Paramby Swallowing Final Exam

VFSS procedure is designed to

observe and describe a disorder and assess effectiveness of interventions

VFSS is both a diagnostic and

interventional procedure

goals of instrumental swallowing study

diagnosis and treatment of dysphagia

oropharyngeal swallow

continuum of temporally overlapping events divided into stages

what structures are active during the entire oropharyngeal swallow

• mandible

• soft palate

• tongue

• hyolaryngeal complex

• UES

anchoring attachments for the tongue

mandible, hyoid bone, skull base

what anchors all of the anterior muscles responsible for HLE

mandible

Boyle’s law

when volume increases, pressure decreases

anterograde

forward moving process

beginning of oropharyngeal mechanism

oral cavity

end of oropharyngeal mechanism

UES

what is considered to be the anatomical entrance to the pharynx

faucial pillars

HLE does this

reorients the airway away from oncoming bolus and laryngeal shortening.

posterior wall of larynx

cricoid cartilage

premature spillage

contrast is seen entering the pharynx before the pharyngeal stage has began

2 reasons for premature spillage

1. delayed onset

2. impaired oral containment

the onset of pharyngeal swallow activity is marked by

onset of maximal HLE

small volume swallow

1-3 ml

large volume swallow

10-20 ml

stages of swallowing

1. oral prep

2. oral

3. pharyngeal

4. esophageal

percentage of tippers

72%

how do you create suction

soft palate lowers to tongue base and muscles in the cheek and face contrast

sarcopenia

loss of muscle tissue due to the natural aging process

path of swallowing

food and liquid → mouth → digestive system

what two systems share swallowing

• aerodigestive

• respiratory

global definition of dysphagia

difficulty in swallowing

dysphagia is not a primary

diagnosis. It is iatrogenic

effects of dysphagia

• dehydration

• pneumonia

• social isolation

• depression

• choking

• malnutrition

• spiritual

main cause of dysphagia in adults

stroke (CVA)

greek root of dysphagia

phagein (to ingest)

SLP scope of practice area

from the lips to the end of the cricopharynxgeus muscles

which phase is an SLP unable to work on due to lack of volitional control

esophageal phase

can SLP recommend tube feeding

No

with thickened liquid, pressure

increases

aspiration

food and liquid entering the airway below the vocal folds

penetration

food and liquid entering the airway but stay above the vocal folds

penetration/ aspiration scale

1. normal

2. penetration/ normal

3. penetration

4. penetration

5. penetration

6. aspiration

7. aspiration

8. silent aspiration

3 branches of the vagus nerve

• pharyngeal branch

• superior laryngeal

• recurrent laryngeal

iatrogenic diagnoses

side effects

another name for VN 10 (Vagus)

wanderer

3 parts of the brainstem

pons, midbrain, medulla oblongata

cranial nerves are

ipsilateral

pneuomina

infection in the lungs

3 layers of protection when swallowing

• epiglottic inversion

• true vocal folds close

• false vocal folds close

pressure used with a straw

negative

mendehlson maneuver

keeps the UES open

what leads to dysphagia

incoordination or abnormal obstruction of flow

the vagus nerve innervates the

larynx

when does pharyngeal stage of swallowing begin

faucial pillars and ramus of the mandible

factors that lower chances of pneumonia

physical exercise, independent feeding, good oral hygiene

muscles of mastication

• temporalis

• masseter

• medial pterygoid

• lateral pterygoid

thyrohyoid shortening =

laryngeal elevation

every tongue muscle is innervated by CN 12 except

palatoglossus

muscles responsible for ANTERIOR movement

• mylohyoid

• stylohyoid

• ABD

muscle responsible for SUPERIOR movement

hyoglossus

what muscle opens the UES

cricopharyngeus muscle

what is cricopharyngeus muscle innervated by

recurrent laryngeal branch of the vagus nerve

2 reasons why the UES is not opening

1. not enough anterior movement of hyoid

2. cricopharyngeus is not relaxed enough

4 suprahyoid muscles

1. mylohyoid

2. stylohyoid

3. ABD and PBD

4. geniohyoid

signs of oral containment impairment

bolus trickles down

duration of healthy swallow

less than one second

what innervates the palatoglossus

CN 10 Vagus

what muscle aids the tongue to move superior towards the hyoid

hyoglossus muscle

hyoid is the origin

tongue is the insertion

3 pharyngeal constrictor muscles

superior

middle

inferior constrictor muscle

without bolus pressure, does the epiglottis invert

no

HLE important events

• contributes to epiglottic inversion

• movement of suprahyoid muscles (stylohyoid, ABD, PBD, geniohyoid, mylohyoid, hyoglossus)

• shortens larynx

• UES opening

thyroid cartilage and cricoid muscle

move together

when is the HLE open

only when food comes, no other time

FEES

flexible endoscopic evaluation of swallowing

MBS = FEES →

multidisciplinary evaluation

MBS is dynamic

True

swallowing maneuvers

better protect the airway immediately before, during, and after swallow

major maneuvers

• supraglottic swallow

• super supraglottic swallow

• effortful swallow

• mendehlson maneuver

• masako / tongue hold

most common swallowing postures

• head back

• chin down

• head rotation

• head tilt

TTOS

thermal tactile oral stimulation

the HLE or Shaker was developed to

treat UES dysfunction by strengthening the suprahyoid muscles

shaker exercise

lay down and tilt head up to look at feet

EMST

expiratory muscle strength training

NMES

neuromuscular electrical stimulation

applies electrical shock to the neck as a means of stimulating laryngeal elevation

muscles targeted with NMES

geniohyoid, mylohyoid, ABD

when vital stem is on →

the hyoid bone movement depresses

dysphagia risks

• UTI

• reduced hydration

• isolation

• choking

treatment risks

• reduced nutrition, hydration, social contact, quality of life, and patient choice

the use of chin tuck during swallowing

improves airway protection

the primary outcome of Shaker

strengthen muscles that open UES

• geniohyoid, thyrohyoid, digastric

frazier water protocal

free water protocol

general posture adjustments

• sit upright

• side lying down

head postural adjustments

head extension, chin tuck, head rotation (odynophagia) and candida

tongue strengthening exercises

• Iowa oral performance instrument

• swallow strong device

supraglottic swallow

• take deep breath

• hold

• hold while swallow

• gentle cough

super supraglottic swallow

bear down

3 negative consequences of masako

1. reduced duration of airway closure

2. increased post swallow residue

3. increased delay in initiation of pharyngeal swallow

symptoms

patient report; subjective

signs

what we can observe; objective

high sensitivity

able to identify those with dysphagia

high specificity

able to screen out those without dysphagia

advanced directive

will

4 characteristics of movement

1. symmetry

2. strength

3. range of motion

4. coordination

safest way to evaluate swallow

saliva swallow

our job is to recommend the

least restrictive diet