| Term | Definition |
| _______ and ________ are neurological near neighbors | Breathing; swallowing |
| Where do the breathing and swallowing pathways cross? | Pharynx |
| Why do we care about deficits in breathing? | Breathing and swallowing impact each other, deficit in one can cause deficit in other |
| Types of Artificial Airways | Endoctacheal tubes (intubation/extubation)
Tracheostomy tubes
Facial masks (CPAP and BPAP)
Nasal Cannulas
Mechanical Ventilation |
| Endotracheal tubes | Through mouth through VF into trachea
Designed for those with respiratory complications |
| How long are endotracheal tubes used for? | Short-term to limit complications |
| What happens when you stop transglottal airflow? | Loss of sensation, saliva in airway |
| Factors for deciding if intubation needed | Swallow function
Ability to protect the airway |
| Tracheostomy tubes | Temporary or permanent
Stoma in trachea
Supports swallowing |
| When tracheostomy is cuffed | No airflow above it |
| Key issue about cuffs in tracheostomy | How much air is going around it to VF |
| Complications of tracheostomy | Infection
Decreased smell/taste
Increased secretions
TEF (tracheostomy fistulas) |
| 3 causes of possible aspiration | Loss subglottic pressure
Poor laryngeal excursion
Loss of upper airway sensitivity
Loss of notable laryngeal closure reflux at swallow |
| Do tracheostomies negatively affect laryngeal elevation? | NO |
| Does occluding the stoma at trach restore subglottic air pressure? | It:
Improves speech
Reduces upper airway secretions
Restores smell
Improves ability to cough |
| Physical examination of airway includes..... | upper airway integrity
cognition (maintain status) |
| 3 things to consider during airway evaluation of tracheostomy patient | 1) Cuff status
2) Suspected loss of airway sensation
3) Time on/off ventilator |
| Items to measure during evaluation of tracheostomy patients | O2 Saturation
Swallow impact on respiratory pattern |
| What should you consider when treating tracheostomy patients? | The whole patient |
| Additional care issues of tracheostomy patients | Medical compromise (length of stay, secondary conditions)
Patient oriented issues (anxiety, reduced compliance) |
| SLP key role with tracheostomy patients | Weaning them off trach |
| What to consider when weaning from tracheostomy? | Aspiration risk
Respiratory challenge |
| Protocol for tracheostomy weaning | 1) Gentle finger occlusion
2) Longer finger occlusion
3) Loose placement of one-way valve for speaking
4) Increased duration of one-way valve
5) Discuss capping with physician |
| Latrogenic dysphagia | Dysphagia that is secondary to surgical or medical disorders |
| Common surgical predispose for dysphagia | Surgery in neck |
| What causes dysphagia post-surgery? | Edema
Interference of peripheral nerve supply
Loss of CNS innervation
Replacement of swallow structures |
| What can result from thyroidectomy? | Vagus nerve issues resulting in unilateral VF paralysis |
| What can result from endarterectomy? | PNS or CNS damage |
| Cervical fusion | Surgical stabilization of the spinet eliminate pain/weakness, |
| What type of dysphagia results from cervical fusion? | Oropharyngeal |
| Why does cervical fusion often cause dysphagia? | Injures the pharyngeal plexus (CN IX and X), Causing pharyngeal weakness |
| Poorest outcomes of associated with cervical fusion are seen when ________ | Halo is used |
| Osteophytes are _______ | Usually asymptomatic |
| Where do osteocytes commonly occur? | C3 and C6 |
| Why do we care about skull/posterior foss surgery? | Potentially affects peripheral CNs and central medullary controls for swallow |
| What is impacted by impairment of medulla/peripheral CNs? | BOTH swallowing and respiration |
| Steps of evaluation following cranial surgery | 1) CN evaluation is provided
2) Eval of respiratory fx
3) Eval of cognition
4) Eval of general motor fx |
| Types of head/neck trauma that can impact swallow | Dental trauma
Thermal burn trauma |
| 3 things to consider when working with patient with head/neck trauma | 1) Alertness
2) Motor/cognitive impact
3) Respiratory support |
| What two things should be considered when looking at the impact of certain medications? | Cognition and motor functions |
| Drugs that inhibit smooth muscle control | Anticholinergics, antidepressants, alcohol, calcium channel blockers |
| Drugs that inhibit lower LES pressure | Albuterol, corticosteroid |
| What should be considered as far as swallow efficiency when looking at medications? | Some medications can get stuck in esophagus |
| COPD | Umbrella term, describe chronic lung disease that limits airflow |
| Why do we consider presence of COPD when looking at swallow function? | Change in respiratory pattern will alter swallow; they're closely related |
