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38 terms

LAST EXAM OF COLLEGE

acquired final
STUDY
PLAY
dysphagia
"difficulty eating"
How many Americans are evaluated each year with dysphagia?
10 million
___ of these Americans are over 50 years of age
22%
Phases of swallowing
1. Oral Preparatory phase
2. Oral Transport phase
3. Pharyngeal Transport phase
4. Esopharyngeal Transport phase
Oral Prep phase
manipulation and/or prep of bolus to swallow. Food is manipulated (masticated if solid)
-sensory input from CN V, VII, IX
-motor input from CN V, VII, IX, XII
Oral Transport phase
tongue begins the anterior to posterior propulsion of the bolus. This is accomplished by lingual peristaltic movement of tongue against hard palate.
-sensory input from CN V, VII, IX
-motor input from CN V, VII, IX, XII
Pharyngeal Transport phase
involuntary movement begins. Tongue (base) propels bolus into pharynx. Velum is elevated. Pharyngeal muscles begin contraction from top to bottom, stripping the bolus through pharynx. hyoid bone elevates.
Esophageal Transport phase
upon entry of bolus through sphinctor, phase begins. Continues by peristalsis
Pediatric swallowing
infants - structures smaller, larynx higher in neck, difference in swallowing pattern.
-suckling - 8 mo. gestation to 6 months after birth
-sucking - after 6 months
Elderly swallowing
changes when older -
vertebral thinning, decreased lung elasticity, laryngeal ossification, laryngotosis (abnormal contraction of larynx, weaker), drying of oral mucosa (xerostomia), taste decrement, smell decrement, GERD
Penetration
material enters larynx
Aspiration
material passes through vocal folds into trachea
-strong protective response against = cough
Silent Aspiration
dangerous, cough response absent
-materials entering airway w/o indication
Dysphagia - Stroke
#1 cause of dysphagia in adults. Due to Cerebral Vascular Accident, Iscemic and Hemorrhagic
Dysphagia - TBI
may result in impaired cognition, interfere with treatment
Dysphagia - Amyotropic Lateral Sclerosis
degenerative disease, upper and lower motor neuron systems
-Bulbar type most affects swallowing early in disease process
-feeding tube almost always necessary
Dysphagia - Parkinson disease
weakness, tremor, silent aspiration
Dysphagia - Progressive Supranuclear Palsy (PSP)
weakness, cough present with aspiration
Dysphagia - Myasthenia Gravis
disease affects lower motor neuron system
-neuromotor junction - difficulty with transmission of neurochemicals
-result is progressive weakness with continued use
-assessment may look normal at onset, performance can deteriorate, sometimes in just minutes
Dysphagia - Multiple Sclerosis
demyelinating disease affects brain and spinal cord - dysphagia may be present when symptoms are present
Dysphagia - Huntington's disease
movement disorder, motor system and cognition affected. Involuntary movement and muscle dysfunction, weakness
Dysphagia - Guillain-Barre
auto-immune virus affecting peripheral NS. can be very rapid, feeding tubes may be necessary, long course of recovery, symptoms are weakness and sensory loss of PNS
Dysphagia - Dementia
progressive disease affecting the cortex. cognitive decline, personality change, unaware of food in mouth, loss of desire to eat
Dysphagia - Head and Neck Cancer
medical management may result in a dramatically altered system -
-muscle damage due to surgery/radiation
-structural alternations due to removal of tissue/bone
-can be severely dysphasic
Bedside evaluation
aka clinical swallow evaluation or non instrumental evaluation
Bedside evaluation - why important?
-determine candidacy for a videofluroscopic evaluation
-determine optimal food/liquid recommendations
-monitor progress, determine possibility of upgrading or downgrading diet
warning signs of dysphagia
-decreased mental status
-dysarthria
-drooling
-coughing/choking
-lengthy meal times
-weight loss
-effortful swallow
-decreased oral management
medical chart review
medical history, respiratory conditions/disease, weight loss, disease process, current event, symptoms, CN eval, surgeries, respiratory status, medications
medical staff interview
impression of swallowing, speech, cognition abilities
-oral secretion management
Oral mechanism examination
-face at rest/facial symmetry
-speech sample
-sustained "ah"
-oral mucosa
-dentition
-tongue
-sensation
-reflexes
-swallow on command
-description of symptoms if possible
Instrumental Assessment
-videofluoroscopy
-FEES
-Ultrasound
-electromyography
-cervical auscultation
Fluoroscopy
dynamic xray
Cinefluoroscopy
film, frame by frame analysis
Videofluoroscopy
videotape, immediate playback capabilities, audio recording capability
-assess overall swallow function (4 phases)
Modified Barium Swallow Study
determine presence of aspiration, why aspiration occurring, alleviation of symptoms
-3 consistencies, at least 2 swallows each
MBSS Patient Positioning
can be time consuming
-sitting or standing, 90 degree angle
MBSS measures/observations
-oral transit time, pharyngeal transit time
-stasis/residual material
-penetration
-aspiration (before, during, or after swallow?)
A-P view
front
-asymmetries
-collection of material unilateral or bilateral