Term
| List 4 of the 7 aspects of cognition |
|
Definition
a. Attention
b. Orientation
c. Arousal
d. Memory
e. Speed processing
f. Reasoning
g. Visuo-spatial perception |
|
|
Term
The left side of the brain is responsible for all of the following except:
a. Language
b. Analytical thought
c. Spatial perception
d. Logic |
|
Definition
|
|
Term
| (T/F) The motor strip is found in the frontal lobe and is responsible for voluntary movement. |
|
Definition
|
|
Term
The pre-motor area and supplemental area receive information from the brain and integrate, refine, plan and program motor speech. What Problem would a patient have if the lesion was in one of these areas?
a. Aphasia
b. Autism
c. Dysarthria
d. Apraxia |
|
Definition
|
|
Term
| (T/F) A lesion in Wernicke’s area results in non-fluent aphasia. |
|
Definition
| False – should be fluent aphasia. |
|
|
Term
| List 3 areas of RCVA deficit and 3 areas of TBI deficit: |
|
Definition
a. RCVA
i. Cognition
1. Attention
2. Orientation
3. Perception
4. Confabulation
ii. Communication
b. TBI
i. Attention
ii. Memory
iii. Executive functioning
iv. Communication
v. Behavior |
|
|
Term
| (T/F) Impulsivity is the #1 descriptor of TBI? |
|
Definition
|
|
Term
| Name the two points of impact in a Closed-Head Injury (CHI) |
|
Definition
|
|
Term
What is the medical term common in RCVAs for the inability to recognize faces?
a. Confabulation
b. Prosopagnosia
c. Pragmatics |
|
Definition
|
|
Term
| (T/F) A score of 5 is considered a coma on the Glasscow Coma Scale? |
|
Definition
| True (Remember any number LOWER than 8 would be considered being in a coma) |
|
|
Term
| List 3 different deficits of RCVA |
|
Definition
a. Cognition
b. Attention
c. Orientation
d. Perception
e. Confabulation
f. Communication |
|
|
Term
All of the following are symptoms of RCVA except:
a. Anosognosia (denial of Illness)
b. Left side neglect
c. Confabulation
d. Anomia |
|
Definition
|
|
Term
| (T/F) Hemorrhagic stroke is caused by the obstruction of blood vessels. |
|
Definition
| False – should be Ischemic Stroke. |
|
|
Term
| List 3 different paraphasias with an example: |
|
Definition
a. Phonemic: Happer
b. Semantic: Screwdriver
c. Literal: Waiter
d. Neologism: Floofer |
|
|
Term
Which of the following is not an Etiology of Aphasia?
a. Tumor
b. Anoxia
c. Dementia
d. CHI/OHI
e. Pick disease
f. Primary Progressive Aphasia
g. Binswanger’s Disease
h. Hydrocephalus
i. Nutritional& Metabolic disorders
j. Prosopagnosia |
|
Definition
|
|
Term
| List 6 types of Dysarthria |
|
Definition
a. UUMN
b. Spactic
c. Hypokinetic
d. Hyperkinetic
e. Ataxic
f. Flaccid
g. Mixed |
|
|
Term
Parkinsonism is a term used to describe which type of Dysarthria?
a. Spastic
b. Hypokinetic
c. Hyperkinetic
d. Ataxic |
|
Definition
|
|
Term
| (T/F) AOS is characterized by distortion errors. |
|
Definition
| False; substitution errors. |
|
|
Term
| List the 5 stage process for speech |
|
Definition
a. Conceptualization
b. Linguistic planning
c. Motor planning
d. Performance
e. Feedback |
|
|
Term
All of the following are general principle of AOS treatment except:
a.Intense treatment with mass amounts of practice
b.Many repetitions are needed to stabilize newly learned targets
c.A brief resting period between targets is best
d.Therapy of prosody should accompany therapy of artic
e.Successful communication NOT perfection is the goal
f. Prosody is the sole focus |
|
Definition
| f. Prosody is the sole focus |
|
|
Term
| Name 3 main types of Dementia and name on disorder/disease that goes with it |
|
Definition
a.Cortical – Alzheimers, Pick’s, or Primary Progressive Aphasia
b.Subcortical – Parkinson’s, Progressive Supranuclear Palsy, Huntington’s, or HIV
c Mixed – Vascular Dementia or Lewy Body |
|
|
Term
| (T/F) To be qualified as an impairment, Dementia must be sudden in onset. |
|
Definition
| False – Slow and progressive. |
|
|
Term
| This type of stroke occurs when a traveling clot from an artery in the body travels to an artery in the brain |
|
Definition
|
|
Term
| List 4 categories that make a differential diagnosis of aphasia |
|
Definition
a. Naming
b. Conversational Speech
c. Auditory Comprehension
d. Word or Sentence Repetition |
|
|
Term
Which of the following is not a higher cortical function of Dementia:
a. Memory
b. Orientation
c. Calculation
d. Language
e. Thinking
f. Comprehension
g. Learning capabilities
h. Judgment
i. Paraphasia |
|
Definition
|
|
Term
| What is the difference between an OHI and CHI? |
|
Definition
| When the skull is fractured or perforated and the meninges are torn. Primary damage is along the path of the penetrating object for an OHI. |
|
|
Term
| Wernicke’s is a type of _______ aphasia and Brochas is a type of _________ aphasia. |
|
Definition
|
|
Term
| (T/F) TPA would most likely be administered to someone with a TBI. |
|
Definition
| False – TPA is for STROKE patients |
|
|
Term
| Which disordered group presents with fluent empty speech? |
|
Definition
|
|
Term
| (T/F) Standard aphasia tests are not usually appropriate for assessing TBI communication skills. |
|
Definition
|
|
Term
| True or False: These are the major areas of deficit for TBI: attention/memory, executive functioning, communication, and behavior. |
|
Definition
| False - change TBI to Dementia |
|
|
Term
All are types of subcortical dementias except:
A) Parkinsons Dx
B) Progressive Supranuclear Palsy (PSP)
C) Huntington’s Dx
D) Picks |
|
Definition
|
|
Term
Primary damage for OHI :
A) Along the coup and contracoup
B) Results in diffuse axonal injury
C) Is along the path of penetrating object
D) Results in hypoxia, edema, intercranial pressure, CVA |
|
Definition
| C: is along the path of the penetrating object |
|
|
Term
| True or False: Both Dementia and TBI patients can have irrelevant speech. |
|
Definition
|
|
Term
| Describe the difference between Pretraumatic Amnesia and Posttraumatic Amnesia. |
|
Definition
Posttraumatic Amnesia- Loss of memory for events occurring AFTER injury.
Pretraumatic Amnesia- Loss of memory for events that occurred BEFORE injury. |
|
|
Term
| What is the definition of Dysphagia? |
|
Definition
Difficulty Swallowing that occurs from when food/liquid is placed into the mouth until it reaches the stomach
Can also include difficulty managing and swallowing saliva |
|
|
Term
| How many times a day on avg. do we swallow? |
|
Definition
|
|
Term
| We swallow the most when and swallow the least when? |
|
Definition
| Most when eating least when asleep |
|
|
Term
| What are signs and symptoms of Dysphagia in children? |
|
Definition
Arching of stiffening of body during swallowing
Irritability or lack of alertness during feeding
Prolonged feeding times (more then 30 min.)
Excessive drooling or leaking food/liquid from the mouth
Gurgly, hoarse or breathy voice quality
Coughing or gagging during meals or recently after
Recurring pneumonia or respiratory infections
Frequent spitting up
Less then normal weight gain or growth |
|
|
Term
| What are signs and symptoms of Dysphagia in adults? |
|
Definition
Coughing during or right after eating or drinking
Extra effort or time needed to chew or swallow
Food or liquid leaking from the mouth ot getting stuck in mouth
Pocketing of food in the mouth or residue on the toungue post swalloe
Coughing more frequently at the ends of meals
Runny nose during eating, but not observed at other times
Reported or observed pain during swallowing
Temperature spikes after eating |
|
|
Term
| What kind of system in Swallowing? |
|
Definition
| Pressure system with sets of tubes and valve |
|
|
Term
| What are the three Tubes of the Swallowing System? |
|
Definition
1.Oral Cavity (horizontal Tube)
2.Pharyngeal Cavity (vertical)
3.Esophagus (vertical) |
|
|
Term
| What are the 7 valves are in the swallowing system? |
|
Definition
1. Lips
2. Oral Tongue – contracts the hard and soft palate
3. Velopharyngeal Complex – the velum rises and pharyngeal constrictions contrast
4. Larynx – by sealing off the lungs the pressure pump continues
5. Tongue base and Velopharyngeal Walls - make complete contract to generate pressure and drive the bolus thorough the pharynx cleanly
6. Cricopharyngeal Walls – allows bolus to enter esophagus, seals off pharynx from esophagus so pressure continues to move down to the stomach
7. Lower esophageal Sphincter (LES) – relaxes to open. Prevents and backflow of food from the stomach |
|
|
Term
| What are the 4 phases of the swallow? |
|
Definition
1. Oral Preparatory
2. Oral
3. Pharyngeal
4. Esophageal |
|
|
Term
| What happens in the Oral Preparatory Phase? |
|
Definition
Food is manipulated in the mouth, masticated in necessary, reducing the food to a consistency ready to swallow
Includes saliva production, as a person recognizes food approaching the mouth and being placed in mouth.
Movements of oral preparatory phase vary by person and consistency. |
|
|
Term
| What is phase 1 of the Oral Preparatory Phase? |
|
Definition
Labial Seal
1.ensures no escape of food or liquid, drooling or anterior bolus loss
2.Adequacy of seal to retrieve bolus from spoon, cup or straw, anterior or lateral spillage
Requires the ability to coordinate nasal breathing |
|
|
Term
| What is phase 2 of the Oral Preparatory Phase? |
|
Definition
Bolus Control
1.With liquids, tongue cups the liquid bolus with the sides of the tongue sealed around the lateral alveolus.
2.With foods, “tippers” or “dippers” are two NORMAL swallowing patterns |
|
|
Term
| What is the difference between tippers and dippers? |
|
Definition
Tippers - hold food between midline of tongue and hard palate with the tongue tip elevated to the alveolar ridge
Dippers - hold food in floor of the mouth in front of the tongue (less common, only 20% of us are dippers) |
|
|
Term
| What is the tongue thrust pattern and is it abnormal? |
|
Definition
Tongue thrust pattern is abnormal. These swallowers often hold food between their tongue and teeth (abnormal pre-swallow position) and then move the tongue anteriorly often pushing the bolus out
Seen most commonly with adults with frontal lobe damage and children with cerebral palsy, but can have typically developing kids who have this abnormal swallow pattern. |
|
|
Term
| What is phase 3 of the Oral Preparatory Phase? |
|
Definition
Mastication
Involves tongue’s ability to lateralize bolus and the rotary movement of the mandible and tongue.
The tongue position the bolus on the teeth and then the buccal (cheek) muscles act to push the masticated food back towards the tongue.
Tongue is also mixing saliva into the masticated bolus.
During active chewing, the soft palate is not pulled down and therefore it is NORMAL for there to be some premature spillage into the pharyngeal cavity.
*NOTE*Premature spillage is NOT normal for liquid to puree consistencies that do not require chewing. |
|
|
Term
| When does the oral phase begin and end? |
|
Definition
Begins when the tongue initiates posterior movement of the bolus
Ends when the pharyngeal swallow is triggered |
|
|
Term
| What happens during the oral phase? |
|
Definition
1.The tongue uses a stripping or rolling action in which the midline of the tongue sequentially squeezes the bolus against the hard palate.
2.The sides and tip of the tongue remain firmly anchored against the alveolar ridge.
3.The thicker the food the greater the oral pressure needed to propel them.
4.Should take <1 to 1.5 seconds to complete. |
|
|
Term
| During an Oral Preparatory and Oral Phase Assessment, look for what, for each consistency? |
|
Definition
1.Spillage
2.ROM, strength, endurance of mandibular and lingual movement
3.Post-swallow, looking for oral residue
-On tongue, which side or both?
-In buccal (cheek) cavity, which side
or both? |
|
|
Term
| When does the Pharyngeal Phase start? |
|
Definition
1.Pharyngeal swallow is triggered when the leading edge of the bolus is moved past the point between the anterior faucial pillars and where the tongue base crosses the lower rim of the mandible.
2.In older patients it is normal for the bolus to be at the lower rim of mandible before swallowing triggers. |
|
|
Term
| What are the steps of the Pharyngeal Phase? |
|
Definition
1.The velum elevates and retracts to close off the nasal cavity
2.The hyoid and larynx elevate and move anteriorly
3.The larynx closes at all 3 valves
-The epiglottis
-The laryngeal vestibule with false
vocal folds and tilting of the
arytenoids
-The true vocal folds
4.The tongue base retracts to contact the anterior bulging posterior pharyngeal wall
5.Progressive top to bottom contraction of the pharyngeal constrictors
6.The cricopharyngeus or UES opens |
|
|
Term
| What are the 3 things to look at during a Pharyngeal Phase Assessment? |
|
Definition
1. Swallow delay
-Time between posterior tongue
propulsion and laryngeal excursion
-Audible swallow may be a bedside
assessment indicator
2. Signs of Aspiration or Penetration if Bedside Eval
-Cough, throat clear, BEFORE, DURING,
or AFTER the swallow
-Silent aspirators may have wet vocal
quality or runny nose
-Allow sufficient time between each
presentation for pharyngeal residue
to clear if you suspect weakness to
r/o aspiration after the swallow vs.
difficulty with the subsequent
consistency
3. Signs of reduced pharyngeal constriction/tongue base retraction
-Increased pharyngeal residue
-Look for multiple effortful swallows
to indicate pharyngeal residue at
bedside |
|
|
Term
| What is the blue dye test with trach patients? |
|
Definition
Done with trach patients
Use blue color because it is not naturally found in the body
Do one consistency a day
Watch for a blue secretion coming out of the trach of with suction |
|
|
Term
| What are two ways of assessing the Pharyngeal Phase? |
|
Definition
1.Modified Barium Swallow Study or Videofluoroscopy Study
2.Fiberoptic Endoscopic Evaluation of Swallowing Test |
|
|
Term
| What is the difference between Aspiration and Penetration and how can you diagnose? |
|
Definition
Can only differentially diagnose between the two via MBSS.
Penetration occurs when any material enters the laryngeal vestibule
Aspiration occurs when any consistency passes beyond the level of the true vocal folds |
|
|
Term
| Aspiration and Penetration can be: |
|
Definition
Fleeting/Flash- quickly and briefly enters but is retrieved during the swallow
Trace- a very small and negligible amount enters the airway
Frank- a large amount (>10%) of the bolus enters the airway
Fleeting or trace penetration can be normal in elderly populations and may not warrant diet changes. |
|
|
Term
| What is the Esophageal Phase, and whose job is it to asses and treat? |
|
Definition
The GI doctor
When esophageal peristalsis carries the bolus into the stomach, this take approximately 8 to 20 seconds. |
|
|
Term
| What are some problems a patient can have during the Esophageal Phase? |
|
Definition
| Can have decreased peristalsis, achalasia, hernia, effects of GERD, a T-E fissure |
|
|
Term
| While this is not our domain we often see Esophageal Phase Patients for |
|
Definition
| MBSS due to their symptoms masking as pharyngeal deficits |
|
|
Term
| What is the most common complaint for patients with difficulties during the Esophageal Phase? |
|
Definition
“It feels like food gets stuck here” (point to throat), Usually with solids such as meat and potatoes.
Esophagus has a poor sense of location. Something can be stopping at LES and feel as though it’s up above UES. |
|
|
Term
| What are 3 complications of Dysphagia? |
|
Definition
1. Recurring Pneumonia
2. Malnutrition
3. Dehydration |
|
|
Term
| What are some compensatory techniques for presentation, to try before diet modification? |
|
Definition
Eat upright 90 degrees only
Small bites or sips only
One bite or sip at a time
Swallow ___ times for each bite/sip
Alternate each bite with a sip
Present food/drink to stronger side
Check for pocketing after every other bite |
|
|
Term
| What are some compensatory techniques for postural, to try before diet modification? |
|
Definition
Turning Head Towards the Weak Side -closes side off and directs bolus to strong side
Chin Tuck – bowing head down as swallowing
Tilt Head to Stronger Side- bolus fall to that side in your mouth for easier manipulation and mastication
Tilt Head Back- **for oral deficits only- NEVER use with pharyngeal deficits present. |
|
|
Term
| What is NPO and when is appropriate to recommend to a patient? |
|
Definition
Nothing Per oral – nothing by mouth
Person should have SIGNIFICANT aspiration, more then 10% of all consistencies or take longer then 10 seconds to swallow a single bolus of all food types. |
|
|
Term
| What are options for alternative caloric intake and hydration? |
|
Definition
Nasogastric (NG) tube or Dobhoff-
Dobhoff is a smaller diameter NG tube and instead of ending in the stomach, it ends in the Jejunum reducing risks of reflux
Short term solution-usually couple of weeks, but never more than 3-4 months max
PEG tube- percutaneous endoscopic gastrostomy- more long-term solution
Can use Ensure or blenderized food
J-tube- jejunostomy- because it enters below the stomach, only special prepared feeding are allowed which makes it more expensive
Reduces the risk of reflux |
|
|
Term
| What are the 4 types of Diet Consistencies we can recommend? |
|
Definition
1.Regular or semi – solid Consistency
2.Mechanical Soft
3.Pureed
4. Mixed Consistencies |
|
|
Term
| Regular or Semi-solid Consistency |
|
Definition
-Greater amount and strength of
mastication required
Meats, raw veggies, nuts, breads |
|
|
Term
|
Definition
-Easy chew, but chewing required.
-Cooked veggies, canned fruits |
|
|
Term
|
Definition
-No mastication required
-Yogurt, pudding, mashed potatoes with
gravy |
|
|
Term
|
Definition
Can be hardest for dysphagics
BE EXTREMELY CAREFUL
Cereals and soup |
|
|
Term
| What are the 3 liquid consistencies? |
|
Definition
Thins – enemy of swallow delay or reduced airway closure
Specify if from cup only or can use straw
Nectar thick
Honey thick |
|
|
Term
| If reduced tongue strength, coordination, or ROM |
|
Definition
Hardest = Solid foods requiring laborious mastication
Easiest = thickened liquids (may not necessarily REQUIRE thickener though) |
|
|
Term
| Swallow delay or reduced airway closure |
|
Definition
Hardest =Thin Liquids
Easiest = Thick liquids, purees, mech soft |
|
|
Term
| Reduced Pharyngeal Constriction |
|
Definition
Hardest = purees
Easiest = liquids and mech soft |
|
|
Term
|
Definition
Hardest = Regular and mech soft consistencies
Easiest = liquids |
|
|
Term
| If reduced tongue strength, coordination, or ROM |
|
Definition
Hardest = Solid foods requiring laborious mastication
Easiest = thickened liquids (may not necessarily REQUIRE thickener though) |
|
|
Term
| Swallow delay or reduced airway closure |
|
Definition
Hardest =Thin Liquids
Easiest = Thick liquids, purees, mech soft |
|
|
Term
| Reduced Pharyngeal Constriction |
|
Definition
Hardest = purees
Easiest = liquids and mech soft |
|
|
Term
|
Definition
Hardest = Regular and mech soft consistencies
Easiest = liquids |
|
|
Term
| What are some examples of Indirect Treatment? |
|
Definition
Exercise Programs
No food or liquids given
Thermal-tactile stimulation
For tx of swallow delay/ poor initiation of swallow
SLP strokes the anterior faucial pillars with a cold laryngeal mirror
Can be used with meals (if so then it is considered Direct Treatment)
Deep Pharyngeal Nerve Stimulation (with cold mirror)
Invasive and the jury is out!! |
|
|
Term
| What are some examples of Indirect Exercise Treatments? |
|
Definition
Labial closure
Lip seal exercises (holding tongue depressor in lips)
Tongue exercises
Elevation, lateralization, retraction (tongue-hold swallow, yawn, “Hawk”, “Coca-Cola”)
Pharyngeal/UES exercises
Shaker exercises
Laryngeal
Valsalva Maneuver (bearing down while voicing)
Pitch glides up, falsetto, glottal attack (ah-ah) |
|
|
Term
| What are some examples of Direct Treatment? |
|
Definition
VitalStim
Jury also out, but more promising IF PROPERLY USED
Must use with food/liquids and exercises |
|
|
Term
| What are some Treatment Considerations? |
|
Definition
Diagnosis
Severity of Dysphagia
Prognosis
Reaction to Compensatory Strategies
Ability to Follow Directions
Respiratory Function (both for strategy use and aspiration risks
Caregiver support
Patient Motivation |
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|
