Neurogenic & Respiratory Swallowing Disorders – Week 4

A comprehensive set of vocabulary flashcards covering key terms, structures, disorders, and clinical concepts related to neurogenic and respiratory causes of dysphagia presented in Week 4 lecture notes.

Dysphagia

Difficulty or discomfort in swallowing that can involve the oral, pharyngeal, and/or esophageal phases.

Neurogenic Dysphagia

Swallowing disorder caused by pathology within the nervous system (cortex, brainstem, cranial or peripheral nerves).

Respiratory-Related Dysphagia

Swallow impairment that arises from, or is worsened by, disorders of breathing or airway management.

Modified Barium Swallowing Impairment Profile (MBSImP)

Standardized tool for scoring physiologic components observed during a videofluoroscopic swallow study.

Neuroplasticity

The brain’s ability to reorganize neural connections after injury, experience, or learning.

Oral Phase

Stage of swallowing involving bolus preparation, manipulation, chewing, and anterior-posterior oral transit.

Pharyngeal Phase

Involuntary stage in which the bolus passes through the pharynx while the airway is protected.

Hyolaryngeal Elevation

Upward–forward movement of the hyoid and larynx that contributes to airway closure and UES opening.

Vallecular Residue

Bolus material remaining in the valleculae after the swallow, indicating inefficient tongue base retraction or elevation.

Pyriform Sinus Residue

Bolus material remaining in the pyriform sinuses after the swallow, usually from impaired hyolaryngeal elevation or UES opening.

Aspiration

Entry of food, liquid, or secretions below the level of the true vocal folds into the airway.

Laryngeal Penetration

Entry of material into the laryngeal vestibule that does not pass below the true vocal folds.

Silent Aspiration

Aspiration that occurs without overt signs such as coughing or throat clearing.

Swallow Apnea

Brief cessation of breathing that normally occurs during pharyngeal bolus passage.

Swallowing Apraxia

Difficulty initiating swallow in the absence of motor weakness or sensory loss, often from cortical damage.

Xerostomia

Abnormal dryness of the mouth that can impair bolus formation and transport.

Cerebrovascular Accident (Stroke)

Interruption of blood flow to the brain causing focal neurological deficits; a leading cause of neurogenic dysphagia.

Left-Hemisphere Stroke Dysphagia

Characterized by mild oral and pharyngeal delay and possible apraxia of swallow.

Right-Hemisphere Stroke Dysphagia

Similar physiologic defects as left-sided stroke but poorer outcomes due to attentional and judgment deficits.

Brainstem Stroke

Often produces the most severe dysphagia because the medullary swallowing centers and multiple cranial-nerve nuclei are affected.

Traumatic Brain Injury (TBI)

Acquired brain damage from external force; dysphagia prevalence can reach 93% and often relates to injury severity.

Glasgow Coma Scale (GCS)

Acute measure of consciousness used to grade TBI severity and predict dysphagia risk.

Rancho Los Amigos Scale (RLAS)

Behavioral rating of cognitive recovery after TBI; higher levels often parallel improved swallow function.

Functional Independence Measure (FIM)

Scale of disability assessing self-care and mobility; low scores correlate with dysphagia in TBI.

Dementia

Progressive decline in cognitive abilities; later stages commonly include swallowing and feeding difficulties.

Alzheimer’s Disease

Most common neurodegenerative dementia that can produce slow oral and pharyngeal swallow responses.

Frontotemporal Dementia

Dementia variant with prominent behavioral changes; exhibits distinct eating habit alterations versus Alzheimer’s.

Parkinson’s Disease

Basal ganglia degeneration causing bradykinesia, tremor, rigidity, and dysphagia marked by tongue pumping and delayed swallow.

Tongue Pumping

Repetitive anterior–posterior tongue rocking seen in Parkinson’s disease, prolonging oral transit.

Huntington’s Disease

Hereditary basal ganglia disorder with chorea and cognitive decline; dysphagia includes impaired bolus control and aspiration.

Amyotrophic Lateral Sclerosis (ALS)

Progressive degeneration of upper and lower motor neurons; eventually produces pervasive oral and pharyngeal dysphagia.

Myasthenia Gravis

Autoimmune neuromuscular disease causing fatigable skeletal-muscle weakness, including muscles of swallowing.

Sjögren’s Syndrome

Autoimmune disorder causing severe dryness of mucous membranes; patients often perceive greater swallow difficulty than instrumental findings reveal.

Guillain-Barré Syndrome

Acute polyneuropathy leading to rapid weakness and possible transient dysphagia during the demyelinating phase.

Collagen Vascular Disease

Autoimmune conditions (e.g., rheumatoid arthritis, lupus) that can affect connective tissues and swallowing structures.

Modified Barium Swallow Study (MBSS/VFSS)

Radiographic assessment that visualizes bolus flow and physiology across all swallow phases.

Respiratory Failure

Inadequate gas exchange (low oxygen and/or high carbon dioxide) requiring medical intervention and often airway support.

Ventilation

Mechanical movement of air in and out of the lungs via the pumping action of respiratory muscles and diaphragm.

Respiration (Gas Exchange)

Diffusion of oxygen and carbon dioxide across alveolar and cellular membranes.

Intubation

Placement of an endotracheal tube through the mouth into the trachea for airway protection and mechanical ventilation.

Post-Extubation Dysphagia

Swallow impairment following tube removal due to laryngeal edema, reduced sensation, and muscular atrophy.

Tracheostomy

Surgical creation of a stoma in the trachea with tube placement to establish a stable airway for prolonged ventilation.

Cuffed Tracheostomy Tube

Tube design with an inflatable balloon that seals the tracheal wall to prevent aspiration and deliver ventilator volumes accurately.

Passy-Muir Valve (PMV)

One-way speaking valve that redirects exhaled air through the vocal folds; restores subglottic pressure and can improve swallowing.

Chronic Obstructive Pulmonary Disease (COPD)

Progressive airflow limitation (emphysema and/or chronic bronchitis) leading to dyspnea and potential dysphagia.

Emphysema

Type of COPD where alveolar walls are destroyed, reducing elastic recoil and surface area for gas exchange.

Chronic Bronchitis

COPD variant characterized by chronic airway inflammation, thickened walls, and excessive mucus production.

Pneumonitis

Non-infectious inflammation of lung tissue due to irritants, allergens, radiation, or gastric contents.

Pneumonia

Infection plus inflammation of lung parenchyma caused by bacteria, viruses, or fungi; severity varies with host factors.

Aspiration Pneumonia

Infectious pneumonia resulting from inhalation of oropharyngeal or gastric material in patients with dysphagia.

Pulmonary Clearance Mechanism

Combined ciliary transport and alveolar macrophage activity that removes inhaled particles and secretions.

Muco-Ciliary Escalator

Ciliated epithelial transport that moves mucus and trapped debris upward toward the pharynx to be expelled or swallowed.

Alveolar Macrophage

Immune cells in alveoli that ingest and dispose of foreign particles via enzymatic degradation or lymphatic transport.

Cough Reflex

Protective mechanism (voluntary or involuntary) that clears the airway of irritants, secretions, or aspirated material.

Paroxysmal Cough

Sudden, uncontrollable bursts of coughing often due to pertussis or airway irritation.

Penetration-Aspiration Scale

Instrumental rating (PAS) that quantifies depth of airway invasion and patient response during swallow studies.

Stroke-Associated Pneumonia Predictors

Older age, greater stroke severity, COPD, dysphagia, coronary artery disease, and preadmission dependency raise pneumonia risk.

Costophrenic Angle

Radiographic junction of diaphragm and chest wall; blunting on CXR suggests pleural effusion.

Chest X-Ray Infiltrate

Area of increased opacity indicating fluid, infection, or consolidation within lung tissue.

White Blood Cell Count (WBC)

Laboratory measure (normal 4,500–11,000 cells/µL) that rises with infection such as pneumonia.

Arterial Blood Gas (ABG)

Test measuring PaO₂, PaCO₂, and pH to evaluate respiratory status; normal PaO₂ ≈ 85–100 mm Hg.

Oxygen Saturation (SpO₂)

Pulse oximetry estimate of hemoglobin saturation; values < 90 % often indicate hypoxemia.

Bronchodilator

Medication that relaxes airway smooth muscle, improving airflow in conditions like COPD and asthma.

Swallowing Screening

Rapid bedside procedure to identify individuals at risk for dysphagia who require full evaluation.

Videofluoroscopic Swallow Study (VFSS)

Dynamic X-ray assessment of all phases of swallowing using barium-coated materials; gold standard for diagnosing aspiration.

Esophageal Phase

Final swallow stage where bolus passes through the esophagus to the stomach via peristalsis.

Cricopharyngeus Muscle

Primary component of the upper esophageal sphincter; its relaxation is essential for bolus passage into the esophagus.

Pharyngeal Constrictors

Superior, middle, and inferior muscles that sequentially contract to propel the bolus toward the esophagus.

Deglutition

Scientific term for the act of swallowing.