DYSPHAGIA FINAL PREP

Human fetuses begin swallowing as early as ____ weeks gestation

12 weeks gestation

Infants are preferential nasal breathers until approximately ____ months of age

4-6

3 multiple choice options

Which of the following infant reflexes dimishes first

Rooting

3 multiple choice options

The major functions of the oral cavity, pharynx, and larynx can be grouped into three categories. Select the category that is NOT correct.

Integumentary

3 multiple choice options

The infant larynx is situated ____ than the adult larynx

higher

1 multiple choice option

suckle movements are: _____, sucking movements are:________

protusion and retraction, elevation and depression

1 multiple choice option

What nerve activates the muscles that open/close the VF?

RLN

In an MBS, the pharyngeal response is noted by _____

hyolaryngeal elevation

Two hallmarks of PD swallow/ oral issues?

Repetitive tongue pumping and lingual fasciculations

_____ pneumonia is the aspiration of oils used in a ventilation machine into the lungs

lipid

What is retraction surgery trauma

it being moved

What populations are most likely to get a trach

people with laryngeal obstruction, traumatic accident, respiratory failure, CA, chronic respiratory conditions, degenerative conditions

Cranial Nerves important for speech

CN V, VII, IX, X, XI, XII

What is propulsion

The oral transport moving bolus from front to back

Odonophagia

Painful swallowing

Deglutition

Medical term for swallowing

Penetration

the entrance of anything into the laryngeal vestibule (but not below the level of the vocal folds)

Aspiration

the entrance of anything into the laryngeal vestibule and below the vocal folds

3 divisions of the pharynx

nasopharynx, oropharynx, hypopharynx

What two structures create a potential reservoir for pharyngeal residue?

Vallecula, piriform recesses/sinuses

Normal oral transport time is ____ many seconds

0.5 to 1

Where is the pharyngeal swallow typically triggered?

Ramus of the mandible/faucial arches

Why is the pharyngeal stage the most important stage?

protection of the airway, opening of the UES, downward propulsion of the bolus through the pharynx

Which population typically inhales after a swallow?

COPD

What is the primary muscle of the UES

Cricopharyngeus

What initiates primary peristalsis

Initiation of the pharyngeal stage also initates…

Where is the swallowing center found

medulla oblongata

a ____ is a pass/fail process in which the clinician determines whether the patient is at risk for aspiration.

screening

The RLN is damaged. Will this play a bigger role in the severity of dysphagia than the SLN?

Yes

A particular cranial nerve has been impacted. The primary areas impacted include the jaw and MOM movement, motor to the TVP, sensory to face/oral cavity, and sensory to anterior 2/3 of tongue. Which CN am I?

Trigeminal V

A particular cranial nerve has been impacted. The primary areas impacted include facial symmetry, muscle movement/sensation, taste to anterior 2/3 of tongue. What CN am I?

Facial VII

A particular cranial nerve has been impacted. The primary areas impacted include the pharynx, and taste to posterior 1/3 of tongue and faucial arches. What CN am I?

Glossopharyngeal IX

A particular cranial nerve has been impacted. The primary areas impacted include soft palate, VF movement, pharynx, motor innervation to all velar muscles except the TVP, and taste to the BOT and valleculae. What CN am I?

Vagus X

A particular cranial nerve has been impacted. The primary areas impacted include shoulder/neck. What CN am I?

Accessory X

A particular cranial nerve has been impacted. The primary areas impacted include motor innervation to the intrinsic and extrinsic muscles of the tongue. What CN am I?

Hypoglossal XII

Disordered physiology is present during the swallow. The symptoms/signs include decreased jaw movement/sensation to the face, jaw and mouth. What CN am I?

Trigeminal V

Disordered physiology is present during the swallow. The symptoms/signs include decreased facial movement/sensation, and increase in difficulty controlling saliva. What CN am I?

Facial VII

Disordered physiology is present during the swallow. The symptoms/signs include weakness tilting/turning head, impact on voluntary control of the pharynx and soft palate, difficulty with posture, and endurance for extended periods of eating. What CN am I?

Accessory XI

Disordered physiology is present during the swallow. The symptoms/signs include reduced lingual strength and ROM. What CN am I?

Hypoglossal XII

I am having some dysphagia symptoms, which include reduced mastication and difficulty with oral containment. What cranial nerve is impacted?

Trigeminal V

I am having some dysphagia symptoms, which include residue/stasis in lateral sulci (buccal cavities) and anterior loss of saliva. What cranial nerve is impacted?

Facial VII

I am having some dysphagia symptoms, which include penetration and/or aspiration before/during a swallow. What cranial nerve is impacted?

Glossopharyngeal IX

I am having some dysphagia symptoms, which include fatigue, difficulty clearing boluses, difficulty with maintaining upright/seated posture. What CN is impacted?

Accessory XI

I am having some dysphagia symptoms, which include difficulty with oral prep (bolus formation and control), difficulty with AP transit of bolus, oral residue/stasis. What cranial nerve is impacted?

Hypoglossal XII

The _____ laryngeal nerve supplies sensory innervation to the larynx BELOW the level of the VF

Recurrent

The _____ laryngeal nerve supplies motor innervation to all the intrinsic muscles of the larynx except for the _______ muscle

recurrent, cricothyroid

The ____ laryngeal nerve supplies supraglottic sensory innervation

Superior

What tract in the brain is responsible for voluntary control of face/head and neck?

Corticobulbar

What tract in the brain is responsible for control of the body/limbs?

Corticospinal

The act of swallowing involves max, how many muscles?

36

Healthy persons can trigger the pharyngeal swallow as low as ____

the pyriform sinuses

Pharyngeal phase- the transit time is ____

0.8 seconds

At what stage of the swallow does a person become apneic?

Pharyngeal phase

In a FEES, the pharyngeal response is noted by the

movement of the arytenoids....

In the esophageal phase, the transit time is approximately how long?

8-20 seconds

Signs and symptoms of a ______ Phase Disorder include premature bolus spillage to vallecula, delayed trigger of pharyngeal swallow, incomplete hyolaryngeal elevation, incomplete epiglottic inversion, pooling in sinuses, nasal regurgitation, penetration/aspiration

pharyngeal

Silent Aspiration is very common in what kind of CVA?

Brainstem CVA

The normal response to penetration is a ____

Swallow

What is a fistula?

a hole where there shouldn't be a hole

What is a diverticulum?

a sack/pocket

what is hiatial hernia?

When part of the stomach protrudes through the LES

List some of the tx options for esophageal dysphagia

postural maneuvers, increasing swallowing frequency. medications, dietary changes, dilation, surgery

What is globus hystericus?

sensation of lump in throat when none is present

Three types of CVA

Ischemic, hemorrhagic, AVM

Pneumonia is a leading cause of death in people with

Parkinsons

What patient population has difficulty coordinating respiratory control and swallowing- resulting in rapid intake of breath and aspiration

ALS patients

_________ is an autoimmune disorder characterized by fatigue and exhaustion of the muscular system caused by impaired conduction of the NMJ

Myasthenia Gravis

5 types of pneumonia

Community Acquired, Aspiration, Lipid, Chronic, Nosocomial/HAP

Hallmark characteristic of COPD

Shortness of breath

ACSS and ACDF surgeries do what?

Fuse portions of the cervical spine

Example of direct surgery trauma

knicking

The surgical removal of part of all of the larynx

Laryngectomy

An opening at the base of the neck for the purpose of breathing

stoma

a ______ is a procedure that allows people who have had a total laryngectomy (larynx removal) to speak again by creating a connection between the trachea and esophagus and inserting a one-way valve to redirect air for voice production

tracheoesophageal puncture (TEP)

Tracheostomy is the "--------" while tracheotomy is the "__________"

the hole/stoma, the surgical procedure

Pressure in the trachea is ______ during swallowing if the pt has an open tracheostomy

reduced

With an occluded tracheostomy, it causes ______ pressure

normal

Does a cuffed trach prevent aspiration?

NO

A pt has a trach. They are breathing in through the stoma and out through their mouth. Are they wearing a speaking valve?

Yes

A pt has a trach. They are breathing in through the stoma and out through the stoma. Are they wearing a speaking valve?

no

What are the 5 steps to a PMV trial?

Check chart to see PMV approval, Check again to see if cuff can be deflated, obtain the PMV, deflate the cuff, instruct pt on the 3 steps

weight loss, odynophagia, voice changes, dysarthria, and tongue immobility are early signs and symptoms of _____

H/N Cancer

Alternate nutrition needs, xerostomia, globus, fibrosis, loss of tongue strength, disrupted timing of swallow are all long term effects of

radiation in H/N cancer pts

Is an order needed for a dysphagia screening?

no

Is an order needed for a BSE/CSE?

yes

Is an order needed for an instrumental assessment (MBS/FEES)?

yes

Clinical observation of aspiration, being diagnosed with a particular diagnosis (like stroke), chart review, and occasionally patient questionnaire can result in what kind of request for you as an SLP? What service might you provide?

dysphagia screening

With this particular screen, the patient receives an immediate fail if they have a bilateral stroke, brainstem stroke, history of pneumonia acute stroke phase, coughing associated with feeding or during a 3oz water swallow test, failure to consume 1/2 of meals, prolonged time required for feeding, non-oral feeding program in progress. What screening test am I?

Burke Dysphagia Screening Test

primary goals of dysphagia tx

prevent air way compromise (aspiration), prevent malnutrition, and prevent dehydration (meet nutritional needs)

in the U. S., you (SLP) have to prove what about treatment to get it for a patient?

that treatment is skilled and targeted (i. e., designed for improved outcomes)

factors that affect oral intake (not an exhaustive list)?

alertness, stamina, reaction to food, judgment & cognition, and oropharyngeal anatomy and fx

limiting/providing social distractions, dimming the lights, etc. are examples of what kind of adaptation

environmental

_________ are designed to eliminate the symptoms of the swallowing problem

compensatory strategies

Do compensatory strategies directly impact swallow physiology?

no

Quick example of compensatory strategies- list 4

postural changes, modification of bolus, environmental/behavioral adaptations and some swallow "strategies"

examples of postural changes

90 degrees upright for eating, laying position for eating, chin tuck, head tilt, head rotation

bolus modifications- what is viscosity?

thickened liquids

bolus modifications- what is consistency?

modifying solids

examples of what can be done to modify the bolus

viscosity, consistency, small bites/sips, alternating liquids and solids, changing temperature and taste

rate of food presentation, single bite/sip w/ break in between, no multiple swallows, slow rate, limiting distractions, and compensatory utensils are examples of what kind of modifications during the swallow?

behavioral and environmental