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[Dysphagia] Re: Dysphagia Digest, Vol 35, Issue 21
Please take my name off the list. Thank you.
lvd@gwu.edu
Laura Dumbrava
Quoting dysphagia-request@b9.com:
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> Today's Topics:
>
> 1. RE: Gag and epiglottis (Kate Milford)
> 2. references re: oral care/aspiration pneumonia (S. Langer)
> 3. Deflection of epiglottis (Irene Campbell-Taylor)
> 4. The radiologist's view (Irene Campbell-Taylor)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Thu, 19 Oct 2006 14:54:22 +1300
> From: "Kate Milford" <KMilford@adhb.govt.nz>
> Subject: RE: [Dysphagia] Gag and epiglottis
> To: <dysphagia@b9.com>
> Message-ID:
> <CB37B770D06ADF4488F1F76C687E65560C80DE4B@Exchange03.adhb.govt.nz>
> Content-Type: text/plain; charset="us-ascii"
>
> I agree that the epilgottic deflection is not an issue of airway
> protection, but what occurs when the epiglottis does not fold down is
> that the pharyngeal stripping is severely impaired and there is no
> pressure to propel the bolus downwards. The result is lots of pharyngeal
> residue and often redirection of the bolus up into the oral cavity and
> sometimes nasal cavity.
> I therefore do not see how one can say epiglottic deflection is of no
> importance.
>
> Kate
>
>
> -----Original Message-----
> From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
> Behalf Of Irene Campbell-Taylor
> Sent: Thursday, 19 October 2006 14:21
> To: dysphagia@b9.com
> Subject: [Dysphagia] Gag and epiglottis
>
>
> This gentleman's problem is clearly esophageal. Epiglottic deflection is
> of no importance since it is the apposition of the arytenoids against
> the epiglottic base that is the primary protection of the airway. One
> can swallow perfectly well without an epiglottis as long as the base is
> intact and arytenoid function preserved.
>
> Palate Elevation and Gag Reflex (CN IX, X) Does the palate elevate
> symmetrically when the patient says, "Aah"? Does the patient gag when
> the posterior pharynx is brushed?
> What is Being Tested? Palate elevation and the gag reflex are impaired
> in lesions involving CN IX, CN X, the neuromuscular junction, or the
> pharyngeal muscles. Many normal individuals have no gag reflex and its
> presence or absence is not related to the ability to swallow. A very
> brisk gag reflex, however, MAY indicate UMN lesion as in ALS for
> example.
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mailing list
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>
>
> ------------------------------
>
> Message: 2
> Date: Thu, 19 Oct 2006 02:53:42 GMT
> From: "S. Langer" <s_langer@juno.com>
> Subject: [Dysphagia] references re: oral care/aspiration pneumonia
> To: dysphagia@b9.com
> Message-ID: <20061018.195400.9049.1232281@webmail01.lax.untd.com>
> Content-Type: text/plain
>
> I was wondering if someone could provide me with references re: the
> importance of oral care for dysphagic pts. and/or correlation between oral
> care and development of aspiration pneumonia (I seem to recall one article
> suggesting that risk of aspiration pneumonia more closely correlated with how
> good oral care was...rather than any other factor, e.g. amt of aspiration
> etc.... but have lost the reference)
> I know this has been posted on the listserv several times in the past few
> mos, but I seem to have misplaced the references...and I'm giving an
> inservice to the nursing staff on our CVA unit in a few days...so I'd really
> appreciate the information.
> Thank you, in advance, for your help,
> Sharon
>
>
>
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> ------------------------------
>
> Message: 3
> Date: Thu, 19 Oct 2006 05:14:09 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley@yahoo.com>
> Subject: [Dysphagia] Deflection of epiglottis
> To: dysphagia@b9.com
> Message-ID: <20061019121409.21272.qmail@web30208.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> It is important to differentiate between failure of deflection because of
> failure of anterior hyoif movement and other impairments of epiglottic
> downfolding. The movement of the epiglottis alone is unimportant. It is the
> related actions that count.
> Please see:
> http://www.nature.com/gimo/contents/pt1/full/gimo36.html
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
> Message: 4
> Date: Thu, 19 Oct 2006 05:20:35 -0700 (PDT)
> From: Irene Campbell-Taylor <eripley@yahoo.com>
> Subject: [Dysphagia] The radiologist's view
> To: dysphagia@b9.com
> Message-ID: <20061019122035.51162.qmail@web30201.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> The following is an excerpt from a recent article with good AVI movies of
> swallowing (previously posted). I find the excerpts interesting in that they
> repeat what has been said for many years about VFSS but seems to be seldom
> done. Also, the lack of trained radiologists has been an increasing
> phenomenon that will have a significant effect on clinical practice:
> Drs Gates, Hartnell, and Gramigna respond:
> We thank Dr Peer for his interest in our article (1). Videofluoroscopy is
> fast becoming a dying art for radiologists in the United States; all too
> often, speech pathologists work independently or may ?benefit? from the
> company of a technologist who is present only to ?stand on the pedal.? Many
> radiologists are pulled in too many directions to lend detailed input or
> guidance for swallow studies. Ultimately, radiology residents suffer and are
> not well trained. To that end, we saw a need to fill a void with a primer
> rather than a definitive and comprehensive text. Thus, we focused on
> neurologic disorders, as these are the most commonly encountered causes of
> swallow abnormalities, and tried to formulate a straightforward, systematic
> approach.
> We do not disagree with Dr Peer?s opinion that a frame-by-frame analysis is
> extremely important. A detailed analysis occurs when the videotape is
> replayed over (and over). We certainly benefit from image manipulation in
> every study we analyze. These techniques include freeze-frame,
> frame-by-frame, and slow motion playback. Both the oral and pharyngeal phases
> can be studied; the timing and coordination of complex neuromuscular events
> can be evaluated. As Logemann (2) has stated, ?The modified barium swallow
> is designed not only to assess whether the patient is aspirating, but also
> why, so appropriate efficient treatment can be initiated.?
> References
> 1. Gates J, Hartnell GG, Gramigna GD. Videofluoroscopy and swallowing
> studies for neurologic disease: a primer. RadioGraphics 2006;26:e22.
> doi:10.1148/rg.e22. Published November 8, 2005.
> 2. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed.
> San Diego, Calif: College Hill Press, 1998.
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
>
> ------------------------------
>
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>
> End of Dysphagia Digest, Vol 35, Issue 21
> *****************************************
>
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