Dysphagia and Swallowing Flashcards
Two steps in oral phase
Oral Preparation and Oral Transport
Oral Preparation
Manipulation and mastication of food in to bolus
Muscles & Structures Involved: lips, jaw, tongue, soft palate, buccal and mastication muscles
Oral Transport
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
Steps in pharyngeal transport
- Pharyngeal phase initiated
- Bolus nears tongue base
- Bolus nears upper esophageal sphincter (UES)
Pharyngeal Phase
Laryngeal and hyoid elevation, velopharyngeal closure, epiglottis closes airway
Esophageal Phase
Food transports from the pharynx to the stomach
Intrinsic Muscles of Tongue
Superior Longitudinal
Inferior Longitudinal
Transverse
Vertical
Extrinsic Muscles of Tongue
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Compensatory Strategies
Focus is on eliminating the symptoms of dysphagia (e.g., positioning strategies, food/liquid modifications)
Rehabilitative Strategies
Improves safety and efficiency of swallowing by directly targeting swallow physiology
Sensory Stimulation Strategies
Goal is to increase sensory stimulation (e.g., downward pressure of spoon, sour/sweet bolus, cold bolus etc)
Compensatory Maneuvers
- Supraglottic Swallow
- Super-Supraglottic Swallow
- Mendelsohn Maneuver
- Effortful Swallow
Rehabilitative/ Muscle Strengthening Maneuvers
- Lingual Resistance
- CTAR
- Shaker Head Lift
- EMST
Supraglottic Swallow
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
Super-Supraglottic Swallow
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
Mendelsohn Maneuver
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
Effortful Swallow
Aimed to improve tongue base retraction and pressure; bolus clearance
Instructions: push and squeeze muscles to swallow as hard as you can
Lingual Resistance
Strengthening tongue muscles; can use tongue depressor or device like the IOPI
CTAR
Chin tuck against resistance; designed to improve UES opening; squeezing rubber ball and tucking chin in
Shaker Head Lift
Designed to improve UES opening; patient lays flat, raises their head (looks at toes) holds position for about 1 min x 3 reps
EMST
Expiratory muscle strength training: designed to improve maximal expiratory pressure and strengthen expiratory muscles
