SLPA 966 - Swallowing - Exam 1 Flash Cards

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Title:	SLPA 966 - Swallowing - Exam 1
Description:	swallowing disorders; anatomy and physiology
Number of Cards:	49
Save Count:	0
Author:	maria.longenecker15
Created:	2012-01-23
Tags:	anatomy disorders physiology swallowing
Private	No

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- Question
- Answer
- Side 3

- Define dysphagia.
- -difficulty moving food from mouth to stomach
  -may include behavioral, sensory, and preliminary motor acts
- What function does CN V Trigeminal serve during swallowing? Swallowing problems?
- -important for chewing
  -both sensory and motor to the face
- What function does CN VII Facial serve during swallowing? Swallowing problems?
- -both sensory and motor
  -important for sensation of oropharynx and taste to anterior 2/3 of tongue
- What function does CN IX Glossopharyngeal serve during swallowing? Swallowing problems?
- -both sensory and motor
  -important for taste to posterior tongue, sensory, and motor functions of the pharynx
- What function does CN X Vagus serve during swallowing? Swallowing problems?
- -both sensory and motor
  -important for taste to oropharynx, and sensation and motor function to larynx and laryngopharynx
  -important for airway protection
- What function does CN XII Hypoglossal serve during swallowing? Swallowing problems?
- -contains motor fibers that primarily innervate the tongue
- What are the 4 phases of swallowing?
- -oral prep
  -oral transit
  -pharyngeal
  -esophageal
- What is the purpose of oral prep?
- to prepare food for oral transit
- What is the purpose of oral transit?
- get bolus from mouth to pharynx
- What is the purpose of pharyngeal phase?
- get bolus from pharynx to esophagus
- What is the purpose of esophageal phase?
- get bolus from esophagus to stomach
- How long to does oral prepatory take?
- varies depending on food type
- How long does oral transit take?
- 1 second
- How long does pharyngeal phase take?
- 1 second
- How long does esophageal phase take?
- 8-20 seconds
- What structures are involved in the pharyngeal stage?
- -soft palate
  -base of tongue
  -pharyngeal wall
  -laryngeal mechanism
- What is the difference between feeding and swallowing?
- feeding- plate to mouth
  swallowing- lips to stomach
- What structures are involved in oral preparatory?
- -lips
  -tongue
  -jaw
  -cheeks
  -back of tongue
  -soft palate
- What is the function of the soft palate in the pharyngeal transit?
- -elevates and retracts to form VP closure
  -prevents nasal reflux and builds up normal pressure in the pharyngeal cavity
- What is the function of the base of tongue in pharyngeal transit?
- retracts to pharyngeal wall
- What is the function of the pharyngeal wall in pharyngeal transit?
- shortens and stiffens
  -contracts (circular) from top to bottom
- What is the function of the laryngeal mechanism in pharyngeal transit?
- -VF adductions
  -laryngeal elevation
  --epiglottis- desemination
  --cricopharyngeal opening (vagus stops firing to relax this)
  -arytenoids- tilt toward epiglottis (closes off laryngeal vestibule)
- What are the structures involved in oral preparatory? and their functions?
- -lips (seal)
  -tongue (lateralizes- mixes saliva + food=bolus)
  -jaw (rotary-grinding)
  -cheeks (some tension)
  -back of tongue (up)
  -soft palate (bulges down and forward)
- What are the structures involved in oral transit? and their functions?
- -lips (seal)
  -tongue (tip to alveolar ridge, forms trough, wave motion)
  -cheeks (compression, prevents pocketing)
- What are the structures involved in esophageal phase? and their functions?
- -criocopharyngeal (closes, contracts to prevent reflux)
  -esophagus (top to bottom contraction- peristalsis)
- What are the boundaries of the laryngeal vestibule?
- -epiglottis (anterior)
  -arytenoids (posterior)
  -aryepiglottic folds (sides)
  -true VFs (floor)
- Where is the pyriform sinus located?
- between pharyngeal wall and arytenoids (lower in pharyngeal cavity)
- Where is the vallecula located?
- where base of tongue meets epiglottis
- What is penetration?
- when material enters below laryngeal vestibule (above VFs)
- What is aspiration?
- material enters airway (passes below VFs)
- What are the benefits of the MBS?
- -considered gold standard in clinical assessment of dysphagia
  -dynamic measure, provides thorough evaluation of biomechanics
  -only comprehensive assessment of all 4 phases of swallowing
  -readily accessible in hospitals
- What are the limitations of MBS?
- -radiation (don't want repeat trials)
  -aspiration documented but not the effects
  -difficulty in appreciation of airway closure mechanism
  -limited access outside hospital setting
  -access based on very short period of measurement in unfamiliar environment
- What are warning signs that a person may have swallowing problems?
- -change in voice
  -weakness (facial droop, tongue pressure)
  -coughing, choking
  -repetitive swallows
  -regurgitation
  -fullness, tightness in throat
  -pain
  -weight loss
  -changes in salivation
  -appetite changes
  -sleep disturbances
  -malnurished, dehydrated
  -history of pneumonia
  -wet vocal quality post swallow
  -dysarthria
  -abnormal gag
  -cough post swallow
- What is the purpose of the clinical evaluation of swallow (bedside)?
- -determine presence/absence of dysphagia (if so, how severe?)
  -information regarding etiology (ALS-degenerative, stroke-recovery)
  -determine severity, prognosis (how likely and quickly to recover), and responsiveness to therapy (try tx approaches to see if they work)
  -determine dysphagia symptoms (what the disorder)
  -determine appropriate diagnostic tools (laryngeal and esophageal--need instrumentation, MBS, FEES, none?)
  -determine therapy techniques and/or strategies (plan) (need for alternative means of nutrition management)
- What are the goals of instrumental swallowing evaluations?
- -preceded by clinical assessment
  -provides info on anatomy and physiology of structures and muscles used in swallowing
  -evaluate the ability of patients to swallow various materials
  -assess secretions and the patient's reaction to them (usually done at beginning)
  -document adequacy of airway protection and coordination between respiration and swallowing
  -help evaluate the impact of compensatory therapy maneuvers on swallowing function and airway protection
  -look for period of normal apnea
  -need to be able to tell why they are aspirating
- What are the purposes of instrumental swallowing examination?
- -image structures of upper Aero digestive tract (at-rest)
  -assess movement patterns of swallowing to formulate inferences regarding physiologic integrity (e.g., speed, symmetry, range, strength, sensation, coordination)
  -assess swallowing related movement patterns of structures in the upper Aero digestive tract (effectiveness [ability to clear cavities] and safety [how well they maintain hydration, nutrition, and airway protection])
  -identify and describe any airway compromise such as aspiration/penetration and the circumstance under which these occur
  -evaluate impact of compensatory maneuvers to improve swallowing safety and efficiency
  -identify and describe any pooled secretions within the hypopharynx and larynx. include description about patient's ability to move or clear with swallows or coughing/clearing activities
  -complete a cursory evaluation of esophageal anatomy and physiology to identify any esophageal contributors to dysphagia symptoms
  -assist in forming clinical recommendations, including type of nutrtion or hydration intake, safest and most efficient dietary level, feeding modification or therapeutic intervention
- True or false: Feeding modification should be a last resort.
- True
- What amount of material is presented for a barium swallow? MBS?
- barium= cup
  MBS= spoon trials (varies)
- What type of consistency is presented for a barium swallow? MBS?
- barium= liquid
  MBS= liquid, puree, solid
- What position is the patient placed in for a barium swallow? MBS?
- barium= anterior/posterior or supine
  MBS= AP/lateral
- What is the purpose of a barium swallow? MBS?
- barium= assess structural abnormalities, esophageal, presence of aspiration
  MBS= determine presence and specific swallowing disorder tx (identify: behavior, disorder, tx)
- What phases does a CBE assess? MBS?
- CBE= oral prep, oral transit
  MBS= all phases
- What food items are presented for a CBE? MBS?
- CBE= real food
  MBS= food with barium
- What does the CBE tell us about penetration/aspiration? MBS?
- CBE= infer; do not know cause
  MBS= can identify location, temporal events, and disorder
- What observations during CBE indicate DEFINITE need for instrumental assessment?
- -CBE fails to address clinical questions posed by patient
  -dysphagia characteristics are vague and require confirmation
  -nutritional or respiratory issues indicate suspicion of dysphagia
  -safety or efficiency of swallowing is a concern
  -direction for swallowing rehab is needed
  -help is needed to assess underlying medical problems (no confirmed dx)
- What observations during CBE indicate POSSIBLE need for instrumental assessment?
- -patient has medical condition that has a high risk for dysphagia (e.g., brainstem damage, premature babies)
  -follow function demonstrates a change
  -patient is unable to cooperate for a clinical exam
- What observations during CBE indicate NO need for instrumental assessment?
- -patient no longer has dysphagia complaints
  -patient's condition is too medically compromised or the patient is too uncooperative
  -clinician's judgment is that the exam would not alter clinical course or management plan
- What are some highly reliable measures that assess oral function? (know 4)
- -tongue strength
  -tongue range
  -lip strength
  -jaw range
  -oral mucosa
  -dentition
  -strength of cough
  -dysarthria
  -intelligibility
- What are some highly reliable measures that assess laryngeal function? (know 4)
- -phonation, vocal quality (not gurgle, breathy, harsh)
  -rapid alternating movements using consonant-vowel combos
  -hypernasal versus hyponasal
  -dry swallow- laryngeal elevation