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Lower motor neuron functions & Muscle Disease (Polyneuropathy…
Lower motor neuron functions & Muscle Disease
ALS
Swallowing
deficits
respiratory failure
pharyngeal stage
1.Nasopharyngeal regurgitation
2.Valleculaepooling
3.Piriformsinus pooling
4.Airway spillage
5.Ineffective airway clearance
6.Shortness of breath (hypopnea)
Oral stage
1.leakage
2.mastication
3.bolus formation
4.bolus transpot(tongue fasiculations)
5.residue pooling
considerations
Predominantly corticobulbar/ corticospinalinvolvement
Nutrition
Oral-intake/ tube feeding
Diet control
Degenerativ
Exercise benefits
Compensatory strategies
posture, sensory enhancement
Polyneuropathy
Systemic diseases
H&N cancer after radiotherapy
Guillain-Barre syndrome
therapy
•ROMexercise
•Resistance exercise
As respiratory improved:
•Mendelsohn manerver
•Supraglotticswallow
Swallowing
deficits
•Reduced tongue ROM
•Reduced laryngeal& anterior mov.
•Reduced airway closure
•Reduced pharyngeal contraction
Swallowing
deficits
Rapid onset of paresis
Respiratory
difficulty
tracheostomy / mechanical ventilatin
Polymyositis
therapy
•Tongue ROM exercise
•
Bolus propulsion exe.
•Head rotate to damaged side
•
Thin paste
Swallowing
deficits
•Reduced lingual control of bolus
•Disturbed lingual bolus propulsion pattern
•Reduced velopharyngeal腭咽肌 closure
•Reduced pharyngeal contraction
•Unil. Pharyngeal
paralysis
Myasthenia gravis
Swallowing
deficits
•Reduced pharyngeal contraction
•Reduced tongue muscle strength
•
Velar dysfunction
•Reduced mastication muscle strength
therapy
•
Medication
•
Diet change
•
Small meals