Exam 1 Flashcards
What is VPC
Velopharyngeal closure
3 levels of airway protection
Epiglottic inversion
Vestibule squeeze
Closure of true and false folds
What is hyolaryngeal excursion
Superior and anterior movement of hyoid bone during the swallow
What does the superior movement of the hyoid do
Squeezes the vestibule
What the anterior movement of the hyoid do
Opens the URS
What muscle controls the UES
Cricopharyngeus
When is sensory info about the bolus transmitted to the brain
When the tip of the bolus reaches the faucial arches
What is pharyngeal stripping
Contraction and relaxation of the pharyngeal constrictors that creates pressure changes causing the bolus to move downward
What happens in the oral prep stage
The bolus is formed
What happens in the oral stage
The tongue mives the bolus backwards
What happens in the oharyngeal stage
Initiation of swallow by sensory info to brain Velopharyngeal clisure Base of tongue back and pharyngeal wall forward for pressure change Epiglottic inversion Hyolaryngeal excursion Laryngeal vestibule squeeze Pharyngeal stripping Opening of UES
What are the goals of treatment
To swallow efficiently and safely
Where are 4 possible lesion sites
At muscle or myopathy
At junction of nerve and muscle or myoneural junction
On nerve or neuropathy
At junction of LMN snd UMN or motor neuron disease
What is the central pattern generator
Collection of nuclei that share a common function
Composed of neucleus tractus solitarius for sensoryand nucleus ambiguous for motor
What is the progression for neural information
Faucial arches Nucleus tractus solitarius Post central gyrus Precentral gyrus Nucleus ambiguous
What are the 5 cranial nerves for swallowing
Trigeminal Facial Glossopharyngeal Vagas Hypoglossal
What are the sensory and motor functions of the trigeminal nerve
Maxillary branch: sensory for upper lip, maxillary teeth, palate
Mandibular branch:
Sensory: general sensation to anterior 2/3 tongue, mucous membranees
Motor: muscles of mastication, digastric, mylohyoid, tensor veli palatini,
What are the motor and sensory functions of the facial nerve
Sensory: taste to anterior 2/3 tongue through chorda timpani
Motor: facial muscles for labial seal and stylohyoid for hyoid elevation
What are the motor and sensory functions of the glosdopharyngeal nerve
Sensory: visceral afferent : taste and general sensation to posterior 1/3 tongue
Sensation to mucous membranes of parts of tongue, tonsils, upper pharynx
Faucial arches info to brain
Motor: velum muscles through pharyngeal plexis
What are the sensory and motor functions of the hypoglossal nerve
Sensory: none
Motor: muscles of the tongue except the platoglossus
What are the motor and sensory functions of the vagas nerve
Sensory: sensation to larynx through suprior interior branch of laryngeal nerve
Motor: movement of folds and pharyngeal constrictors
Esophagus
What is a J tube
Nonoral feeding device that leads directly into the small intestines
Who else deals with swallowing
Otilaryngologist Gastroenterologist Radiologist Neurologist Respiratory therapust OT Dietician Dentist Nurse Neurodevelopmentalust Patient family
3 parts of pharynx
Nasipharynx
Oropharynx
Laryngopharynx
What happens in the oral prep stage
Food chewed and formed into a bolus
Affected by poor dentition or saluvary function
Food triggers sensory receptors for taste, smell, pressure, and temp
What happens in the oral stage
Bolus is pushed from front of mouth to back.
Bolus formed and placed on blade
Tongue tip elevates snd backward motion of bolus initiated
Extrinsic tongue muscles, palatal muscles oush bolus back and seal nasopharynx
Sensory receptors in faucial arches guide initiation
Duration 1 to 1.5 sec
What produces saliva
Parotid glands produce both thin and thick sdliva
What happens in the pharyngeal stage
Posterior tongue contracts with lateral and posterior pharyngeal wall to affect pressure
Flow pressure dynamics begins
Pharyngeal stripping
Activation of suprahyoid muscles to move hyoid up and forward
Closure of larynx through epiglottic inversion and vestibular squeeze
Food reaches UES
Duration 1.5-2 sec
What happens in the esophageal stage
Peristalsis oushes bolus downward
Alternate ring like contractions
Assessed by manometry
What are the structures of the oral stage
Lips Jaw Tongue Hard and soft palate Cheek Mandible Maxilla
What are the structures of the pharyngeal stage
Base if tongue
Soft palate
Larynx: hyoud, epiglottis, vestibule, true snd false folds, aryepuglottic folds
Cricopharyngeus
Muscles of mastication
Temporalis
Lateral and medial pterygoid
Masseteur
Trigeminal nerve
What are the muscles used for labial seal
Orbicularis oris Levator labii superioris Major and minor zygomatic Buccal Depressor anguli oris Depresdor labii inferioris
Facial nerve
What are the muscles of the palate
Tensor vili palatini
Trigeminal
Levator vili palatini
Platopharyngeus
Musculus uvulae
Pharyngeal plexis
What nerves make up the pharyngeal plexis
IX glossopharyngeal
X Vagas
XI Spinal Accessory
Which muscles elevate the hyoid
Digastric
Mylohyoud
Trigeminal
Stylohyoid
Facial nerve
Geniohyoid
Cervical nerve
What are the muscles of the tongue
Hyoglossus
Genioglissus
Styloglossus
Hypoglossal nerve
Palatoglossus
Pharyngeal plexis
Which area of cortex is responsible for sensory info
Pistcentral gyrus
Brodmanns area 1-3
What area of cortex is responsible for motor respinse
Precentral gyrus
Brodmanns area 4
Premotor cortex area 6
What are the 2 pathways to the brain
Pathway 1: thalamus to somatosensory to motor to corticobulbar
Pathway 2: nTS to recticular formation to NA to muscles
What areas of the brain are activated during swallowing
Inferior precentral gyrus Post central gyrus. BA 43 Right precentral and premotor Cerebellum BG Thalamus Right inferior parietal
What role does the insula have
Delayed swallowing
Decreased sensory input
Coordination of oral muscles, gustation, and aulmentary tract
What role does the cerebellum have
Timing, coordination, sequencing
Connectivity between primary and supplementary mitor cortex, brainstem and thalamus
Proprioception
How is negative pressure achieved by an infant
Thru jaw not lips for negative pressure
Velum creates posterior seal
Hard palate and tongue for positive pressure
What is the difference between infant and adult physiology
Most oral cavity filled with tongue
High hyoid
Nasopharns to hypophaynx is curved for more fluid movement
What is the difference between suckling vs sucking
Suckle mives backward-forward
Suckung moves up and down
What is the difference between nutritive and non nutritive sucking
Breathing
What refles are involved in infant feeding
Rooting
Suck/swallow: lips and mouth touch causes sucking. As liquid moves into mouth the tongue moves back
Tongue thrust: when lips touched the tongue moves out of mouth for feeding from breast or bottle but not cup or spoon
Gag reflex: object at back of mouth causes gag
What is typucal for infant thry 5 months
Suck/swalliw reflex, tongue thrust reflex, rooting, gag
Swalliws liquids but pushes out solids
What is typical for 4-6 month infant
Draws in lip as spoon is removed Up down munching movement Can transfer food from front to back Opens mouth when spoon approaches Reflexes disappear
What is typical fir 8-11 minth infant
Mive food side to side
Cyrve kups around spoon
Chews in rotary pattern
What physiologic changes happen with aging
Atrophy
Decreased range motion, speed, strength
Liss of seniry
Resouratory compromise
What changes with aging in oral stage
Hypertrophy of tongue
Impaired sensation
Poor teeth
Prolinged chewing
What changes with aging in pharyngeal stage
Mild delayed swallow Inadequate hyolaryngeal excursion Impairments in UES Increased laryngeal oenetration Poor laryngeal adductor Increased residue
What changes in esophageal stage with aging
Decreased mitility
Resting oressure of UES umpaired
Poor peristalsis
Which muscles make up faucial arches
Anterior: palatalglissus
Posterior: palatopharyngus
Both innervated by pharyngeal plexis
What is premature soillage
When part of the bolus falls into the pharynx early
Oral stage deficit
What is preswallow pooling
Delay in swallowing caused by timing (motor) or sensation not registering
Bolus slready formed and pushed back
What are physiologic differences with a higher volume bolus
More hyoid displacement
Prolonged UES opening
What are the physiologic changes with mire viscous bolus
Increased oral pressure
Less chance penetration
More residue
What are dysfunctions of oral stage
Prolonged mastication
Prolinged oral transit
Premature spillage Bith anteriorally and posteriorally
Oral stasis ( residue)
What are the symptoms of delayed swallow initiation
Preswallow pooling
Laryngeal penetration before swallow
What is the symptom of impaired tongue retraction
Residue in valleculae
What is the symptom of impaired epiglottic inversion
Laryngeal oenetration during swallow
What is the symptom of impaired UES opening
Residue in pyriform sinuses
Penetration after swallow
What are sensory deficits assiciated with a stroke
Delayed initiation
Silent aspiration
Poor sensation of residue
Poor oral sensation
What are motor deficits associated with stroke
Poor tongue movement Poor VPC Poor base of tongue retraction Poor pharyngeal stripping Poor hyoid movement poor UES opening Poor coordination of breathing and swallowing
What is the pathology of Parkinsons
Dopamine deletion in substantia nigra
Symptoms: reduced inhibitiin, tremor, hypokinesia, rigidity
Effect on swallowing: motor, especially tongue
What is pathology of ALS
Amyotropic Lateral Sclerosis
Affects both UMN and LMNflaccidity, spasticity, slower mivement, loss if strength
What is the pathology of Multiple sclerosis
Depleted myelin sheath Slowness and rigidity Affects both motor andsensory functions Drlayed swallow, pooling,residue ware ess Weak muscle movements Poor airway protection Poor UES opening
What is the oathology if myesthenia gravis
LMN disorder At myoneural junction Autoimmune respinse Acetylcholine receptor inhibition flaccidity Weakness after use Prolinged pharyngeal transit Facial muscle weakness
What are swallowing symptoms of parkinsons
Unexplained weight loss Pocketing/poolingfoid Cough/choke Reduced loudness Nasal/ oral regurg Droolungexcessive secretionsrecurrent pneumonia
Symptoms of ALS
Progessive weakness muscles of mastication to extrinsic laryngeal Poor control of secretions Sensory preseeved More problems with volume Shortness of breath
WhT is swallowing apraxia
Oral stage
Delay in initiation by no movement or groping
Lack of coordination
Oral stage is more volitional so more affected
Affects voluntary control
