Chapter 11 Disorders of Swallowing Explain why SLPs are involved in diagnosis and treatment of swallowing disorders o They are involved because communication and swallowing problems often occur together and share common structures and functions What are the stages of swallowing o Oral preparatory phase o Oral phase Prepares substance to be swallowed Food liquid is manipulated and or chewed mixed with saliva and formed into bolus Soft palate lowers towards tongue to contain bolus and prohibit flow of material into the pharynx until bolus is adequately formed Time to complete this phase varies on substance being ingested Role is to move bolus to rear of oral cavity and prepare it for propulsion down the throat Tongue propels bolus to the back of mouth with a stripping action as the tongue presses upward against the hard palate This movement combined with tension in the cheeks buccal muscles creates a pressure that pushes the bolus back toward the pharynx Normally completed within 1 1 5 seconds Normal respiratory pattern o Pharyngeal phase Role is to propel bolus down throat to entrance of esophagus Complex phase with many important physiological events happening simultaneously and quickly Bolus reaches anterior faucial pillars band of muscles extending from both sides of palate to tongue which contract to initiate the phase Respiration halts briefly 1 second in duration from initiation of swallow reflex until bolus passes into esophagus o Esophageal phase Bolus moves through the esophagus into stomach Passes through the upper esophageal sphincter and propels through the esophagus via an involuntary wave like contraction esophageal peristalsis Material passes through the lower esophageal sphincter LES into the stomach Ranges from 8 20 seconds for adults Esophageal movement decreases with age and is referred to as a decrease in esophageal motility Know the common causes for dysphagia in adults o Stroke cortical brainstem o Traumatic Brain Injury o Neuromuscular diseases o Dementia o Spinal cord injury o Brain tumors o Head and neck cancer o Infectious disease Know what is involved with swallowing treatment o Diet modifications No liquids foods or meds to be consumed orally Alternative deeding methods Nasogastric Tube NGT Percutaneous Endoscopic Gastrostomy PEG Tube Total Parenteral Nutrition TPN Aspiration puts them at risk for pneumonia which can lead to death If they are not safe to swallow any consistencies SLPs recommend a feeding tube Nasal tube more short term Consistencies Water is the most difficult to swallow Thickening things up will help with swallowing o Compensatory swallowing strategies Change temperature of food or drinks Positioning Changes Chin tuck Turn or tilt head to left or right side Fully upright at 90 degree angle Intake Changes Change food placement in mouth Take small bites sips Dry swallows or extra swallows per bite sip Alternate solids and liquids Reduce rate of intake Clear food from right or left cheek No food or liquids while coughing Remain upright for 20 30 minutes after eating Environmental Changes Minimize distractions Monitor plate tray placement Adaptive feeding equipment high rimmed bowls built up utensils nonsliding placemats cups to control rate of liquid flow Supervision o Constant One on one o Intermittent o Set up o Restorative techniques exercises Techniques If the patient can t close vocal folds then they are at risk for fluid going down so you could have them turn their head and it brings their folds in safe What can swallowing problems result in o Aspiration when the bolus drops into airway instead of the stomach o Malnutrition poor hydration Be able to define a bolus When does the tongue form a bolus When does the tongue move it to the back o Bolus food after it has been chewed and mixed with saliva o Tongue forms a bolus in oral phase o Tongue moves bolus to the back in oral phase Be able to define dysphagia o Used to describe any difficulty discomfort or disorder of swallowing Be able to describe the oral phase of swallowing o Role is to move bolus to rear of oral cavity and prepare it for propulsion down the throat o Tongue propels bolus to back of mouth with a stripping action as tongue presses upward against hard palate This movement creates PRESSURE o Normally completed within 1 1 5 seconds Be able to describe the anticipatory phase oral prep of swallowing o Prepares substance to be swallowed o Food liquid is manipulated and chewed and mixed with saliva to make the bolus o Soft palate lowers towards tongue to contain bolus and prohibit flow of material into the pharynx until bolus is adequately formed o Tongue to contain bolus and prohibit flow of material into the pharynx until bolus is adequately formed o Lips teeth tongue mandible cheeks and soft palate work cooperatively o Time to complete this phase varies depending on substance Know the definition of aspiration folds into the trachea o Occurs when food liquid or saliva falls below the level of the true vocal What happens when the velopharyngeal port does not close during swallowing o The food could go up into the nasal cavity In what population do swallowing disorders occur o All populations children and adults o Approx 10 million Americans are evaluated each year with swallowing difficulties Understand and define a modified barium swallow o X ray technology o Uses barium because it shows up on an x ray to show what the patient is swallowing in this order o Administration and observation of liquids and foods coated with barium Thin liquids thickened liquids pureed soft solid regular solid pills Be able to define and understand what FEES refers to and stands for o Fiberoptic Endoscopic Examination of Swallowing Provides direct view of the swallowing mechanism Fiberoptic endoscope passed through nose into pharynx Provides a real time picture of swallowing before and after the swallow occurs Pharyngeal movement during swallow makes an actual image impossible during the swallow itself Chapter 12 Audiology and Hearing Loss What is the entry level requirement for ASHA s CCC in Audiology o Doctorate o AED Doctor in Audiology What structures is the auditory system made up of o Outer ear inner ear and middle ear auditory nerve CN III central auditory pathways Know the anatomy of the outer ear inner ear and middle ear A Pinna B External auditory meatus ear canal C Tympanic membrane ear drum D Ossicles E Cochlea What is another name for the eardrum o Tympanic membrane What is the