Dysphagia Flashcards
Jaw elevators
Temporalis
Masseter
Internal, medial pertergoid
Types of saliva, produced where?
Viscid-thick, serous-thin
Parotid glands… Serous
Submandibular glands… Mostly serous
Sublingual glands… Mostly viscid
Jaw depressors
External, lateral pertergoid
Anterior belly of digastric
Mylohyoid
Geniohyoid
Lateral movement of jaw, muscle
Internal pertergoid
Anterior digastric muscle fx
Pulls hyoid up and out
Floor of mouth muscle
Mylohyoid
Fan shaped, elevates and pulls hyoid forward
Floor of mouth muscles, top to bottom
Geniohyoid…. Narrow, midline
Mylohyoid… Biggest
Anterior digastric
Intrinsic muscles of tongue, nerve, and which parts are voluntary
CN 12
Superior longitudinal…widen, thicken, shorten! Raises tip
Inferior longitudinal… Same, depresses tip
Transverse muscle… Long, narrow, thick
Vertical muscle…. Widens and flattens tip
Front 2/3 volition all back 1/3 reflex
Extrinsic tongue muscles, nerve
CN 12 , cn 10-palatoglossus only
Depress and retract
Genioglossus...bulk Styloglossus... Bulk Hyoglossus Chondroglossus Palatoglossus, 10, elevates floor, closes oral from pharynx
Pharynx muscles, outer circle
Horizontal… Constrictors
Superior, 5
Middle, 2
Inferior, 2: thyropharyngeus, cricopharyngeus
Pharynx muscles, inner circle
Vertical… Levators
Salpingopharyngeus
Stylopharyngeus
Palatopharyngeus
Tipper or dipper most common?
Tipper… Over 80%
Tongue thrust common with
CP
Frontal lobe injury
Velum moves…
Down in oral prep, close to tongue
Up in transit
Liquids only, des not come down for solids. Spilling normal
Duration of oral phase
Less than 1-1.5 sec
More time, more viscosity
Location of neuroinnervation of swallow
Nucleus Tractus solitarus in medulla gets the sensory info
Goes to cn10s nucleus ambiguous to trigger mvmt
Nerves for pharyngeal swallow
Both sensory and motor
10, 11
Duration of pharyngeal phase
1 sec
Duration of esophageal phase
8-20 sec
Can you diagnose at bedside?
Oral stage only
Recommend for poor oral control
Thickened liquids, then get thinner
Recommend for delayed pharyngeal swallow
Thicker, like applesauce
Reduced base of tongue strength
Best with liquids
Recommend for reduced laryngeal elevation
Liquids best
Recommend for reduced closure of larynx
Best with thicker
Strategies to try first
Postural changes… Chin tuck
A patient aspirating more than what percent of bonus should not be feeding orally
10%
OPSE
Oral pharyngeal swallow efficiency
Measures transit time, % residue and % aspirated
Indirect vs direct therapy
Always do both
Direct uses real food, indirect is exercises without food
