Acoustic or Vestibulocochlear
How to remember the Cranial Nerves in order:
OOO, TTA, FAVG, VSAH
Modality of CN I Olfactory
Modality of CN II Optic
Modality of CN III Oculomotor
Modality of CN IV Trochlear
Modality of CN V Trigeminal
Modality of CN VI Abducens
Modality of CN VII Facial
Modality of CN VIII Acoustic/ Vestibulocohlear
Modality of CN IX Glossopharyngeal
Modality of CN X Vagus
Modality of CN XI Spinal Accessory
Modality of CN XII Hypoglossal
Function of CN I Olfactory
Function of CN II Optic
Function of CN III Oculomotor
Function of CN IV Trochlear
Function of CN V Trigeminal
Innerveates the muscles of mastication: TIME: Temporalis, Internal Pterygoid, Masseter, External Pterygoid;
Sends sensation to the face and scalp and has 3 sensory branches: V1= Opthalamic V2=Maxillary V3= Mandibular
Function of CN VI Abducens
Function of CN VII Facial
Facial expression; secretion of saliva and tears; Taste; anterior 2/3 of tongue
Function of CN VIII Acoustic/ Vestibulocochlear
Equilibrium and audition
Function of CN IX Glossopharyngeal
Swallowing; Taste: posterior 1/3 of the tongue; Visceral sensation from oral pharynx
Function of CN X Vagus
Phonation and swallowing; Sensation: thoracic and abdominal organs
Function of CN XI Spinal Accessory
Head movement and shoulder elevation
Function of CN XII Hypoglossal
Tongue/ Lingual movement
diet as tolerated
eyes, ears, nose, and throat
history and physical
insulin dependent diabetes mellitus
non-insulin dependent diabetes
pupils equal, regular, reactive to light and accommodation
past medical history
PRN or prn
right lower lobe
within functional limits
C with a line over it
S with a line over it
P with a line over it
post or after
Which cranial nerves are located in the cerebral cortex?
CN I (olfactory) and CN II (Optic)
Which cranial nerves are located in the midbrain?
CN III (Oculomotor) and CN IV (Trochlear)
Which cranial nerves are located in the pons?
CN V (Trigeminal), CN VI (Abducens), CN VII (Facial), and CN VIII (Acoustic/ Vestibulocochlear)
Which cranial nerves are located in the medulla?
CN IX (Glossopharyngeal), CN X (Vagus), CN XI (Spinal Accessory), and CN XII ( Hypoglossal)
What is dysphagia?
A swallowing disorder
Who does dysphagia affect?
Infants to adults/ geriatrics
What are some causes and disgnoses with high risk of neurogenic dysphagia?
Stroke, TBI, Tumor, Neurodegenerative or Neuromuscular diseases (ex. Dementia, Parkinson's etc), Chemotherapy, Radiotherapy, and Spinal Cord Injury.
What must I understand about dysphagia before evaluating a person for it?
Must understand the normal swallow process
Name some structures involved in swallowing?
Mandible, tongue, pharynx, glottis, epiglottis, hard and soft palate, larynx, vocal folds, esophagus
Swallowing is a _______________ _________ act
What are the 4 phases of normal swallowing?
1.Oral Preparatory Phase
2. Oral Phase
3. Pharyngeal Phase
4. Esophageal Phase
What keeps the bolus before the start of the oral phase of the swallow? (Muscles and glands)
Muscles:Temporalis, Masseter, Buccinator, and Pterygoid
Glands: Partoid, Submandibular, and Sublingual
Oral Preparatory Phase
Mxing food with saliva to form a bolus
Voluntary; Bolus is propelled posteriorly in the oral cavity
Structures invoved in the oral phase of swallowing?
Teeth, lips, tongue, hard palate, doft palate, uvula, mandible, and hyoid
Involuntary; The materal reaches the anterior faucial arches
Involuntary; Peristalsis carries bolus through esophagus and into the stomach
Goal of working with an multidisciplinary team?
Identify pateints with swallowing and chewing problemes, Prevent aspitation and reduce incident of aspiration pneumonia, Prevent malnutrition and dehydration, Help pt. have safety, adequacy, and independence in swallowing, chewing, feeding etc, To educate staff, family, and pateint about it
_______ are objective measurments or observations of behaviors that people elicit during physical examination
________ defined as any perceptible change in bodily function that the patient notices
_________ entry or penetration of foreign materal into the larynx and entering the trachea below the level of the vocal folds. It can occur before, during, or after swallowing.
_______ ________ entry of foreign material in the trachea without coughing or any sign/ symptoms of swallowing problems
_________ material penetrates the larynx and enters the airway above the true vocal folds
_________ the process of chewing food in preparation for deglutition and digestion
________ is the act of swallowing
_______ ________ the result of weakness or incoordination in the arm used to move the food from the plate to the mouth
__________ is a common disorder characterized by dilation of the esophagus caused by failure of the cardiac sphincter to relax
______ refers to a "sip" of liquid or a "bite" of food placed in the mouth for ingestion
_________ is a wavelike progression of contraction and relaxation of muscle fibers in the esophagus
________ is a depression created between base of tongue and epiglottis
___________ _________ circular band of muscles that sits between the cervical esophagus and the hypopharynx; remains closed except during swallowing
_________ _________ are pouches or cavities constituting the lower end of the nasopharynx located to the side and partially to the back of the larynx
_________ _________ ________ is the most common term used by the gastroenterologist to refer to the opening of the esophagus
Upper esophageal sphincter (UES)
________ is residue of material in the oral or pharyngeal cavities; stoppage of the normal flow of material
__________ _________ is difficulty in the oral preperatory and oral phases of the swallow
_________ _________ is difficulty swallowing in the pharyngeal area
________ __________ difficulty in swallowing that starts at the level of the criocopharyngeus and below as the food travels through the esophagus to the stomach
_________ movement, as in the peristalsis of the esophagus
________ _________ this range from severe nonfunctional dysphagia to minimal dysphagia based on the SLP's swallowing evaluations
__________ is lacking teeth
_________ is when stomach contexts move up the esophagus
___________ is the condition in which food already in the esophagus backs up without ever having entered the stomach
How can I know what to look for as I am performing my clinical swallowing examination? (Signs and symptoms that a patient may exhibit)
(Most importantly poor nutrition or dehydration), change in lung sounds, facial grimacing, gagging, chest pain, unexplained low grade fever or spiked fever, increased chewing time, change in mental status, weight loss, malnutrition, pneumonia or history of it, coughing, gurgly voice quality, drooling, pooling or pocketing food, reported loss of appetite, eyes watering, refusal to eat, complaint of pain during eating, regurgitation of material through mouth or nose etc...
Any deficiency, imbalance, or excess of nutrient (s) that occur within the body in a variety of combinations and degrees
Causes of malnutrition?
Dysphagia, weight loss, poor oral/ dental status, cognitive status
Silent aspiration signs?
Significant delay in swallowing, premature release of bolus into the pharynx, difficulty in terminating respiration, less than 1" excursion of larynx, history of pneumonia, gurgly voice, chronic copious clear secretions
Many hospitals have standard diets which are:
Regular diets, Mechanical soft diet, Puree diet
What is the number one cause of individuals from nursing homes get admitted into hospital is _________
What are the dysphagia level diets?
Level 1: Puree
Level 2: Puree base
Level 3: Mechanical soft
Level 4: Regular
All levels should contain the patient's dietary restrictions
There are 4 levels of liquids: (highest to lowest)
Think (regular) liquid, Nectar thick liquid, Honey thick liquid, and Spoon (Pudding) thick
What does History and Physical ( Medical chart) contain:
PMH, Patient's Chief Complaint, Premorbid status, Family and social history, medications, elevated temperature, and advanced directives, amounts of liquids and solids eaten per meal, weight loss, medications patient is taking, and lab values
__________ is a plasma protein
_________ is one of the nonprotein constitutients of blood and a component of renal products (urine) formed as the end product of creatine metabolism
__________ a condition that results from low volume of body water
________ is an excess of water in the interstitial space within body tissues
__________ lacking teeth
__________ chemical compound that dissolve and seperate molecules carrying either a positive or negative electrical charge
_______ vomited stomach contents
_______ ______ the state in which water remains in normal amounts and percentages in the body tissues
_______ ______ all sources of fluid consumed or introduced into the body
________ ______ all fluid eliminated from the body
_________ a protrusion of part of the stomach through the esophagus opening of the diaphragm
Hiatus or Hiatal hernia
What are the 6 lab values?
Sodium (Na) and potassium (K) levels, WBC, CBC, Blood urea nitrogen/ creatinine ratio (BUN), Albumin,
Olfactory CN I Pathology
A lesion causes Anosmia, condition in which the ability to smell is partially or fully impaired. Also could be Hyponosmia, decreased sensation and Hypernosmia is an abnormally acute sense of smell.
Optic CN II Pathology
causes selected field loss. (homonymous hemianopsia
Oculomotor CN III Pathology
Deviation of the ipsilateral eye to the lateral side and Ptosis, which the eylid droops because of paralysis. (Diplopia, Double Vision.)
Trochlear CN IV Pathology
Attemps to look down and outward results in diplopia because only one eye moves down and out, causeing misalignment of the eyes.
Trigeminal CN V Pathology
(Sensory) ipsilateral loss of sensation in the area of distribution for the nerve, face rostral tongue, teeth and gingiva, nose, orbit and mouth. (Motor) LMN syndrome characterized by flaccid paresis or paralysis of the ipsilateral muscles of mastication.Jaw deviates toward the side of the injury. Bilateral UMN lesions produce paralysis of the masticators, causing difficulty with the production of vowels and labial and lingual consonants sounds.
Abducens CN VI Pathology
causes the affected eye to turn in medially. (medial strabismus) With misalignment of the eyes, the pt. has double vision (Diplopia) when looking straight or to the affected side.
Facial CN VII Pathology
A dysfunction is Bell palsy, LMN syndrome. Sudden onset of paralysis of all ipsilateral upper and lower facial muscles. UMN syndrome the patient exhibits only Lower facial palsy.
Acoustic/ Vestibulocochlear CN VIII Pathology
Disturbances with equilibrium and audition. Nystagmus, eyes moves away slowly from center and comes back quickly
Glossopharyngeal CN IV Pathology
Loss of general taste sensation from ipsilateral posterior 1/3 of tongue. Poor control of parotid gland.
Vagus CN X Pathology
Ipsilateral paralysis of soft palate, pharynx, and larynx. Leading to swallowing difficulty. LMN: Breathy voice, hoarsness, minimally affects phonation, vocal fold paralysis. UMN: Harsh voice quality and lesions do not produce severe phonatory and swallowing symptoms.
Spinal Accessory CN XI Pathology
Affect the ability to control head movements, can indirectly effect phonation.
Hypoglossal CN XII Pathology
Weakness and muscle atrophy contribute to dysarthria and chewing difficulty (form bolus). On potrusion the tongue deviates to side of the lesion. Bilateral LMN damage causes severe difficulty in swallowing, eating and speaking.
Whar CN's are most important for speech and swallowing?
VIII- Acoustic/ Vestibulocochlear
XI- Spinal Accessory