Class #3 (Normal swallowing in adults) Flashcards
Review: Stages of the Swallow
1A Anticipatory Phase/Oral Preparatory Phase
1B.Oral Phase
- Pharyngeal Phase
- Esophageal Phase
Oral Preparatory Stage
(After food is introduced into the mouth)
_____ of mouth
Tongue bunches up in the back with pulled down ________
Tongue is in charge of ___________ - sealing along the alveolar ridge
- compressing food against the \_\_\_\_\_ - moving the food onto teeth - pulling back of food to mix it with saliva
Salivary glands ____________
Facial and ____-wall contraction
Closure
soft palate
keeping the food in oral cavity
hard palate
(parotid, submandibular, sublingual)
buccal
Oral Stage
The bolus is ________
Tongue drops down and pulls ______
Mastication ______
Anterior tongue _______ to the hard palate, squeezing the bolus toward the ______
Contact with the ______________________triggers the pharyngeal stage reflex
ready to be swallowed
posteriorly
stops
elevates; faucial pillars
fauces, soft palate, or posterior tongue
Pharyngeal Stage
Bolus reaches ______
Elevation of _______
(separation of oropharynx from nasopharynx)
Cease of _______
- lip _____
- tight adduction of _____
- constriction of ________
- depression of _____
- elevation of ______
faucial pillars
soft palate
respiration
sealed
larynx
false vocal folds
epiglottis
larynx
Pharyngeal Stage
Relaxed _________ (upper esophageal sphincter)
Sequential ________
of superior, middle, and
inferior ________
Reaching esophageal
entrance through _______
cricopharyngeus
constriction; pharyngeal
constrictors
pyriform
sinuses.
Esophageal Stage
Purely _____
Bolus reaches the _________
Transported to the LES by _____and _____
_________ contracts again, when the bolus enters the UES
Depressed _____ and_____
________ re-begins
reflexive
orifice of the esophagus
peristaltic contraction and gravity
Cricopharyngeus
larynx and soft palate
Respiration
Cavities
Nasopharynx
Oropharynx
Hypopharynx
Innervation of the Swallow
“Normal swallowing includes an integrated, interdependent group of complex feeding behaviors emerging from interacting cranial nerves of the brainstem and governed by neural regulatory mechanisms in the medulla, as well as in the sensorimotor and limbic cortical system.”
Neurological Control:
“Swallowing is mediated by a distributed neural network that includes_____ and ______structures with descending input to the brainstem.” –Daniels,(2010)
Theories of neural control:
1.
2.
cortical and subcortical
- Chain of linked Reflexes
- Central pattern generator hypothesis
Neural Control
Efferent Motor fibers: (________)
Afferent sensory fibers (________)
______ and ______ fibers
________ swallowing centers
Dorsal Nucleus Tractus Solitarius
1.
2.
3.
Cerebral control
- ______cortex
- _________- face area
- Primary _________ Cortex
- _____
- Periventricular _____
away from organ
toward organ
Cerebral and midbrain
Brainstem
- Nucleus Ambiguous
- Primary Trigeminal Nucleus
- Ventral Medial reticular formation
Pre-Motor
Primary motor cortex
somatosensory
Insula
White matter
Cortical and Sub-cortical Lesions leading to dysphagia:
Anterior to the _________
____ vessels more than _____
Specific Areas:
central sulcus
Large more than small
- Brainstem
- Pre-Motor cortex
- Primary motor cortex
- Primary somatosensory Cortex
- Insula
- Periventricular White matter
Brainstem
Made up of:
1.
2.
3.
Cranial nerves and their nuclei arise from the _____
Basic ____________are maintained here
- midbrain
- pons
- medulla oblongata
brainstem
bodily functions for life
Cranial Nerves-Swallowing
**________
3 branches:
Motor supply (efferent) to __________
Sensory info (afferent) :
V Trigeminal Nerve
- opthalmic (GSA),
- maxillary (GSA),
- mandibular (GSA, SVE)
the muscles of mastication
anterior 2/3 on tongue, floor of mouth, gums, teeth, inner lining of cheek, pinna, auditory meatus, TMJ, nasal cavity, eyelids, etc.
VII Facial Nerve
Facial expression :
Tears:
Taste for…
bilateral innervation for the upper facial muscles, contralateral innervation for the lower facial muscles
(lacrimal gland)and salivation (sublingual , submandibular gland)
anterior two-thirds of tongue
Damage to the facial nerve
Oral & Pharyngeal
Distorted facial appearance
Loss of taste in front 2/3 of the tongue
IX Glossopharyngeal Nerve
- taste for posterior 1/3 of tongue and soft palate
- touch, pain, and temperature for posterior tongue, faucial pillars, upper pharynx
- muscle activation for stylopharyngeus and superior constrictor muscles
- efferent portion for parotid gland
IX Glossopharyngeal Nerve
(Phases)
oral phase
and pharyngeal phase
X Vagus Nerve
Motor innervation of most
Afferent:
laryngeal, palatal, and pharyngeal muscles as well as intestines, stomach, esophagus, kidney, heart, trachea, and bronchi
pain, touch, temperature to skin surrounding ear drum, posterior pinna, external auditory meatus as well as pain from lower pharynx, larynx, esophagus, palatopharyngeus, palatoglossus, levator veli palatini, uvula (tensor veli palatini is not innervated by Facial nerve) taste to epiglottis and valleculae.
Lesions of Vagus nerve:
difficulty swallowing, hypernasality and nasal regurgitation due to paralysis of levator veli. flaccidity of VF on side of lesion (bilateral lesion would cause paralysis of both VFs in adducted position or medial position), laryngeal stridor, aspiration, decreased pitch range.
Vagus Nerve
__________ & __________ phases
(Note: often damaged in
___________ surgery)
Sensation and motor to
__________
______ effected
X only = ______________
Pharyngeal & Esophageal
endarterectomy
pharynx & larynx
Peristalsis
hoarseness, swallow, soft palate on one side
XI Accessory Nerve
Efferent innervation of __________
Also works with Vagus to…
(Less direct- some ____ muscles)
sternocleidomastoid and trapezius muscles
innervate laryngeal, pharyngeal, and soft palate muscles
neck
XII Hypoglossal Nerve
Extrinsic & intrinsic muscles of _________
- Upper motor neurons serve ___________, therefore left damage will cause right sided ___________
- Lower motor neurons will result in _________
- deviation of tongue to _________
- fasciculations (__________)
tongue
contralateral side; tongue paralysis
ipsilateral paralysis
side of lesion
(twitching movements of tongue)
Hypoglossal XII: (phases)
Motor to…
Some _______
Can’t ________
Oral, Oral prep., pharyngeal
oral functions
pharyngeal
protrude tongue
Testing for Cranial Nerve Function
Barbara Sonies Cranial Nerve Assessment
Cranial Nerves related to Taste
VII facial nerve
IX Glossopharyngeal
X Vagus
VII facial nerve
anterior two-thirds of the tongue and palate
sweet, salty, and sour sensation
IX Glossopharyngeal
posterior one-third of the tongue
bitterness
X Vagus
epiglottis and esophagus
Motor Responses to Tastes
The nucleus of the _______ projects to the motor cortex serving the tongue
Our bodies will ______ tastes like salt as this is a necessary nutrient
The tastes we crave will elicit salivation as well as ingestive responses such as ___________
Bitter and sour tastes will elicit opposite responses like __________
solitary tract
crave
tongue protrusion, mastication, and swallowing
gagging, coughing, and saliva to protect the oral cavity
Motor Responses to Taste
Gag response involves ________________________
Coughing entails __________
elevation of larynx and velum, clamping of VFs, compressing abdomen & thorax, and protrusion of tongue (Not volitional)
tightly closing VFs, compressing abdomen & thorax, and then blowing VFs apart.
Olfaction
Increase magnitude of the ________
Arise from _______
________of the upper posterior nasal cavity
Olfactory sensors are replaced every_____and have cilia that are specialized for over _____
taste perception
olfactory bulb
Epithelia lining
60 days
1000 different smells
Tactile Sense
Mechanoreceptors
Glabrous skin _____ vs ____
(hairless) vs. hairy skin
Muscle Stretch Sense
Muscle ______
Nuclear ____and nuclear ____
Found in______as well as______(e.g., mandibular elevators and tongue muscles)
Return a muscle to its original _______ following passive stretching
Normally_______during active contraction
spindle
chain fibers and bag fibers
larger muscles; oral muscles
position
inhibited
Respiration and Swallowing
Linked by _______
Control centers in _____
Respiratory disorders affect ______
Airflow inhibition-onset of ________
Protection of airway achieved by: 1. 2. 3. 4.
anatomy
medulla
swallowing
oral stage
- True and false vocal folds
- Laryngeal elevation
- Tongue base retraction
- Epiglottic tilt
Normal Aging Issues
McCullough article
Swallowing and the Frail/Aged
Patient: McCullough
Sensory Changes: McCullough article
Motor Changes: McCullough article
Changes related to stages (Text) Oral stage: 1. 2. 3.
Hypertrophy of tongue
Dentition
Salivary flow
Pharyngeal Stage/Aging
Reduced anterior ___ movement
Less distention of ____
More laryngeal penetration in _________
Aviv, et al.: reduced sensory response leads to ___________
hyoid
PES
males over 50
upper airway protection problems
Esophageal Aging
- Reduced motor activity
- Smooth muscle thickening
- Delay in emptying
