Bolus Flow and Physiological Correlates

Question 1

A swallow has to be ** and **.

Answer 1

Safe and efficient

Question 2

What does it mean for a swallow to be safe?

Answer 2

The airway is protected. No penetration or aspiration

Question 3

What does it mean for a swallow to be efficient?

Answer 3

Bolus is completely cleared.

No oral or pharyngeal residue.

Question 4

What does premature spillage refer to?

Answer 4

When the bolus falls back into the pharynx before it should. (Oral stage deficit)

Question 5

What is pre-swallow pooling?

Answer 5

When the bolus is already formed and on the back of the tongue blade, but the sensory fibers are diminished and the bolus falls back into the pharynx, but the other reflexes don’t happen like the tongue moving backward, the velum closing, posterior pharynx doesn’t move anteriorly.
Could be a sensation issue or the nerve has registered by the motor timing has been slowed.

(Delay in swallowing initiation)

Question 6

What are some symptoms of impaired oral bolus prep/oral stage?

Answer 6

Prolonged mastication

Prolonged oral transit time

Premature spillage of bolus either anteriorly or posteriorly.

Oral stasis or Oral Residue

Question 7

What are some symptoms of delayed swallow initiation?

Answer 7

Pre-swallow pooling. That is, bolus falls back into the pharyngeal/laryngeal area before the patient actually wants to swallow.

Laryngeal penetration/aspiration before the swallow.

Question 8

When someone isn’t coughing during aspiration, what is it called?

Answer 8

Silent aspiration.

Question 9

What are some symptoms of Impaired tongue base retraction?

Answer 9

Residue in the Valleculae

Question 10

What are some symptoms of Impaired UES opening, hyoid excursion?

Answer 10

Residue in the pyriform sinuses.

Laryngeal penetration/aspiration during the swallow (after the swallow too if there is a build up of residue in the pyriform sinuses).

Question 11

What are some symptoms of Impaired pharyngeal propulsion/pharyngeal stripping wave?

Answer 11

Residue in the posterior pharyngeal walls, valleculae, pyriform sinuses – diffuse pharyngeal residue.

Prolonged pharyngeal transit time.

Question 12

What are some symtoms of Impaired epiglottic inversion, laryngeal vestibule squeeze?

Answer 12

Laryngeal penetration/aspiration during the swallow.

Question 13

Why should you mention when aspiration occurs?

Answer 13

So you know what to treat!

Question 14

What should you treat if aspiration happens before the swallow?

Answer 14

Swallow initiating aspects

Question 15

What should you treat if aspiration happens during the swallow?

Answer 15

Airway protection issues

Question 16

What should you treat if aspiration happens after the swallow?

Answer 16

Depends on WHERE the residue came from:
Vallecula –> base of the tongue retraction
UES –> UES opening or anterior hyolaryngeal excursion
Diffuse pharyngeal area –> pharyngeal stripping aspect

Question 17

Spillage is indicative of an impairment in which stage?

Answer 17

Oral Stage (both posterior and anterior spillage can occur)

Question 18

Pooling is indicative of an impairment in which stage?

Answer 18

Swallow initiation (Pharyngeal Stage)

Question 19

How do you tell the difference between spillage and pooling?

Answer 19

Spillage occurs before the bolus is created, during mastication and oral transit. But if the bolus is already created and being transported to the faucial arches and begins to go down the pharynx without a swallow initiated, then it is pooling.