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