Exam 1 Flashcards
What is laryngeal penetration?
When the bolus is above or at the level of the vocal folds.
What is aspiration?
When the bolus goes below the level of the vocal folds.
What is residue?
Food left behind after we complete a swallow
What is a feeding disorder?
One that deals with the process of eating
What is a swallowing disorder?
A disorder that deals with the swallowing process in the pharynx and esophagus
Which type of swallowing disorder do SLPs treat?
oropharyngeal
What type of function is swallowing?
neuro-motor
Most children and adults with ______ have an accompanying swallowing disorder.
neuro-motor speech disorder
Speech production and swallowing involve the same _____ ____.
anatomical structures
What other professionals help with swallowing disorders?
ENT, Neurologist, radiologist, GI physician, Respiratory therapist, OT, dietitian, dentist, nurse, neuro-developmental specialist, patient’s family
What healthcare settings treat swallowing disorders?
in patient (sub-acute and acute care), skilled nursing facility, inpatient rehab, outpatient clinics, home health
Why are our lips important in swallowing?
They help build up pressure and keep the bolus from spilling out of the mouth
What causes swallowing to occur?
Higher pressure in the mouth pushes the bolus to the back of the throat for swallowing
Why are our tongue and jaw important in swallowing?
Mastication and bolus formation
Why does the velopharyngeal port close?
to prevent naso-regurgitation
What is pharyngeal stripping?
contraction of the pharyngeal wall to push food down the esophagus
What does “inversion of epiglottis mean”
the epiglottis is closing
Which structures are needed for the oral stage?
lips, jaw, tongue, hard palate, soft palate, cheek, mandible, and maxilla
Which structures are needed for the pharyngeal stage?
base of tongue, soft palate, larynx, cricopharyngeus
Which structures are needed for the esophageal stage?
esophagus
What does the cricopharyngeus muscle do?
opens the UES
What are the five cranial nerves needed for swallowing?
Trigeminal, facial, vagus, hypoglossal, glossopharyngeal
What are the muscles of mastication? (4)
Temporalis, Masseter, Lateral pterygoid, medial pterygoid
Which nerve innervates the muscles of mastication?
Trigeminal
Which muscle of mastication is important for projection of the jaw?
Lateral pterygoid
What will occur if there is a lesion on the trigeminal nerve?
the mastication process will be impaired
What are the 10 muscles of the face? (that we need to know)
- Orbicularis oris
- Zygomaticus minor
- Levator labii superior
- Zygomaticus major
- Levator anguli oris
- Depressor anguli oris
- Depressor labii inferior
- Mentalis
- Risorius
- Buccinator
What nerve innervated the muscles of the face?
Facial
The facial nerve controls the ____ of the tongue.
anterior 2/3
Which muscle closes, opens, protrudes, inverts and twists lips?
orbicularis oris
Which muscles elevate the upper lip?
- Zygomaticus minor
2. Levator labii superior
Which muscle elevates the oral cavity?
Levator anguli oris
Which muscle lowers the oral cavity?
Depressor anguli oris
Which muscle depresses the lower lip?
depressor labii inferior
Which muscle pushes up the lower lip and raises the chin?
Mentalis
Which muscle gives the expression of strain and angles the mouth outward?
Risorious
Which muscle flattens the cheeks?
Buccinator
Why are the facial/ lip muscles important?
They help prevent anterior spillage.
What are the 5 muscles of the palate?
- Levator veli palatini
- Tensor veli palatini
- Palatoglossus
- Palatopharyngeus
- Uvulae
What nerve innervates 4/5 of the palatal muscles?
Vagus
What is the only palatal muscle not innervated by the vagus nerve?
tensor veli palatini
Which nerve innervates the tensor veli palatini?
Trigeminal
Which palatal muscle elevates the soft palate?
Levator veli palatini
Which muscle stretches out the soft palate?
Tensor veli palatini
Which muscle raises the back of the tongue during the first stage of swallowing?
Palatoglossus
Which muscle shuts of the nasophrynx during the second stage of swallowing?
Palatopharyngeus
Which muscle raises the uvula?
Uvulae
What are the 4 supra-hyoid muscles?
- Mylohyoid
- Diagastric
- Geniohyoid
- Stylohyoid
Which 2 supra-hyoid muscles are innervated by the Trigeminal nerve?
Mylohyoid and Digastric
Which 1 supra-hyoid muscle innervated by the Hypoglossal nerve?
Geniohyoid
Which supra-hyoid muscle is innervated by the facial nerve?
Stylohyoid
Which tongue muscle is innervated by the glossopharyngeal and vagus nerve?
Palatoglossus
Which muscle controls the anterior and superior movement of the hyoid bone?
Geniohyoid
What is impaired if there is a lesion of the facial nerve?
Motor:
-Control of the lips- causing anterior spillage
- Control of facial muscles
- Movement of the stylohoid
Sensory: Taste on anterior 2/3rds of tongue
What is impaired if there is a lesion on the hypoglossal nerve?
anterior and superior movements of the hyoid bone and tongue movements
What is impaired if there is a lesion on the trigeminal nerve?
Motor:
- stretching of the palate (tensor veli palatini)
- mastication
- use of the mylohypid and digastric muscles
Sensory:
- Sensation on the anterior 2/3rd of tongue
What is impaired if there is a lesion on the vagus nerve?
Motor: -laryngeal, pharyngeal, and velum movements - some esophageal movements Sensory - impaired ability to sense aspiration
What happens in the oral prep phase?
labial seal –> mastication–> bolus formation
What happens during the oral phase?
Tongue pushes the bolus to the back of the mouth
What happens during the pharyngeal phase?
- velopharyngeal port closes
- base of tongue retraction
- posterior pharyngeal wall retraction
- hyolaryngeal excursion
- epiglottic inversion
- squeeze of the laryngeal vestibule
- approximation of the true and false vocal folds
- pharyngeal stripping
- UES opening
What negatively affects the oral prep phase?
poor salivary function, poor dentician, surgical defects, and neurological disorders
Why is saliva important?
It triggers the sensory receptors which trigger saliva production
Which gland produces the majority of our saliva?
sub-mandibular
What are the two kinds of saliva?
thick mucous and thin serum-like
What kind of saliva does the parotid gland produce?
thin serum-like
What kind of saliva does the sublingual gland produce?
thick mucous like
What kind of saliva does the sub-mandibular gland produce>
a combo of thick and thin
What is Xerostomia?
dry mouth
Which nerve controls oral sensation in the posterior 1/3rd of the tongue?
Glossopharyngeal
Which nerve controls oral sensation in the anterior 2/3rds of the tongue?
Facial
What happens during the esophageal stage?
Peristalsis propels the bolus from the UES to the LES–> secondary peristalsis if needed
What would patient’s with an insula abnormality present?
delayed swallowing
Where is the Central Pattern Generator for swallowing housed?
In the brainstem
The CPG is made up of ___ nuclei
2
Which CPG nucleus is responsible for sensory?
nucleus tractus solitarius
Which CPG nucleus is responsible for motor?
nucleus ambiguous
The severity of the dysphagia is ____ when someone has a stroke in the brain stem?
higher because that is where the CPG is located.
What happens if there is a lesion on the glossopharyngeal nerve?
Motor: - impaired pharyngeal stripping - impaired velopharyngeal port closure Sensory: - impaired taste function in posterior parts of tongue - impaired initiation of the swallow
The ________ in the medulla is the principle motor nucleus that provides input to the cranial nerves.
nucleus ambiguous
Sensory information from the pharynx is relayed by afferent fibers that terminate in the _______
nucleus tractus solitarius
Describe pathway 1.
Sensation –> nucleus tractus solitarius –> thalamus–> sensory strip –> motor strip –> nucleus ambiguous –> swallowing movements
Pathway 1 is….
More complex, controlled and voluntary
Describe pathway 2.
Sensation–> nucleus tractus solitarius–> nucleus ambiguous –> swallowing movements
Pathway 2 is….
reflexive
What function does the basal ganglia play in swallowing?
coordination of movement of the finer elements of swallowing
What function does the thalamus play in swallowing?
it is the relay station for motor movement
What function does the insula play in swallowing?
coordinated the interaction of oral musculature, sense of taste and the digestive tract
What happens if there is a lesion on the right anterior insula?
delayed swallow and sensations of taste, volume, and temperature due to reduced sensory input
What is proprioception?
awareness with respect to height and movement
What function does the cerebellum play in swallowing?
timing, coordination, and sequencing of movements–> uses proprioceptive, vestibular and motor planning to create smooth movements
Describe the normal anatomy of an infant’s oral cavity.
- Jaw provides stability and neg pressure
- Large tongue that creates a central groove
- hard palate and tongue provide pos pressure
- velum provides posterior seal
Describe the normal anatomy of an infant’s pharynx.
- high hyoid position
- naso-pharynx and hypo-pharynx are curved
- larynx grows and descends
What is non-nutritive sucking?
rhythmic movements on a pacifier or finger
NO apneic period
What is nutritive sucking?
- for nutrition purposes
- apneic period present
- starts around 32 weeks gestation
- suck swallow ratio of 1:1
What is suckling?
backward and forward movement of the tongue
What is sucking?
up and down movement of the tongue
What is the rooting reflex?
When you touch a infant’s mouth or cheek and the infant turns towards the object and opens mouth
What is the suck/swallow reflex?
When infant’s mouth is open and lips/ mouth are touched the infant begins suckling or sucking. When a liquid enters, the tongue moves it to the back of the mouth for swallowing
What is the tongue thrust reflex?
When the lips are touched, the infant’s tongue moves out of the mouth
What is the gag reflex?
When an object is placed into the back of the mouth, the object is quickly moved back out on the tongue
By what age do the reflexes usually diminish in infants?
12 months
What are the mouth patterns during feeding of an infant birth -5 months?
- suck/swallow reflex
- tongue thrust reflex
- rooting reflex
- gag reflex
What are the mouth patterns during feeding of an infant 4-6 months
- draws in upper or lower lip when eating with a spoon
- up and down munching movements
- can transfer food from front to back of tongue to swallow
- tongue thrust and rooting begin to disappear
- gag reflex diminishes
What are the mouth patterns during feeding of an infant 8-11 months?
- moves food from side to side in mouth
- curves lips around cup
- begins to chew in rotary pattern
What are general physiological changes in aging individuals?
- atrophy
- decreased range of motion, speed and strength
- delayed swallowing initiation
- coordination of breathing and swallowing may be off
Is aspiration ever normal?
NO
What impact does aging have on the oral stage?
- loss of muscle mass in the tongue
- decreased tongue pressure
- prolonged mastication
- poor dentition
What impact does aging have on the pharyngeal stage?
- delayed swallow initiation
- inadequate hypolaryngeal excursion
- Cricopharyngeal muscle may be impaired
- Poor laryngeal adductor reflex
- sensory and motor impairments leading to residue
What terms do we use to define the level of laryngeal penetration?
shallow, middle and deep
What impact does aging have on the esophageal stage?
decreased movement
resting pressure impaired
poor peristalsis
Name the symptoms if there is impaired oral bolus prep.
- prolonged mastication
- longer oral transit time
- anterior or posterior spillage
- residue in oral cavity
Name the symptoms if there is delayed swallow initiation.
- pre-swallow pooling
- laryngeal penetration
- aspiration BEFORE the swallow
What is pre-swallow pooling?
bolus falls back into the pharyngeal/ laryngeal area before patient actually wants to swallow
Name the symptoms associated with impaired epiglottic inversion and laryngeal vestibule squeeze
laryngeal penetration/ aspiration DURING the swallow
Name the symptoms associated with tongue base retraction.
- residue in the valleculae
If bolus is past the level of the vallecular spaces, then there is an issue with ____________.
pharyngeal stripping
What are the symptoms of impaired tongue base retraction?
residue left in the valleculae due to a lack of pressure
What are the symptoms of an impaired velopharyngeal port closure?
nasal regurgitation
What are the symptoms of impaired UES opening and hyoid excursion?
- residue in the pyriform sinuses
- laryngeal penetration/ aspiration AFTER the swallow
What are the symptoms of impaired pharyngeal propulsion and pharyngeal stripping?
- diffuse pharyngeal residue in pharyngeal walls, valleculae, and pyriform sinuses
- prolonged pharyngeal transit time
Patient has laryngeal penetration DURING the swallow. What is impaired?
epiglottic inversion
Patient has residue in the posterior pharyngeal wall. What is impaired?
Poor pharyngeal stripping
Patient has pre-swallow pooling of bolus to the pyriform sinuses. What is impaired?
delayed swallow initiation
Patient has residue in the base of the tongue. What is impaired?
tongue base retraction
Patient aspirates AFTER the swallow of this liquids. What is impaired?
Could have multiple causes
- impaired UES opening
- impaired hyoid excursion
Patient takes 3 seconds to propel pudding into the oropharynx. What is impaired?
the oral stage leading to extended oral transit time
What is bolus flow?
movement of the bolus from the oral cavity to the esophagus
Describe volume in terms of bolus flow.
Higher the volume, more is the hyoid displacement.
Prolonged UES open times with higher volume.
Describe viscosity in terms of bolus flow.
Increased oral pressures for thicker consistencies.
Higher chances of laryngeal penetration/aspiration for thinner consistencies (Better airway protection for thicker consistencies).
Chances of residue are more for thicker consistencies.
Where do cranial nerves 1 and 2 originate?
In the cerebral cortex
Where do the cranial nerves 3-4 originate?
midbrain
Where do the cranial nerves 5-8 originate?
pons
Where do the cranial nerves 9-12 originate?
medulla
What happens if there is a lesion on the UMN?
spasticity
What happens if there is a lesion on the LMN?
flaccidity
What is it called if there is a lesion on the nerve itself?
neuropathy
What is it called if there is a lesion on the muscle?
myopathy
What is it called when there is a lesion where the nerve and muscle connect?
myoneuropathy
What are common swallowing symptoms associated with a stroke?
- sensing the residue
- sensing penetration/ aspiration
- sensing swallowing initiation
What are the stages of a stroke?
Acute- first few days
Sub-acute- up until 6 weeks
chronic - after 6 weeks
What sensory deficits are associated with a stroke?
delayed pharyngeal initiation
silent aspiration
poor sensation of residue
poor oral sensation
What motor deficits are associated with a stroke?
poor oral coordinations
poor VPC
poor base of tongue contraction
poor pharyngeal stripping
poor hyoid movement
poor UES opening
poor coordination of swallowing and breathing
Bilateral lesions lead to ____ forms of dysphagia
severe
Representation of swallowing in the brain is ______.
bilateral
What is Parkinson’s disease?
slowly progressive neuro movement disorder caused by lack of dopamine in the substantia naigra
Why is dopamine importnat?
it inhibits movements so that they are not overactive
What is hypokinetic dysarthria?
reduced movement of the muscles of speech and swallowing
What are the 3 classic symptoms of Parkinson’s
rigidity, tremors, and hypokinesia (slow movements)
What are the swallowing related symptoms in Parkinson’s disease?
Aspiration Pocketing/pooling of food or saliva. Nasal /oral regurgitation Drooling. (reduced muscle movements or sensation) Excessive secretions. Pre-swallow pooling Incomplete airway protection limited pharyngeal stripping
_______ is one of the biggest things effected by Parkinson’s
lingual propulsion
What is ALS?
A degenerative and progressive motor neurom disease that affects the UMN and LMN
What are swallowing symptoms of ALS?
More motor deficits than sensory
- aspiration/ penetration after the swallow
- weakened muscles of larynx and mastication
- shortness of breath
What is Myasthenia Gravis?
a myo-neura; junction disease where the body makes antibodies to ACH
How does Myasthenia Gravis impact swallowing?
- muscle weakness
- prolonged pharyngeal transit time
What is MS?
Destruction of the myelin sheath that causes sensory and motor deficits
How does MS impact swallowing?
SENSORY pooling residue delayed swallow initiation MOTOR weak muscle movements poor airway protection
poor UES opening
What is the main stage impacted by swallowing apraxia?
the oral stage because it is the only one that can be voluntarily controlled
What is swallowing apraxia?
lack of coordination of movements during the oral stage of swallowing
