Dysphagia and Neuromotor Functions Flashcards
Is dysphagia a disorder?
No.
It is a symptom!
What is a simple definition of dysphagia?
Pathology in the physiology of swallowing.
List the three kinds of bolus flow abnormalities.
Aspiration
Laryngeal Penetration
Residue
What are the two (sometimes three) stages of swallowing that we deal with as SLPs?
[Oral Preparatory phase]
Oral phase
Pharyngeal phase
What is the phase after the pharyngeal phase?
Esophageal Phase.
But this is not within our scope of practice.
The goal is to swallow blankly and blankly
Efficiently and Safely
What is a bolus?
What you form of the food you consume to prep it for swallowing.
What is laryngeal penetration?
When the bolus goes into the airway, but not into the trachea. Above the vocal folds.
What is aspiration?
When the bolus passes the vocal folds in the airway.
What is residue?
When the bolus remains in the oral and/or pharyngeal areas after a swallow.
Explain a Feeding vs. Swallowing Disorder
Swallowing is more anatomical with respects to the oral and pharyngeal aspects of swallowing.
BUT
Feeding is a larger aspect of eating, nutrition.
Why do SLPs deal with Swallowing?
Swallowing is a neuro-motor function – like speech production.
Most children and adults with neuro-motor speech disorders have an accompanying swallowing disorder.
Speech-production and swallowing involve same anatomical structures.
Who else can be on a swallow team?
Otolaryngologist Gastroenterologist Radiologist Neurologist Respiratory therapist Occupational therapist Dietician Dentist Nurse Neurodevelopmental specialist Patient’s family
What is swallow apnea?
Swallow apnea designates the oropharyngeal phase of swallowing during which respiration ceases.
What are some of the healthcare settings for dysphagia treatment?
In patient: Acute and Sub-acute care Skilled Nursing Facility (SNF) Inpatient Rehabilitation setting Outpatient clinics Home health setting (not as common)
What are the 5 cranial nerves involved in swallowing?
Trigeminal (V) Facial (VII) Glossopharyngeal (IX) Vagus (X) Hypoglossal (XII)
Are cranial nerves LMN or UMN?
Lower Motor Neurons!
What are the four stages of swallowing?
Oral Preparation Stage
Oral Stage
Pharyngeal Stage
Esophageal Stage
What structures are involved in the oral stage?
Lips, jaw, tongue, hard palate, soft palate, cheek, mandible, and maxilla.
What structures are involved in the pharyngeal stage?
Base of the tongue, velum soft palate, larynx (hyoid bone, epiglottis, laryngeal vestibule, true and false vocal folds, ary-epiglottic folds.), and cricopharyngeus (the other name for the UES = Upper Esphageal Sphincter).
What structures are involved in the esophageal stage?
The esophagus.
What occurs in the oral prep stage?
The food or liquid is prepared into a bolus
What occurs in the oral stage?
Bolus is propelled to the back of the mouth (oropharynx) 1-1.5 seconds
What occurs in the pharyngeal stage?
Velopharyngeal closure
Tongue base to posterior pharyngeal wall retraction
Closure of the epiglottis
Hyoid elevation and laryngeal vestibule squeeze
Approximation of the true and false vocal folds
Pharyngeal stripping - alternating contractions
The opening of the UES (or cricopharyngeus)
Why is the movement of the tongue base posteriorly and the pharyngeal wall retraction important?
It reduces the space, creating a high-pressure system to propel the bolus down the pharynx.
What is the space called between the tongue and the epiglottis?
The vallecula
What is the triangular space on either side of the larynx called? Why should we care?
Pyriform sinuses. Because this can be a location for residue to collect.
What is peristalsis?
The alternating contraction/relaxation that pushes the bolus through the esophagus to the stomach. A wavelike motion.
What is the other sphincter in the esophagus? Why do we care?
The lower esophageal sphincter.
Because of GERD and LPR.
How many kinds of consistencies of food are tested during a swallow exam?
5
What would negatively affect the efficiency of the oral prep phase?
poor salivary function, surgical defects, and neurological disorders.
What are the three salivary glands?
Parotid
Sub-Mandibular
Sub-lingual
