derek sheppard
This surgery, done by neurosurgeons, can affect the larynx and often lead to swallowing issues.
Cervical Spine Surgery
if a client is presenting with left vocal fold paralysis in which the cause is not immediately known, what is one of the first things you should ask them?
If they have any known heart conditions or recently underwent surgery, specifically heart surgery
pneumothorax, air in the pleural space resulting from trauma, can cause what to happen?
interrupt pleural linkage and cause lung to collapse (deflate towards the sternum)
COPD stands for... Primary characteristics are... Some examples are...
Chronic Obstructive Pulmonary Disease
laboured airflow (hard to move air), decreased lung capacity
Emphysema and Bronchitis
What is paradoxical vocal fold movement?
vocal folds close when they should be open. inspiration is interrupted by adduction of vocal folds.
cause is unknown
which cranial nerve might be associated with vocal fold paralysis?
recurrent laryngeal nerve of the Vagus (CNX)
the right lung; the bronchi is more vertical, making it easier for things to pass through
what is it called when a material enters into your airway + makes its way into the lung? what is a likely result?
aspiration; aspiration pneumonia
Why does Hyperkinesias lead to highly variable speech?
the increased, involuntary movement as a result of the disorder can involve the respiratory muscles
Cervical Osteophytes can lead to swallowing difficulties in one of two ways (or maybe both???)
a) bony protuberances on the cervical vertebrae grow towards the esophagus and constrict it, leading to swallowing problems
b) an individual experiencing swallowing (or other) issues relating to the osteophytes may receive surgery to remove them, and as operation would be happening near the structures used in swallowing, it is possible that this surgery may also cause difficulties swallowing
(in addition, the vents used in surgeries may also sometimes lead to swallowing problems, and, thus, could be an outcome in this case as well)
this degenerative diseases involves destroyed motor neurons, which leads to weakness in all muscles.
Amyotrophic Lateral Sclerosis (ALS)
In a person with Emphysema, this measure of respiratory volume may be expanded.
Residual Volume (amount of air that stays in your lungs after fully exhaling)
what is the difference between a tracheotomy and a tracheostomy?
a tracheotomy is a surgical incision made at the 2nd or 3rd tracheal rings
a tracheostomy is the whole created by the incision where the tracheotomy tube will be inserted
Frequent lung infections and airway obstruction in chronic bronchitis is due to what?
Prolonged exposure to irritants leading to a build up of mucous in the lungs, (resulting in inflammation and fibrosis and making it hard for gas exchange to occur)
What concerns would emphysema raise for an SLP?
The shallow, clavicular breathing leads to difficulties coordinating breathing and swallowing, which can lead to swallowing impairments or aspiration.
*deterioration of alveolar walls and lung elasticity due to increased activity of macrophages - alveoli collapse and trap air - enlarged lungs and flattened diaphragm
when might vocal fold paralysis become life-threatening?
when it is bilateral paralysis. When both folds are paralyzed, swallowing and breathing issues intensify
vital capacity (total amount of air exhaled after maximum inhalation)
what injury may result in the following symptoms: shortness of breath, dysphonic (hoarse) voice, coughing up blood, difficulty swallowing, mild stridor, tenderness over larynx, subcutaneous emphysema (air trapped under skin)
fracture of the thyroid and cricoid cartilages
what are some signs of unilateral vocal cord paralysis?
breathy or hoarse voice, limited pitch and loudness/intensity, possible swallowing difficulties
Give 3 examples of things an SLP could expect to see in a patient with ALS.
1. MLU is decreased, retaining enough air for lengthy speech production is a challenge
2. voice becomes less intense, quieter, and may eventually result in aphonia
3. cough is weak fatigued, causing a risk for aspiration (and, thus, aspiration pneumonia)
how does the deterioration of motor neurons in ALS affect speech?
muscle weakness in the respiratory and phonatory symptoms can lead to difficulties with speech
How might an SLP be able to help identify an aortic aneurysm?
An aortic aneurysm may cause pressure on the left recurrent laryngeal nerve (of the Vagus), which would lead to left vocal fold paralysis. Left vocal fold paralysis can result in changes in voice quality that an SLP can identify, and, without any other probable cause, could attribute the paralysis to an aortic aneurysm and refer client to proper professionals for the necessary care
why would a doctor do a tracheotomy? how would an SLP help in this situation?
a tracheotomy tube is inserted directly into the trachea to be used as an artificial airway to bypass upper respiratory obstruction. This may be used with a ventilator if necessary.
When cutting into and inserting a tube directly into the trachea, the (very) close by mechanisms for speech and swallowing may be affected. Any signs of damage to these structures will need to be examined by an SLP
What is the result of impaired hyolaryngeal elevation?
upward and forward movement of hyoid bone and larynx is impaired which can increase risk of material entering the the airway
list some possible causes for impaired hyolaryngeal elevation.
neurogenic issues, such as stroke, ALS
surgery disrupting suprahyoid muscle
irradiation of the neck