Day 3 Flashcards
3 anatomical planes of reference
coronal, horizontal/transverse, saggital
Transverse plane
divides top (head) and bottom (toes)
Coronal plane
Divides front (stomach) from back (back)
Saggital plane
Divides left from right
Superior
above, over
Inferior
below, under
Lateral
side/outer part of body
Medial
near middle/midline
Anterior
in front of, front
Posterior
behind, near back/rear
Supine
laying face up
Prone
laying face down
Define: pathophysiology
the study of the changes of normal mechanical, physiological, and biomechanical functions, either caused by a disease, or resulting from an abnormal syndrome.
Define: kinematics
the branch of mechanics that studies the motion of a body or a system of bodies without consideration of the forces acting upon it
Define: biomechanics
the study of the action of external and internal forces on the living body, especially the skeletal system
Define: rheology
the branch of physics that deals with the deformation and flow of matter
Efferent/motor nerve function
flow of info from brain INTO muscle
Afferent/sensory nerve function
flow of info AWAY from sensory receptor in the muscle to the brain
Definition and purpose of muscle
The principal mediator of all of our movements
•Responsible for voluntary and involuntary movements
3 types of muscle
striated (skeletal), smooth (visceral), cardiac (heart)
Explain striated/skeletal muscle, how many? Paired? Innervated by?
- Innervated by the peripheral nervous system (PNS)
* ~329 skeletal muscles, most are paired
Names of 2 attachments of striated muscle that develop during embryonic development
origin and insertion
Muscle name is usually a composite of its ______ and _________
origin and insertion points
Muscle contraction _______ the distance between origin and insertion, so we can predict what a particular muscle contraction will do.
shortens
What is the purpose of striated/skeletal muscle?
Move the skeleton
Define: muscle hydrostat
biological structure found in animals used to manipulate items (food)
muscles with no skeletal support interdigitated muscle orientation
deforms, many trajectories
3 examples of muscle hydrostats
tongue, trunk, tentacles
Action in a living body is _____ a laboratory model of muscle activity
NOT
Muscles act in _______ groups, so the lab model often ((does/doesn’t) account for opposing or complementary muscles in the group.
functional, doesn’t
5 special senses
vision, hearing, balance, smell, taste
Touch is a _______ sensation
general
What defines a special sense?
Does not have a specialized organ devoted to it
More info about touch
Touch includes mechanoreception (pressure, vibration and proprioception), pain (nociception) and heat (thermoception), and such information is carried in general somatic afferents and general visceral afferents.[1]
Sensation carried to brain by (various/similar) forms of (sensory/motor) receptors
various, sensory
Thermoreceptors
respond to heat energy
Chemoreceptors
respond to chemical energy (smell, taste)
Photoreceptors
respond to light energy (rods, cones)
Mechanoreceptors
respond to mechanical energy (pressure, distortion)
Nocioceptor
specialized chemoreceptor that detects pain via chemicals released from injured tissue
Proprioreceptors
specialized mechanoreceptors, particularly in joints, that detect body position
Golgi tendon
specialized mechanoreceptor (i.e. proprioreceptor) that detects shape change in tendon (i.e. knee jerk reflex)
Muscle spindles
specialized mechanoreceptors (i.e. proprioreceptor) that detect stretch in muscles
Hair cells
specialized mechanoreceptors that detect hearing and equilibrium in middle ear
3 common items used to test receptors
cold laryngeal mirror, flavored tongue depressor, needle
Intrinsic lingual (tongue) muscles
Intrinsic lingual muscles are within the body of the tongue (all cranial nerve XII)
Extrinsic lingual (tongue) muscles
Extrinsic lingual muscles connect the body of the tongue with surrounding structures (all cranial nerve XII, except palatoglossus X)
Purpose of tongue
rich, diverse sensory perception
3 receptors of general sensation in tongue
Mechanoreceptors – pressure/touch Thermoreceptors - temperature Nociceptors - pain
3 nerves that innervate tongue, their proportion/location
Cranial nerve V- anterior 2/3 general sensory, cranial nerve IX- posterior 1/3 general and special sensory, cranial nerve VII- anterior 2/3 special sensory
1 receptor of special sensation in tongue
Chemoreceptors- taste
CN-V innervates
anterior 2/3 of tongue, palate
CN-IX innervates
posterior 1/3 tongue, palatal arches, upper pharynx, valleculae
5 main points: normal posterior lingual propulsion
- Primary driving force of the bolus
- Active bolus containment
- Lingual compression due to intrinsic and extrinsic muscles
- Propulsion very brief (168msec)
- Healthy elders may adjust lingual propulsion pressures alter residue
Define: mucosa
an epithelial tissue that secretes mucus and that lines many body cavities and tubular organs including the gut and respiratory passages
Mucosa function
lines structures of the oral cavity
Cranial nerves that innervate the oral cavity, their function
CN V- general sensation, CN-IX- taste
The richest, most diverse sensory region is the _______
oral cavity
Define: two point discrimination
is the ability to discern that two nearby objects touching the skin are truly two distinct points, not one. It is often tested with two sharp points during a neurological exam.
The primary goals of the oral cavity for oropharynegal swallowing are
- Processing food for safe swallowing
2. Posteriorly propelling the food into the pharynx to be swallowed (tongue).
What happens when there is reduced oral sensation?
Absent, late, reduced pharyngeal response
What happens when there is increased oral sensation?
Early, robust pharyngeal response
Airway protection movements are modified when _________, likely due to _________.
bolus sizes vary, oral sensory information that helps to plan swallowing movements
Are there swallowing kinematic differences between oropharyngeal swallows and isolated pharyngeal swallows?
NO- both 5 mL
Are there swallowing kinematic differences by bolus volume between oropharyngeal swallows and isolated pharyngeal swallows?
YES for OP swallows, NO for IP swallows
Oral sensation (is/is not) required to induce adequate swallowing kinematics
is not
Oral sensation (can/can’t) optimize swallowing kinematics
can
Purpose of oral movements
Oral movements break food down for safe swallowing
Purpose of oral sensation
Oral sensation allows planning for swallowing kinematics that best accommodate the approaching bolus
A swallow is triggered by (sensory/motor) stimulation to the _______ region
sensory, oropharyngeal
Once triggered, _______ should follow.
a cascade of sequential swallowing events
Define stage transition duration
Time between bolus at ramus of mandible and time of hyoid burst of swallow-related activity.
2 steps in processing the signal of triggering a swallow. Where does trigger go?
To brainstem Oral horizontal (time to process the bolus) Pharynx, larynx vertical (gravity=danger)
Explain the critical area in a swallow trigger
Critical area – sensory region to trigger patterned, automatic neuromuscular events
Transition between oral and pharyngeal (difficult/seamless) in normals, but (sometimes/always) in patients
seamless, sometimes
When transition between oral and pharyngeal not seamless, it causes a _______
delayed swallow onset
Swallow normal range (decimal #)
-0.22 –> 0.54 seconds
Sensory innervation from oropharynx
CNV – anterior 2/3 tongue, palate
CNIX – posterior 1/3 tongue, palatal arches, upper pharynx, valleculae
CNX – lower pharynx, upper esophagus, intrinsic larynx, valleculae
Sensory nerves for triggering the swallow provide input to what 2 brainstem regions:
Nucleus Tractus Solitarius (NTS) •Trigeminal Nucleus
4 main points: normal swallow trigger
- Bolus position at swallow onset varies in healthy adults
- Bolus position at swallow onset varies in healthy adults
- Bolus position at swallow onset varied is sequen-tial swallowing
- Healthy elders have longer swallow onset delays
Theme of sliding door analogy
timing is critical!
4 swallowing structures
velum, pharynx, larynx, UES
Define velar elevation
Posteriorly directed elevation of the velum (soft palate) that contacts the pharyngeal wall. Contact should be COMPLETE
Motor nerve innervation to palatal muscles
CNV (mandibular branch, pharyngeal plexus)- tensor veli palatini
CNX (pharyngeal branch)- levator veli palatini, palatoglossus, palatopharyngeus, muscularis uvulae
Sensory innervation to palatal muscles
CNV (maxillary division, lesser palatine n)- general sensory
CN-IX- general sensory (palatal arch); special sensory (taste)
Main point about velopharyngeal closure
More power in swallowing than speech, blowing
Pharyngeal swallowing process
Horizontally aligned muscle fibers in the superior, middle and inferior constrictors sequentially contract to help move the bolus downward through the pharynx.
pharyngeal stripping wave is (typically, not typically) seen on fluoro in normal adults
typically
Longitudinal pharyngeal muscles are connected to (higher, lower) structures (i.e. palate, styloid process) and to the hyo-larynx to (elevate, lower) both the _____ and the _______.
higher, elevate, pharynx and larynx.
3 primary muscles of the pharynx
Superior, Middle, and Inferior pharyngeal constrictors
Pharynx is innervated by
Pharyngeal plexus: CN IX and X
2 primary functions of the pharynx
Elevate and constrict, facilitate downward bolus movement
3 longitudinal pharyngeal muscles, innervation, function
Salpingopharyngeus (CNX) Pharyngeal elevation
Stylopharyngeus (CNIX) Pharyngeal & laryngeal elevation
Palatopharyngeus (CNX) Pharyngeal & laryngeal elevation
4 primary structures of pharynx movement
suprahyoid muscles, thyrohyoid muscles, long pharyngeal muscle, upper esophageal sphincter
PARTS for pharynx sensation
Mucosa in the nasopharynx
(cranial nerve IX)
Mucosa in the hypopharynx (cranial nerve X)
Pharynx sensory innervation
CN-IX and CN-X (pharyngeal plexus)- general sensory
5 main points: normal pharyngeal constriction
Main Points
- duration: ~410msec
- Pharynx elevates, shortens
- Max constriction after UES at max open
- Time to max constriction longer with age
- Little age related pressure changes
Hyoid bone movement and innervation
Superior, anterior CN V mylohyoid, anterior belly dig. CN XII geniohyoid, hyoglossus CN VII stylohyoid, posterior belly dig. Superior, posterior Hyoid Bone Movement Inferior Ansa cervicalis C1-3 omohyoid, sternohyoid
Laryngeal movement and innervation
C1 of Ansa Cervicalis coursing with CNXII Thyrohyoid muscle Superior CN IX stylopharyngeus CN X palatopharyngeus Inferior Ansa cervicalis C1-3 sternothyroid
Intrinsic laryngeal muscles: motor innervation
Motor Innervation
Cranial nerve X (recurrent laryngeal): all intrinsic laryngeal muscles, except cricothyroid
Cranial nerve X (superior laryngeal): cricothyroid
Laryngeal sensation and innervation
CN X superior laryngeal (SLN): Glottis and above
CN X recurrent laryngeal (RLN): Mucosa below the glottis
Why is laryngeal vestibule closure necessary?
To prevent the bolus from entering the larynx
During laryngeal vestibule closure, the ____ contacts the ______.
Epiglottis, arytenoids
Which muscle is primarily involved in laryngeal vestibule closure?
Aryepiglottic muscle
Measurement of laryngeal vestibule closure
Measured between two time points: 1st frame closed - until - 1st frame re-open
Laryngeal Vestibule Closure Duration- Normal Range?
0.31-1.07 seconds
5 main points: laryngeal vestibular closure
- LVC occurs from bottom to top
- LVC events preceded UES events
- LVC has both biomechanical and neuro- muscular parts
- LVC varies in sequential swal.
- LVC varies in sequential swal.
Hyoid anterior movement- normal range?
7.6mm-18mm
Larynx and hyoid superior movement- normal ranges?
Hyoid- 5.8mm-25mm
Larynx- 21mm - 34 mm
Define UES (upper esophageal sphincter)
Pharyngeal esophageal segment Pharyngeal esophageal junction
Primary muscles of UES
Cricopharyngeus is the primary muscle of UES
Also comprised of: •Lower Inferior Pharyngeal Constrictor •Superior cuff of Esophageal muscle
Motor and sensory innervation of UES
Cranial nerve X
UES opening and inhibition
Relax to open- superior view
CN-X = inhibition
2 structures involved in opening the UES- stretch to open
cricoid cartilage- excursion, cricopharyngeous muscle
Define: Cricopharyngeal bar, near (bottom, top) of cricoid
bottom, appearance of a prominent cricopharyngeus muscle
Duration of UES opening
Measured between two time points: 1st frame open - until - 1st frame closed
Opening the UES- normal range
0.21 sec - 0.67 sec
3 main pointS: normal UES opening
- UES pressures reduce as bolus moves through
- UES opening associated with anterior laryngeal movement
- Vocal fold closure precedes UES opening
Normal swallowing is _______, thus disorders of swallowing are often _________ (same as first).
multifactorial