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Juvenile-HD

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INDEX Page
Tools For Viewing
10 The Most Commonly Asked Questions
Clinical Trials & Research
Huntington's Disease~WeMove Info
Advocacy/Donations/Press Info
Clinical Definition & Search
Facing HD~Family Handbook
JHD Handbook-Chapter 1
JHD Info-Stanford Univ.
Physician's Guide To HD
Caring for People with HD
Physical & Occupational Therapy In HD
Understanding Behaviour in HD-Dr. Jane Paulsen
Understanding Behavioral-Dr. Edmond Chiu
Advanced Stages Caregivers Handbook
First Shift-Certified Nursing Assistants
Activities of Daily Living-HD
Unified HD Rating Scale (UHDRS) Motor Section
Westphal Variant
SECTION 1 - AT RISK
Age & Probability Chart
At Risk For HD-What Next?
At-Risk Checklist
Best Interest of Child?
Crystal Ball?
Food For Thought
Parent Hasn't Tested?
Q&A On Risk of Inheriting JHD
Testing Children
SECTION 2 - GENETIC TESTING
Genetic Disorders & Birth Defects
Genetic Testing for HD
Genetic Counseling-In General
Psychological Impact
Intro: Genetics/Genetic Testing
Prenatal & Preimplanation
Prenatal Testing-In General
o Genetic Testing Resources
o Personal Stories
SECTION 3 - JHD
Coping With The Early Years
Age of HD Appearance
Age of Onset-Historical
Family-HD Underestimated
Children of Parents With HD
Child~Parent Ill
Clinical Description JHD
HD - What Kids Are Saying
HD & Me
JHD-Duration of Illness
JHD-Clinical and Research
JHD Symptoms
Parenting With HD
Patients/Families Coping
Talking With Children About HD
5 Stages of HD
JHD Resources
SECTION 4 - SYMPTOM RECOGNITION
Parent Resources
8 Fears of A Chronic Illness
Anxiety/Apathy/Irritability~HD
Anxiety, Fears & Phobias
Apathy-Physician's Guide
Ataxia
Attention-Perceptual/Unawareness Physician's Guide
Bed/Pressure Sores
Bed/Pressure Ulcer Guideline
Behavior Management
Bi-Polar Disorders
Botulinum toxin therapy
Bradykinesia
Caring Tips
Child Abuse-Reconizing Signs
Chorea-Physician's Guide
Chorea
Cognitive/Decision Making/Impulsivity
Cognitive-Short Tips
Contractures~Joints Locking
Dehydration-Physician's Guide
Dehydration
Delirium
Denial of HD
Depression~Physician's Guide
Depression-Understanding It
Depression-How To Help
Depression - Treatment Resistant Patient
Depression-Other Resources
-Read If Your Child Is On Antidepressant
Disgust - Impaired Recognition in HD
Dissociative disorders
Driving - Physician's Guide
Dyslexia
Dyslexia Resources
Dystonia
Dystonia/Rigidity & Spasticity Physician's Guide
Dystonia-Predominant Adult-Onset HD
Epileptic Seizures and Epilepsy
Epilepsy-Seizures~PG
-Seizures ~Special Populations
Falling~Safety
Falling - Subdural Hematoma Risk
Fevers - Unexplained
Fevers, sweating & menstural cycles in HD
GERD (Stomach)
HD Principle Treatments
Hallucinations/Psychosis~PGHD
Hand muscle reflexes in HD
Hypothalamus - A Personal Theory
Insomia ~Physician's Guide
Irritability~Temper Outburst Physician's Guide
Learning Disability
Mania/OCD~Physician's Guide
Mood Disorder Rate In HD
Myoclonus (Movements)
Nails-What To Look For
Night Terrors
Obsessive Compulsive OCD
Panic Disorder
Personality disorders
Pneumonia
Pneumonia-Advanced Stages
Pneumonia - Aspirated (Inhaled)
Prosody - Social Impairment
Sexuality~Physician's Guide
Skins Sensitivity
Sleep Disorders
Smoking-Physician's Guide
Spasticity
Stress
Tremors
Why Certain Symptoms Occur
Symptom & Treatment Resources
SECTION 5 - COMMUNICATION
Communication Resources
Communication Problems
Communication Strategies For HD~Jeff Searle
SECTION 6 - EATING/SWALLOWING/NUITRITION
Hints For Weight Loss in HD
HD & Diet~HSA Fact Sheet 7
Nutrients: Some Possible Deficiency Symptoms
Nutrition and HD~Anna Gaba (Recipes)
Nutrition Information In HD~Naomi Lundeen
Speech & Swallowing~Lynn Rhodes
Swallowing & Nutrition Physician's Guide To HD
Swallowing & Nuitrition Resources
Swallowing Warning Signs
5 Swallowing Problems
Taste changes in HD
Weight Gain
Resources-Drinks/Shakes
-Feeding Tubes~Advanced Stages of HD
-Feeding Tube~Jean Miller
-Feeding Tubes: One More Word ~Jean Miller
-Feeding Tubes & Baby Foods
-Feeding Tube~Dental Care
-Feeding Tube Instructions~Jean Miller
-Feeding Tube Resources
SECTION 7 - THERAPIES
Finding a Therapist - Behavoir
What Is A Physiotherapist?
Physical Therapy In HD
Speech-Language Therapy
Therapy Descriptions
Therapy Resources- Easter Seal
Therapy Resources
SECTION 8 - MEDICATIONS
HD Treatments
Medications-Movement Disorders
Medication/Emergency Info Forms
Cutting Prescriptions
Drugs-Look 'Em Up
-Adolescents Under 25
-Antidepressant Adverse Effects
-Anti-psychotic
-Anxiety-Antidepressant
A-Z Mental Health Drugs
-Creatine
-EPA~Fish Oil
-Haldol/Haloperidol - Clinical Sheet
-Haldol~Clinician Description
-Haldol & HD
-Haldol/HD Patient Experiences
-Haldol~ Patient Handout
-Mood Stabilizers: ASK 3 Questions
-Neuroleptic Malignant Synd WARNING
-Olanzipine-Risperidone/blood tests
-Celexa/Luvox/Paxil/Prozac/Zoloft
-Psychiatric Drugs & Children
Sertraline ~Zoloft
-Spasticity Meds/Treatments
-SSRI Medications
-Tardive Dyskinesia WARNING
-Weight Gain Medications
-Sites/Help the Medicine Go Down
-Vitamin & Mineral Deficiencies
SECTION 9 - SURGERIES
Surgery-Movement Disorders
o Surgery Resources
SECTION 10 - PROCEDURES
Clinic Visits-How To Prepare
CT Scans, MRI's etc.
Swallowing Tests
Tests Commonly Used
o Procedures Resources
SECTION 11- ALCOHOL/DRUGS
Alcohol-Parent's Guide
Alcohol-Talking To Your Child
Drugs-What To Do?
Drugs-Talking To Your Child
Disciplining-Ages 0-13 & Up
SECTION 12- SUICIDE
Straight Talk On Suicide
Teen Suicide-You Need To Know
o Suicide Resources
SECTION 13 - DIVORCE
Divorce & Child Stress
Tips For Divorcing Parents
SECTION 14 - DISABILITY ISSUES
Guides To Disability Issues
Caring-Child & Medical Technology
Caring for a Seriously Ill Child
Child Long Term Illness
Disability-Special Education Plan
IFSP Early Intervention Process
Disability Resources
Financial Planning
Wishes Can Come True-Children's Wish Foundations
Special Needs Resources
Special Needs Camp - About
Special Needs Camp - Finding One
SECTION 15 - ASSISTIVE TECHNOLOGY
Child Assistive Technology
Adaptive Equipment Resources
Products
SECTION 16 - EMOTIONAL ISSUES
Signs of Unhealthy Self-Esteem
Emotional Behavior Links
o Emotional Support Resources
SECTION 17 - GRIEF
Helping Child Deal With Death
o Grief Addtional Resources
SECTION 18 - ADD/ADHD
ADD & Teens
Conduct Disorders
FAQS & Related Info
Understanding AD/HD
What Is AD/HD?
Research Articles
Resources
SECTION 19 - HD SUPPORT GROUPS
HD Support Groups
National Youth Association
SECTION 20 - HD LINKS
HD Links
Related Resources
Tips For Friends
SECTION 21 - BENEFITS/INSURNACE
HD Disability
Benefits Check UP - See What You Can Get
Medical Insurance Bureau's Facts On You!
Medicare-Medicaid
Medicare Rights-Home Health & Hospice
Medicare Rights Center Resources
No Insurance? Try This!
Prescription Drug Cards Part I
Prescription Drug Cards Part II
Social Security-Children With Disabilities
SECTION 22 - ARTICLES/JHD
JHD and ADD
SECTION 23 - CAREGIVING
Articles-Resources
Caregiver Self-Assessment
Caregiver's Handbook
"First Shift With A Person With HD"
Getting Respite Care/Help At Home
Helpful Forms-Info
Home Emergency Preparations
Symptom Management
Ten Tips
Useful Tools
SECTION 24 - BIO
Our Personal Experience
Coping At The End
Kelly E. Miller
Song & Verse
Letter From My Heart
GUESTBOOK
Swallowing Tests

INDEX Page

Swallowing Tests
 
 
Difficulty swallowing liquids is usually due to poor muscular control before the swallow. This is the most common cause of dysphagia in individuals with neurologic diseases.

Difficulty swallowing solid food is usually associated with anatomic and physiologic abnormality. For example, an alaryngeal patient has difficulty with posterior tongue movement

Oral Stage
The oral stage is voluntary and requires control of oral structures, including the anterior position of the soft palate. Following mastication, the food is pulled together into a cohesive mass. Next, in a second or less, the tongue propels the bolus posteriorly. The oral stage ends once the material passes the anterior faucial arches at the back of the throat.

This posterior tongue movement and the material passing along the anterior faucial arches help activate the involuntary or reflexive swallow that constitutes the pharyngeal stage.
 
The reflex is believed to originate in the fauces, soft palate, base of
the tongue, and posterior pharyngeal wall. Innervation is primarily from the vagus in the brain stem, but involves cranial nerves IX through XI.
 
Because these nerves exit the medulla and pass through the jugular foramen together, localized trauma and disease may damage both structures resulting in dysarthria, dysphagia, and dyspnea.[17]

Potential problems -- The oral stage requires adequate chewing, sealing, and transporting of the bolus. Some of the possible difficulties in this stage may arise from lip paresis as well as reductions in buccal tension, tongue elevation and posterior carriage, range of jaw movement, and oral sensitivity.
 
These may lead to spilling or pocketing of the bolus in lateral sulci, and
may delay the swallow reflex. Problems during the oral stage may cause food or liquid to fall into the pharynx and lead to aspiration before the swallow reflex is elicited.

Pharyngeal Stage 
 
This is a reflexive stage that begins with the raising of the hyoid and larynx, and closing of the thyroarytenoid and ventricular
cords to create a velopharyngeal seal. Next, the epiglottis tilts and the cricopharyngeus muscle, or superior esophageal sphincter, is relaxed, opening the esophagus.
 
With the help of accessory muscles, a peristaltic wave moves the bolus through the hypopharynx and into the esophagus in approximately one second.[18]

Potential problems -- Factors that may lead to difficulties during this stage include: Velopharyngeal insufficiency, reduced swallow reflex, poor peristalsis, reduced pharyngeal pressure, and residue in the valleculae and piriform sinuses. Also, there may be restricted elevation of the larynx and an inadequate tilting of the epiglottis as well as incomplete closure of the vocal cords.

Esophageal Stage

This phase begins as the superior esophageal sphincter opens and, propelled by the peristaltic wave contractions that were started in the pharyngeal phase, the bolus passes through the esophagus and inferior esophageal sphincter into the stomach. This stage takes from 8 to 20 seconds.[18]

Potential problems -- The esophageal phase requires an adequate opening of the superior and inferior esophageal sphincters, as
well as good peristaltic movement of the bolus into the stomach. Possible difficulties in this stage include a reduced cricopharyngeal opening, resulting in some material remaining in the pharynx and posing a risk for aspiration after the swallow; and esophageal reflux, in which material returns to the pharynx from the esophagus and poses a risk for aspiration.
 
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Swallowing Tests X-RAYS AND RELATED TESTS
Certain X-rays may be helpful in determining whether function of the mouth and throat muscles is adequate for safe and effective feeding. These include upper GI (gastrointestinal) series, nuclear scintiscan, and a video feeding study.

An upper GI series can evaluate the structure of the esophogus and stomach, screen for GE reflux and give limited information about mouth (oromotor) and swallowing function.
 
A small swallow of barium is given to and a series of X-rays are taken to visualize the pathway that the barium takes to get to the stomach.

The scintiscan is a nuclear medicine study which can evaluate reflux that occurs through the gastroesophogeal spinchter (the inlet of the stomach), the rate of gastric emptying through the pyloric sphincter (the outlet of the stomach), and check for aspiration into the lungs.

Radioisotope is either swallowed by the patient or placed by nasogastric tube into the stomach, and its' return into the esophagus, appearance in the lungs, and rate of disappearance from the stomach is assessed.
 
The video feeding study is a diagnostic test that incorporates the skills of both the radiologist and the feeding therapist. The patients ability to handle foods is evaluated under X-ray (fluoroscopy) while the therapist feeds the patient a variety of foods and liquids of different textures.

The different types of food and liquid are observed as they pass through the mouth, throat and esophagus, and into the stomach. It is primarily a demonstration of oromotor and swallowing function, and is very helpful in determining the thickness and texture of foods that the patient can safely handle.
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What To Expect When You Have the following tests