Term
|
Definition
| 1. Oral phase 2. Pharyngeal phase 3. Esophageal Phase |
|
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Term
|
Definition
| 1.Oral preparatory, 2. Oral, 3.Pharyngeal, 4.Esophageal |
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Term
Cranial nerves involved in swallowing:
Number, Name, Sensory function, Motor function? CNvV |
|
Definition
CN V - Trigeminal
SENSORY: Mediates sensation from head, jaw, face, some of sinuses & tactile sensation from anterior 2/3 of tongue
MOTOR: motor innervation to the muscles that control mandible, the tensor veli palatini muscle of velum & tensor tympani muscle of middle ear |
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Term
Cranial nerves involved in swallowing:
Number, Name, Sensory function, Motor function? CNvVII |
|
Definition
CN VII Facial Nerve
SENSORY: Mediates taste in front 2/3 of tongue.
MOTOR: Innervates all of the muscles of facial expression (forehead, cheeks lips, stapedius muscle of middle ear, and lip sphincter |
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Term
Cranial nerves involved in swallowing:
Number, Name, Sensory function, Motor function? CN IX |
|
Definition
CN IX Glossopharygeal Nerve
SENSORY: Taste & general sensation, back 1/3 of tongue. Secondary afferent: pharynx, larynx, viscera
MOTOR: Constrictors & stylopharyngeus |
|
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Term
Cranial nerves involved in swallowing:
Number, Name, Sensory function, Motor function?CN X |
|
Definition
CN X Vagus Nerve
SENSORY: Mucosa of valleculae. Tonsils, pharynx, soft palate (pharyngeal branch), pharynx, larynx, visera
MOTOR: Palate, pharynx, larynx, esophagus |
|
|
Term
Cranial nerves involved in swallowing:
Number, Name, Sensory function, Motor function?CN XI |
|
Definition
CN XI Spinal Accessory Nerve
MOTOR (only): innervates the palatopharyngeus muscle (which depresses the velum and constricts the pharynx).
It also innervates the muscularis uvula (which tenses the velum). It, along with CN.X, innervates the levator veli palatini. |
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Term
Cranial nerves involved in swallowing:
Number, Name, Sensory function, Motor function?CN XII |
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Definition
CN XII Hypoglossal Nerve
SENSORY & MOTOR: tongue |
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Term
Which muscle:
Opens the mandible; permits side-to-side movement |
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Definition
|
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Term
Which muscle:
Opens, closes, protrudes, and twists the lips |
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Definition
|
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Term
Which muscle:
Raises the back of the tongue during the first stage of swallowing |
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Definition
|
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Term
Which muscle:
Draws hyoid bone forward; depresses mandible when hyoid is in fixed position |
|
Definition
|
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Term
Which muscle:
Elevates hyoid & tongue base |
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Definition
|
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Term
Which muscle:
Shuts off the nasopharynx during 2nd state of swallowing |
|
Definition
|
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Term
Which muscle:
Flattens cheek, holds food in contact with teeth; retracts angles of the mouth |
|
Definition
|
|
Term
Which muscle:
Raises soft palate |
|
Definition
|
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Term
| How many pairs of striated muscles suspend the pharyngeal cavity of the nect? |
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Definition
|
|
Term
| Name the sphincter that separates pharynx from the esophagus |
|
Definition
| upper esophageal sphincter |
|
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Term
|
Definition
| By cranial nerves I, VII, IX |
|
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Term
| What are 4 primary sensory receptors on the dorsum of the tongue responsible for the perception of? |
|
Definition
| Sweet, sour, bitter, salty |
|
|
Term
| Why is saliva important? What is the role is plays for swallowing? |
|
Definition
Saliva activates the primary receptors of taste.
Controls microrganisms which helps maintain oral health.
Regulates acidity levels in stomach & esophagus.
Keeps the oral & pharyngeal cavities moist when no food or liquid is present.
Facilitates
Chewing increases production of saliva
Nasopharynx? |
|
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Term
| Is there any role smell plays with taste? |
|
Definition
| Taste is influenced by smell, which is sensed by the olfactory epithelium of the nose. If you, for example, have a cold, your sense of smell is impacted by the presence of mucus and therefore your sense of taste is affected as well (as you are not getting the input from your sense of smell). |
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Term
|
Definition
tongue
soft palate/velum
hyoid bone
epiglottis
vocal fold
thyroid cartilage
cricoid cartilage
cricopharyngeus
trachea
esophagus |
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|
Term
| five structures of the intrinsic larynx |
|
Definition
epiglottis
false vocal fold
ary-epiglottic fold
arytenoid cartilage
true vocal fold |
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Term
| The clinical evaluation of patient’s with dysphagia has three main components |
|
Definition
a) medical history
b)physical inspection of the swallowing musculature
c)observations of swallowing competence with test swallows |
|
|
Term
. Logemann lists five reasons for performing a clinical (physical) evaluation for swallowing
disorder. Name 1 |
|
Definition
| to establish a tentative treatment plan |
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Term
| Dysphagia “symptoms” are defined as: |
|
Definition
| any perceptible change in bodily function that the patient notices. |
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Term
| Dysphagia “signs” are defined as: |
|
Definition
| objective measurements or observations of behaviors that people elicit during a physical examination. |
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Term
Give symptom for sign:
SIGN: Difficulty chewing |
|
Definition
SYMPTOM:
food spills from lips; excessive mastication time of soft food; poor dentition; tongue, jaw or lip
weakness |
|
|
Term
Give symptom for sign:
SIGN:
difficulty initiating swallow |
|
Definition
SYMPTOM:
mouth dryness (xerostomia); lip or tongue weakness |
|
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Term
Give symptom for sign:
SIGN:
Drooling |
|
Definition
SYMPTOM:
lip or tongue weakness; infrequent swallows |
|
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Term
Give symptom for sign:
SIGN:
Nasal regurgitation |
|
Definition
SYMPTOM:
bolus enters or exits the nasal cavity |
|
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Term
Give symptom for sign:
SIGN:
Swallow delay |
|
Definition
SYMPTOM:
radiographic study identifies transport beyond normal standard |
|
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Term
Give symptom for sign:
SIGN:
Food sticking |
|
Definition
SYMPTOM:
radiographic study identifies excessive residue in the mouth, pharynx, or esophagus after
completed swallow |
|
|
Term
Give symptom for sign:
SIGN:
coughing and choking |
|
Definition
SYMPTOM:
coughs on trial food attempts; material enters the airway on radiographic study |
|
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Term
Give symptom for sign:
SIGN:
coughing when not eating |
|
Definition
SYMPTOM:
radiographic study shows aspiration of saliva or lung abnormality |
|
|
Term
Give symptom for sign:
SIGN:
regurgitation |
|
Definition
SYMPTOM:
undigested food in mouth; radiographic study shows food returning from esophagus to pharynx or mouth |
|
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Term
Give symptom for sign:
SIGN:
weight loss |
|
Definition
SYMPTOM:
unexplained weight loss; measurement of weight is below ideal standard |
|
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Term
| Explain why clinicians must exercise caution when hearing/evaluating a patient complain of “where” their symptom is located. |
|
Definition
| Clinical studies have shown that there is variability in being able to accurately name the location of discomfort. For example, a third of patients pointed to the upper neck and chest as the location of their discomfort when they were later diagnosed as having esophageal disease. In addition questioning patients who report dysphagia localized to the neck and pharynx should not only have that specific region investigated, but also should have studies appropriate to the esophagus. |
|
|
Term
What questions could you ask a patient to help determine/rule out whether or not the
dysphagia has esophageal origin/component? |
|
Definition
•Are you experiencing dysphagia, heartburn , pain, or weight loss? (This cluster of symptoms is indicative of a subtype of esophageal disorders. )
• Do you have trouble swallowing solids, liquids, or both? (Esophageal disorders are most closely associated with swallowing solid food rather than liquids).
• Do you experience events of coughing and choking? (This correlates with oropharyngeal dysphagia and would therefore indicate a disorder other than esophageal dysphagia.) |
|
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Term
| What are 2 changes in eating habits that may signal the presence of dysphagia. |
|
Definition
The elimination of specific food items, for example avoidance of liquids or crumbly or sticky food.
Excessive chewing of solid food. |
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Term
| When considering a patient’s relevant medical history, the book lists 9 components relevant to dysphagia. List 2. |
|
Definition
Systemic or metabolic disorders
Neurologic disease |
|
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Term
| The book lists 5 “most important elements in predicting airway safety”. Name 2. |
|
Definition
| Failure on thin liquids, a wet voice after swallow. |
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Term
| When evaluating a patient with a nasogastric tube (e.g. dubhoff) in place, how might their swallow be affected?] |
|
Definition
| It delays the swallow, may promote reflux, and cause nasal ulceration. |
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Term
| Why is a patient’s mental status important to consider when determining whether or not toproceed with test swallows? |
|
Definition
| If a patient is not readily alert to the clinician or is unable to sustain attention he/she is not a candidate for safe oral ingestion. In addition, a safe swallow test could not be performed on a patient who is unresponsive, agitated, or noncompliant due to compromised mental status. If the patient is able to cooperate, orientation, linguistic skills, perceptual ability, and memory should be assessed. These modalities are important in giving the examiner an impression of the patient’s ability to cooperate and learn during dysphagia treatment. |
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|
Term
| Why is voice, secretion management, dry swallow and cough important to assess prior to giving any test swallows? |
|
Definition
| Asking the patient to produce a dry swallow helps the examiner assess whether there is adequate laryngeal elevation. Too much or too little saliva can increase the risk of aspiration. Patients with xerostomia often have little moisture throughout the oral cavity and report poor taste. Poor swallow secretions can cause significant airway compromise. Having the patient speak provides information about the location of the dysphagia. For example unimpaired voice and speech can result in a reasonable conclusion that the swallowing problem resides in the late pharyngeal stage or in the esophageal & LES function. Further, it provides useful information on the integrity of the airway protective mechanisms. In addition, a patient’s speech can give the clinician information to determine the status of the neuromuscular system that also serves swallowing. Hypo- or hyper- nasality provides further information on the location and type of swallowing disorder. Assessment of the ability to cough informs the clinician if the patient can protect against aspiration. |
|
|
Term
| What bolus types are typically used to administer test swallows? |
|
Definition
| It is safest to give water/ice as the first bolus because if it is aspirated, there will be little harm. An array of items are used including thin to thick liquids, items with pudding consistency, and soft items that require chewing. The bolus volume ranges from 5 to 10 ml |
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|
Term
| How is cervical auscultation or pulse oxymetry used to facilitate the integrity of swallow function during a clinical exam? |
|
Definition
| Cervical auscultation provides information on whether the swallow sounds normal or abnormal, if there is delay present, and if there are respiratory changes associated with swallowing. |
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Term
| The feeding environment, ability to self-feed, posture, diet level, and endurance ability all provide important information to consider during evaluation. Pick one and explain how |
|
Definition
| A patient with cortical brain damage may be distractible. This can come in the form of external/environmental distractions (the television, other patients in the room, caregiver interaction) or internal distractions (for example physical discomfort). These distractions can create conditions where the safety of feeding/swallowing can be compromised. Observing a patient who is self-feeding or being fed by another, gives the clinician information on how the environment is impacting feeding and on how it might best be structured to minimize distractibility and thereby increase safety. |
|
|
Term
| What is a ‘water test/water screen’? |
|
Definition
| It is a method to clinically detect aspiration or risk for aspiration whereby an alert patient swallows a bolus of water. |
|
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Term
| How and for whom is a ‘blue dye test’ used? |
|
Definition
| This test is to detect aspiration at the bedside. It is used with tracheotomy patients. The patient is given a liquid or a semi-solid bolus after which deep suctioning is performed through the tracheostomy site and is repeated and inspected every 15 minutes to check for aspiration. |
|
|
Term
| What bolus types are typically used to administer test swallows? |
|
Definition
| It is safest to give water/ice as the first bolus because if it is aspirated, there will be little harm. An array of items are used including thin to thick liquids, items with pudding consistency, and soft items that require chewing. The bolus volume ranges from 5 to 10 ml |
|
|
Term
| How is cervical auscultation or pulse oxymetry used to facilitate the integrity of swallow function during a clinical exam? |
|
Definition
| Cervical auscultation provides information on whether the swallow sounds normal or abnormal, if there is delay present, and if there are respiratory changes associated with swallowing. |
|
|
Term
| The feeding environment, ability to self-feed, posture, diet level, and endurance ability all provide important information to consider during evaluation. Pick one and explain how |
|
Definition
| A patient with cortical brain damage may be distractible. This can come in the form of external/environmental distractions (the television, other patients in the room, caregiver interaction) or internal distractions (for example physical discomfort). These distractions can create conditions where the safety of feeding/swallowing can be compromised. Observing a patient who is self-feeding or being fed by another, gives the clinician information on how the environment is impacting feeding and on how it might best be structured to minimize distractibility and thereby increase safety. |
|
|
Term
| What is a ‘water test/water screen’? |
|
Definition
| It is a method to clinically detect aspiration or risk for aspiration whereby an alert patient swallows a bolus of water. |
|
|
Term
| How and for whom is a ‘blue dye test’ used? |
|
Definition
| This test is to detect aspiration at the bedside. It is used with tracheotomy patients. The patient is given a liquid or a semi-solid bolus after which deep suctioning is performed through the tracheostomy site and is repeated and inspected every 15 minutes to check for aspiration. |
|
|
Term
| How and for whom is a ‘blue dye test’ used? |
|
Definition
| This test is to detect aspiration at the bedside. It is used with tracheotomy patients. The patient is given a liquid or a semi-solid bolus after which deep suctioning is performed through the tracheostomy site and is repeated and inspected every 15 minutes to check for aspiration. |
|
|
Term
| Name one standardized/supplemental test used to assess dysphagia? |
|
Definition
| The Mann Assessment of Swallowing Ability –(MASA) |
|
|
Term
Considering cortical functions, explain the role with hemispheric lesions and swallowing in
relation to any 2 of the 4: a) representation, b) hemispheric dominance, c) cortical plasticity, or
d) bilateral vs. unilateral. |
|
Definition
Swallowing motor functions are bilaterally represented in the hemispheres.
If the dominant hemisphere is impaired, a contralateral ‘backup’ area may be available to facilitate recovery. |
|
|
Term
| 2. List 2 of 8 swallowing deficits in patients after hemisphere stroke. |
|
Definition
Reduced ability to initiate a salivia swallow.
Aspiration |
|
|
Term
With respect to all dementias, what are the 4 hallmarks of progressive deterioration in
cognitive abilities? |
|
Definition
| Memory, judgment, abstract reasoning and personality changes. |
|
|
Term
. Provide 1 out of 3 swallowing deviation characteristics and 1 out of 3 feeding deviation
characteristics for persons with mild-stage dementia. |
|
Definition
Slow oral movement
Imitation of feeding behavior from the meal partner. |
|
|
Term
| 5. What is the primary factor related to dysphagia and TBI. Give 1 example. |
|
Definition
| The severity of neurotrauma assessed by clinical scales - for example, the Glasgow Coma Scale. |
|
|
Term
| 6. Impairment to basal ganglia functions disturb what 2 aspects of movement? |
|
Definition
|
|
Term
Persons with basal ganglia related swallowing deficits may have difficulty with every stage
first stage
of swallowing. In addition to saliva management difficulty (sialorrhea), provide 1 salient feature
from each stage of swallowing and explain how the swallow is effected.
1/4stages |
|
Definition
Oral preparatory:
Problem: sialorrhea
Outcome: silent aspiration |
|
|
Term
Persons with basal ganglia related swallowing deficits may have difficulty with every stage
of swallowing. In addition to saliva management difficulty (sialorrhea), provide 1 salient feature
from each stage of swallowing and explain how
2nd stage |
|
Definition
Oral
Problem: lingual tremor.
Outcome: Impaired coordination between swallowing and respiration |
|
|
Term
Persons with basal ganglia related swallowing deficits may have difficulty with every stage
of swallowing. In addition to saliva management difficulty (sialorrhea), provide 1 salient feature
from each stage of swallowing and explain how the swallow is effected.
3rd stage |
|
Definition
Pharyngeal
Problem: Aspiration
Outcome: Increased risk for respiratory infection |
|
|
Term
Persons with basal ganglia related swallowing deficits may have difficulty with every stage
of swallowing. In addition to saliva management difficulty (sialorrhea), provide 1 salient feature
from each stage of swallowing and explain how the swallow is effected.
4th stage |
|
Definition
Esophageal
Problem: Esophageal stasis
Outcome: gastroparesis |
|
|
Term
Swallowing impairment secondary to brainstem deficits generally involve 2 aspects:
(1) __________ (presumably related to disruption of the “swallowing center”)
and (2) ________(resulting from damage to the corticobulbar system). |
|
Definition
|
|
Term
| Provide 2 out of 6 pharyngeal swallowing deficits seen in patients after brainstem stroke. |
|
Definition
Absent or delayed pharyngeal response
Reduced pharyngoesophageal segment opening |
|
|
Term
In addition to pooling in the valleculae and piriform sinus, and ineffective airway clearance
and airway spillage, what are the 2 other salient features of pharyngeal stage difficulty in
persons with lower motor neuron & muscle disease (e.g. ALS). |
|
Definition
Nasopharyngeal regurgitation
Shortness of breath |
|
|
Term
| 4 primary risk factors for head and neck cancer (with the exception of nasopharyngeal cancer) have been identified as |
|
Definition
(1) tobacco
(2) heavy alcohol use
(3) poor oral hygiene and
(4) mechanical irritation. |
|
|
Term
List the 3 primary options which are frequently used in the treatment of head/neck cancers
used in isolation or in various combinations: |
|
Definition
| Surgery, radiation, chemotherapy |
|
|
Term
| Give 2 out of the 7 potential side effects of surgical intervention to treat head/neck cancer. |
|
Definition
Impaired speech and/or voice
Numbness in face, neck or throat. |
|
|
Term
| Radiation therapy is commonly used to treat head/neck cancer. List 2 of 15 potential side effects of radiation therapy. |
|
Definition
|
|
Term
Chemotherapy to treat head/neck cancer has several overlapping potential side effects to
radiation therapy. List 2 potential side effects that do not overlap. |
|
Definition
Weakened immune system
Hair loss |
|
|
Term
There are 7 identified general characteristics associated with dysphagia and radiation
therapy for head and neck cancer; List 2. |
|
Definition
Bolus control deficits
Reduced frequency of swallowing. |
|
|
Term
| For the following esophageal disorders, list whether it is a (1) structural or (2) motility disorder |
|
Definition
| Nutcracker esophagus motility |
|
|
Term
| For the following esophageal disorders, list whether it is a (1) structural or (2) motility disorder |
|
Definition
| Esophageal Diverticulum structural |
|
|
Term
| For the following esophageal disorders, list whether it is a (1) structural or (2) motility disorder |
|
Definition
|
|
Term
| For the following esophageal disorders, list whether it is a (1) structural or (2) motility disorder |
|
Definition
| Disorders of Parastalsis motility |
|
|
Term
| For the following esophageal disorders, list whether it is a (1) structural or (2) motility disorder |
|
Definition
| Stricture & Stenosis structural |
|
|
Term
| For the following esophageal disorders, list whether it is a (1) structural or (2) motility disorder |
|
Definition
| Tracheoesophageal fistula structural |
|
|
Term
|
Definition
| Condition in which a nonrelaxing or incompletely relaxing LES prevents the passage of swallowed material into the stomach. |
|
|
Term
| What is gastroesophageal reflux? |
|
Definition
| Excessive acid in the stomach that enters the esophagus, pharynx, or mouth that may or may not be associated with dysphagia. |
|
|
Term
| What is laryngopharyngeal reflux? |
|
Definition
| It occurs when stomach contents reach the laryngeal level, frequently resulting in odynophagia, hoarseness, sore throat, a globus sensation and chronic throat clearing. |
|
|
Term
| What are the 4 components of airway protection. |
|
Definition
Voluntary breath hold
Supraglottic swallow
Super-supraglottic swallow maneuvers
Voluntary cough |
|
|
Term
| Studies from critical care medicine note higher prevalence of dysphagia and aspiration in patients with tracheotomy. What are 2 of 5 factors that may place patients with tracheotomy at a greater risk for aspiration? |
|
Definition
Loss of upper airway sensitivity because of airway bypass
Loss of the normal laryngeal closure reflex during swallow |
|
|
Term
| Studies using one-way speaking valves to improve swallowing still have mixed findings. However, all studies agree the placement of a valve improves 4 factors; list 2. |
|
Definition
Improvement in speech and reduction of upper airway secretions
Restoration of olfaction |
|
|
Term
| List 2 common surgical procedures of the neck which commonly result in dysphagia. |
|
Definition
1.Endarterectomy
2. Thyroidectomy |
|
|
Term
There have been many studies conducted with patients who have COPD. While there
are no precise cause-effect relationships established, there is evidence to suggest certain
relationships with dysphagia and COPD. Pick one and explain. |
|
Definition
| Patients with COPD are at risk for dysphagia especially during periods of acute exacerbation, because of compromise to the respiratory system. |
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