Dysphagia

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Author:
rlwesley
ID:
253667
Filename:
Dysphagia
Updated:
2013-12-17 21:43:24
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dysphagia
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  1. muscle that helps squeeze bolus down
    superior, middle constrictor
  2. muscle that included TP and CP
    inferior constirctor
  3. Which muscle is tonically active; relaxes during the swallow to open so bolus can pass
    cp
  4. These muscles elevate the pharynx
    stylopharyngeous and palatopharyngeous
  5. This muscle includes the vocalis and can be an adductor, tensor or relaxor
    TA
  6. This muscle lengthens and tenses the VF
    CT
  7. This muscle abducts and externally rotates the arytenoids
    PCA
  8. Adducts and internally rotates the arytenoids
    LCA
  9. Adducts the arytenoids
    transverse and oblique arytenoids
  10. Trigeminal (v)
    • Maxillary Branch- mucous membrane of mouth, palate, nasopharynx, teeth, face
    • Mandibular- jaw movement, chewing, bite, tongue movement to propel bolus
  11. Trigeminal (V) Damage
    Unilateral- no major effects on speech/swallow

    Bilateral- jaw hangs open, slow chewing, poor artic and ROM
  12. Facial (VII)
    Motor nucleus in Pons

    muscles for facial expression, sublingual glands, taste, nasopharynx (swallowing)
  13. Facial (VII) Damage
    • Bell's palsy
    • Affects voluntary, emotional and reflex movement
  14. Glossopharyngeal (XI)
    Nucleus in Medulla

    elevates pharynx, sublingual glans, pharynx, taste, gag reflex (primarily swallowing)
  15. Glossopharyngeal (IX) Damage
    • -Reduced pharyngeal sensation
    • -impaired gag reflex
    • -reduced pharyngeal elevation
    • -Excessive oral secretions
  16. Vagus (X)
    • Nucleus in Medulla
    • -Soft palatte, pharynx (contraction & elevation of soft palate)
    • -Soft palate, base of tongue, supraglottic area, larynx, esophagus, trachea
  17. Vagus (X) Damage
    • Unilateral LMN- resonance, voice, swallowing
    • Bilateral LMN- Resonance, voice, swallowing, prosody, artic

    Swallowing- reduced airway closure and sensation
  18. Spinal/Accessory (XI)
    • pharyngeal and superior RLN
    • -Uvula, levator palatini, intrinsic laryngeal muscle
  19. Spinal/Accessory (XI) Damage
    • Head rotation on contralateral side
    • Shrug shoulder on ipsilateral side
  20. Hypoglossal (XII)
    All muscles of tongue except palatoglossus
  21. Hypoglossal (XII) Damage
    • -Tongue atrophy, weakness, and fasiculations of the tongue (ipsilateral)
    • -Tongue deviation TOWARD side of lesion
  22. Oral Prep Phase
    • -Voluntary & Can be bypassed
    • -Bolus formed (food broken down and moistened with saliva)
    • -Lingual velar closure prevents premature spillage
    • -Airway open, nasal breathing, labial seal, 
    • -Duration is variable
  23. Oral (Transport) Phase
    • -Voluntary
    • -Food moved to back of mouth by tongue (AP rolling)
    • -Tongue propels bolus into pharynx
    • -Duration: 1-1.5 seconds
  24. Pharyngeal Phase
    • -Involuntary
    • -Respiration put on hold
    • -Airway closure
    • -Velum is raised to prevent food entering nasopharynx
    • -Bolus driven through the pharynx
    • -Tongue is retracted to prevent food from re-entering mouth and drive bolus into pharynx
    • Duration: 1-2 seconds
  25. What is the most important phase of the swallow?
    Pharyngeal phase
  26. 3 actions that occur to protect the airway
    • 1. Larynx & hyoid pulled up & forward
    •   -lowers epiglottis
    •   -creates vacuum in pharynx pulls bolus down
    •   -relaxes CP to open esophagus
    • 2. Epiglottis flaps over larynx
    • 3. Larynx closes at:
    •   -Base of epiglottis to aryepiglottic folds
    •   -False VF
    •   -True VF
  27. Esophageal phase of swallow
    • -Involuntary
    • -CP/UES relaxes and is pulled open
    • -Bolus is pulled down esophagus
    • -larynx lowers and returns to original position
    • -CP contracts to prevent reflux
    • -Respiration resumes
    • -Duration: 8-20 seconds (longer in elderly)
  28. When food or bolus enters vestibule/airway to any level but not below the superior surface of the true VF
    Penetration
  29. Entry of food into the airway below the level of the true vocal folds
    aspiration
  30. What is the technical term for bedside eval?
    Clinical evaluation
  31. What does a bedside evaluation include?
    • -History
    • -Physical inspection of swallowing musculature
    • -Observation of swallow (test swallow)
  32. What is the order of solids from "Least restrictive" to "most restrictive"?
    • Regular
    • Mechanical soft
    • Pureed
    • Thin liquids
  33. What is the order of liquids from "least" to "Most" restrictive?
    • Thin
    • Nectar
    • Honey
    • Spoon/Pudding
  34. Order of po trials
    • Oral care
    • Ice chips
    • thin liquid
    • Thick liquid
    • Pudding
    • Solid

    (spoon cup and straw)
  35. Where do you put fingers for laryngeal palpatation?
    • Base of tongue
    • Hyoid
    • thyroid notch
    • cricoid
  36. What are you feeling for during laryngeal palpation?
    • -Timing of swallow
    • -Up and forward movement
    • -Multiple Swallows
  37. How would you interpret immediate coughing/choking?
    Penetration/aspiration
  38. How would you interpret delayed coughing/choking?
    • -P/A of residual
    • -Reflux
    • -aspiration with delayed sensation
  39. How would you interpret nasal regurgitation?
    velopharyngeal imcompetence
  40. How would you interpret food stuck in throat, especially solids?
    • Weak laryngeal constrictors
    • reflux
    • poor hyolaryngeal movement
    • poor base of tongue retraction
  41. How would you interpret burning during/after swallow?
    Reflux
  42. How would you interpret multiple swallows?
    • Reduced hyolaryngeal movement
    • Reduced base of tongue retraction
    • Reduced pharyngeal contraction
  43. How would you interpret food residual throughout mouth?
    • Poor oral bolus formulation
    • Poor propulsion
  44. How would you interpret food falling out of mouth?
    Poor lip seal
  45. Medical Treatment options
    • Dietary modification
    • Pharamacology
    • prokinetics
    • Secretion management medication
  46. Surgical Treatment Options
    • Improve glottic closure (injection, thyroplasty)
    • Improve PES opening (dialation, botox)
    • Protect airway (trach, feeding tube)
  47. Behavioral Treatment Options
    • Diet Modifications
    • Posture Changes
    • Swallowing strategies
    • Active Therapy Techniques
  48. What is an example of diet modification?
    Thickened Liquids (Compensatory)
  49. What is an example of postural changes?
    • Chin up
    • Chin Tuck
    • Head turn
  50. Active therapy techniques (rehabilitative)
    • Oral Motor Exercises
    • Thermal Tactile Stimulation
    • Tongue hold maneuver
    • Head lift exercise
  51. Active Therapy Techniques (Rehabilitative and compensation)
    • Breath hold
    • Supraglottic swallow
    • Super supraglottic swallow
    • Mendoelsohn
    • Effortful swallow
    • Multiple swallows

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