Dysphagia Chapter 4

Question 1

Neural Control of Swallow:

which 2 structures

Answer 1

Supranuclear structures

and cortex

Question 2

Supranuclear structures:

volitional control is mediated by?

Answer 2

cortical brain areas and their connections with subcortical areas

Question 3

Cortex: part of the brain that ?

as we go towards the center of the brain things become less?

Answer 3

decides on things (thinking part)

volitional (subcortical/brainstem areas)

Question 4

Cortical areas:

Answer 4

motor cortex: anterior to central sulcus (on both sides)

sensory cortex: posterior to central sulcus (higher level sensory processing)

Question 5

Subcortical Structures:
areas that communicate with 
what are they (3) 
thalamus and basal ganglia deep in ?
Cerebellum?

Answer 5

brainstem and cortex

thalamus
basal ganglia
cerebellum

cerebral hemispheres
posteriorly

Question 6

Thalamus:
The ?? that sends information about ? to other ?

per the text, considered a key player in ?

conveys info about ?

Answer 6

sensory relay station /bolus characteristics and circumstances / cortical and subcortical structures

afferent system in sensorimotor control

sensation of eating and swallowing

Question 7

Basal Ganglia:
have extensive connections to both?
very key part of ?
function to modulate ?

think of as?

Answer 7

cortical and other subcortical structures

• efferent system of sensorimotor control of the swallow
• modulate or change cortical and cerebellar output for motor control

quality control (tweaker of info being sent out for movement)

Question 8

Cerebellum:
close comm. with the ?
serves as monitor of ?
serves as corrector of ?

dependent on info from ?

Answer 8

thalamus and basal ganglia

• afferent information associated with swallow
• efferent output in order to make online adjustments to cortical efferent output

Question 9

Controlling the Swallow:
the cerebral cortex and subcortical structures play a crucial role in
areas in these structures are thought to be imperative in ?
information from sensory pathways integrate to impact?

Answer 9

automatic and volitional swallowing

initiation and fine-tuning of movements by the sensorimotor system

motor output for modifications in movement to increase safe, efficient swallowing

Question 10

Brainstem is the ?

what two things ?

Answer 10

engine of the swallow

NTS: sensory - oropharyngeal sensory receptors

NA: nucleus ambiguus, motor

Question 11

Modifications: there is evidence that this cortical input modified the swallow commands to muscles by ?

studies show that with oral anesthesia:

• reduced activity in ?
• what was more powerful ?
  theory: when NTS receives less sensory info…?

Answer 11

facilitating efficient synergies that are bolus specific

• sensory and motor cortical areas
• submental muscle activation

-brainstem structures of swallowing respond blindly and less efficiently (nucleus ambiguus defaults to regular swallow)

Question 12

Wrong that there are only four stages of swallow - it is an ?

Answer 12

artificial construct of a functionally integrated and dynamic system

Question 13

Variations due to

Answer 13

motor equivalence
bolus characteristics
swallower variables

Question 14

Historical theories on swallow:
Studies now show more stable swallow regulation is located in?
now shown to have more variability because of ?

evidence now leads us to believe swallow is more

a motor goal can be accomplished in ?

Answer 14

brainstem

• sensory input from oral/pharyngeal areas of the body
• higher cortical information (volitional control of swallow - we can think about and change swallow)

flexible

different ways dependent on particular muscles and joints involved in goal

Question 15

motor equivalence:
examples
oral phase: movement of the jaw (mandible) is relatively?
-all other muscles move with ? but respond by moving?
no?
important because of variance of ?
because of this dynamics of single swallow cannot be ?

Answer 15

stable across motor function (movement of the masseter)

• masseter but respond differently in order to accomplish the task
• focal pattern is same for across motor tasks in or across individuals
• extended to multiple swallows

Question 16

Motor Equivalence continued:

• the pharyngeal swallow is commonly triggered in the hypopharynx when ?
• multiple swallow over a 10 second interval revealed that the swallow response was triggered from ?

sequential swallowing resulted in bolus accumulating ?

the airway would ? however the larynx would not ?
-30% of subjects ? but cleared when ?

Answer 16

liquid swallowed spontaneously rather than on cue

• multiple sites including pharynx, valleculae, epiglottis pyriform sinuses
• deep in pharynx prior to swallow trigger
• close/ fully elevate
• penetrated the bolus/ sequential swallowing was complete

Question 17

Bolus characteristics 
the swallow mechanism must be able to safely handle food differences with:
-
-
-
-

Answer 17

bolus volume (size)
consistency (viscosity)
temperature
taste

Question 18

Swallower variability: 
due to age:
-tissues generally become
-tissue elasticity 
-sensory receptors? 
.. replaces?
sensory and motor nerve fibers 
... and .. of tongue become?
salivary output remains ?
-larynx 
reduced ? especially involving

Answer 18

thicker and more rigid
reduces
reduce in number
fat and connective tissue replaces areas once muscle filled
conduct slower
filiform and fungiform papillae become atrophied
consistent (can be affected by meds)
-descends in neck
cortical and subcortical activity especially involving sensory fx

Question 19

Sex:
most swallowing variability across sexes appears to attribute to ?
onset of submental activation?
distance of hyoid elevation?
degree of ? (contributing to the closer ?)

Answer 19

size
-men earlier than women
men > women (assoc. with swallower height)
men > women (approx. of epiglottis to arytenoid cartilages as the larynx is elevated further under the tongue base)