Dysphagia and Swallowing

Question 1

Two steps in oral phase

Answer 1

Oral Preparation and Oral Transport

Question 2

Oral Preparation

Answer 2

Manipulation and mastication of food in to bolus

Muscles & Structures Involved: lips, jaw, tongue, soft palate, buccal and mastication muscles

Question 3

Oral Transport

Answer 3

Tongue tip and sides in contact with alveolar ridge; anterior to posterior movement; bolus and tongue motion near faucial pillar & tongue base; pharyngeal swallow triggered

Question 4

Steps in pharyngeal transport

Answer 4

1. Pharyngeal phase initiated
2. Bolus nears tongue base
3. Bolus nears upper esophageal sphincter (UES)

Question 5

Pharyngeal Phase

Answer 5

Laryngeal and hyoid elevation, velopharyngeal closure, epiglottis closes airway

Question 6

Esophageal Phase

Answer 6

Food transports from the pharynx to the stomach

Question 7

Intrinsic Muscles of Tongue

Answer 7

Superior Longitudinal
Inferior Longitudinal
Transverse
Vertical

Question 8

Extrinsic Muscles of Tongue

Answer 8

Genioglossus
Hyoglossus
Styloglossus
Palatoglossus

Question 9

Compensatory Strategies

Answer 9

Focus is on eliminating the symptoms of dysphagia (e.g., positioning strategies, food/liquid modifications)

Question 10

Rehabilitative Strategies

Answer 10

Improves safety and efficiency of swallowing by directly targeting swallow physiology

Question 11

Sensory Stimulation Strategies

Answer 11

Goal is to increase sensory stimulation (e.g., downward pressure of spoon, sour/sweet bolus, cold bolus etc)

Question 12

Compensatory Maneuvers

Answer 12

1. Supraglottic Swallow
2. Super-Supraglottic Swallow
3. Mendelsohn Maneuver
4. Effortful Swallow

Question 13

Rehabilitative/ Muscle Strengthening Maneuvers

Answer 13

1. Lingual Resistance
2. CTAR
3. Shaker Head Lift
4. EMST

Question 14

Supraglottic Swallow

Answer 14

Provides airway protection at level of true vocal folds

Instructions: take a deep breath and hold; hold breat as you swallow and cough immediately after the swallow

Question 15

Super-Supraglottic Swallow

Answer 15

Airway protection at level of laryngeal vestibule

Instructions: take a deep breath and hold while bearing down; keep holding and bearing down as you swallow; cough immediately after swallow

Question 16

Mendelsohn Maneuver

Answer 16

Aimed to improve UES opening and bolus flow

Instructions: swallow and try to hold the larynx in elevated position for as long as possible then complete the swallow

Question 17

Effortful Swallow

Answer 17

Aimed to improve tongue base retraction and pressure; bolus clearance

Instructions: push and squeeze muscles to swallow as hard as you can

Question 18

Lingual Resistance

Answer 18

Strengthening tongue muscles; can use tongue depressor or device like the IOPI

Question 19

CTAR

Answer 19

Chin tuck against resistance; designed to improve UES opening; squeezing rubber ball and tucking chin in

Question 20

Shaker Head Lift

Answer 20

Designed to improve UES opening; patient lays flat, raises their head (looks at toes) holds position for about 1 min x 3 reps

Question 21

EMST

Answer 21

Expiratory muscle strength training: designed to improve maximal expiratory pressure and strengthen expiratory muscles