determines whether further evaluation is needed

are screenings used to determine anatomy/physiology?

no; false

order of swallow sequence

1. oral prep

2. oral transit

3. pharyngeal

4. esophageal

muscles that move the soft palate

pallatoglossus

length of normal swallow

1.0 - 1.5 seconds for typical swallow

formal instrumentation for SLPs to use

• MBSS

• FEES

• ultrasound

what procedure is used to assess and measure the precise amount of aspiration and penetration

scintgraphy

when pharyngeal swallow is triggered…

• tongue moves food into the back of the mouth

• faucial arches or pillars

anterior spillage

• nwhen food spills out of someones mouth then they are eating

• they have reduced lip closure

when aspiration is suspected

• coughing or choking

• chest pain

• shortness of breath

• chronic cough

• fatigue while eating

• aversion to eating

cranial nerves involved in lingual and labial function

• VII: facial

• XII: hypoglossal

supraglottic swallow maneuver

• place the bolus in the oral cavity

• hold your breath

• swallow

• cough immediately

• purpose: volitional airway protection (holding breath brings TVFs together, cough redirects any penetrants or apirants)

diet texture levels

liquids, thick liquids, purees, minced

head and neck cancer staging

• TNM approach

• tumor, nodal status, metastasis

• size and location

total glossectomy

removal of entire tongue

partial glossectomy

removal of less than 50% of the tongue

hemiglossectomy

removal of half of the tongue

subtotal glossectomy

removal of more than 50% of the tongue

#20-23

total, subtotal, hemi, partial