Cranial Nerves
How would you test CN VII?
Have pt smile, pucker lips, blink eyes, raise/lower eyebrows
Cranial and spinal nerves are examples of LMN or UMN?
LMN
Name 3 providers who might be part of a dysphagia management team
SLP, ENT, GI, OT, Radiologist, Neurologist, RT, Dentist, Nurse, Neurodevelopmental Specialist
Typical adult response to penetration? Typical adult response to aspiration? Typical infant response to aspiration?
Adult pen. = swallow again
Adult asp. = cough
Infant asp. = apnea
What bolus adjustments decrease AP transit time?
List 2-3 differences between CN IX and CN XII.
CN IX - glossopharyngeal is sensory / motor while CN XII - hypoglossal is motor only.
CN IX controls gag reflex while CN XII controls tongue movement.
CN IX accounts for taste on posterior 2/3 of tongue.
Which part of the brain is the site of the central pattern generator? (controls complex patterned behavior of swallowing)
Medulla Oblongata
Cognitive screen examines what?
Person - what's your name?
Place- where are you?
Time- What is the month,date,year?
Circumstance- Why are you here?
Swallowing is typically initiated in adults when the head of the bolus passes where?
Ramus of mandible
Name the 4 intrinsic tongue muscles and their role.
Hyoglossus- Depression
Styloglossus - elevation up / back
Palatoglossus - elevate posterior tongue
List 1 example of UMN lesion and 1 example of LMN lesion.
UMN Lesion- contralateral lower quadrant droop or weakness (e.g., CVA)
LMN lesion- ipsilateral facial hemiparesis (entire half) (e.g., Bell's Palsy)
Which arterial system supplies blood to the cerebrum?
Which arterial system supplies blood to the brainstem?
Cerebrum- Common Carotid Artery --> Internal Carotid Artery --> Anterior Cerebral Artery and Middle Cerebral Artery
Brainstem- Vertebrobasilar Artery --> Posterior Cerebral Artery
Name 2 pros and 2 cons of MBSS.
Name 2 pros and 2 cons of FEES.
MBSS:
- pros- Can visualize all phases of swallow from AP and Lateral views; standardized / great for training and research.
- cons- radiation exposure, rigid assessment that doesn't account for pt. attention or stamina.
FEES:
- pros- mobile, can be done dynamically incorporating maneuvers or postural changes, can visualize VF and secretions.
- cons- cannot view oral prep / oral phases, "white-out" during swallow, residue consistently rated higher than on MBSS (risk of over diagnosing).
What movement indicates the start of the pharyngeal phase?
anterior burst to hyoid bone (hyolaryngeal excursion)
Name the three infrahyoid muscles or laryngeal depressors.
Omohyoid
Sternohyoid
Sternothyroid
ID which CN are responsible for taste on posterior 1/3 of tongue, general sensation on anterior 2/3 of tongue, and taste on anterior 2/3 of tongue.
CN V- Trigeminal = general sensation on anterior 2/3 of tongue
CN VII- Facial = taste on anterior 2/3 of tongue
CN IX Glossopharyngeal = taste / general sensation on posterior 1/3 of tongue
What are the names of the two control circuits that make up the indirect activation pathway or extrapyramidal tract?
Basal Ganglia Control Circuit and Cerebellar Control Circuit
Esophagram, Manometry, Endsocopy
What are the 3 primary facilitators of epiglottic inversion?
BOT retraction
Pharyngeal constriction
Hyolaryngeal excursion
Describe the difference between Premature Spillage versus Delayed Swallow Initiation
Premature spillage is when bolus material (no clear bolus) leaks into oropharynx without a volitional swallow initiation.
Delayed swallow initiation is when volitional swallow occurs but bolus is “stuck” at level of pyriform sinuses or valleculae and requires a second / third volitional swallow to push bolus down to esophagus.
CN X - ID branches involved. Which branch is responsible for supraglottic sensation, which branch for subglottic sensation? How do you test each branch of nerve?
SLN - supraglottic- pitch glides
RLN- subglottic - cough or pulsating vowels
Vascular junction (in brainstem) offering some degree of redundancy and protection in case of damage.
Name 3 signs of difficulty swallowing and 3 considerations when assessing or screening swallowing.
Coughing / throat clearing, changes in respiration, gagging, absent swallow or difficulty initiating swallow.
Alertness, dentition, respiratory status, method of presentation, patient desires and preferences, cultural/linguistic background.
Name three effects of normal aging on swallowing
Increased frequency of penetration events
Increased pharyngeal residue and premature spillage
Reduced anterior hyolaryngeal movement
Reduced esophageal motility
Less coordinated respiration-swallowing control
Increased AP transit time
Weaker pharyngeal constriction and reduced BOT retraction
In Wallenburg Syndrome or Lateral Medullary stroke, identify which side sensory damage is on (facial and body).
Facial: ipsilateral
Body: contralateral