Final Exam study guide Flashcards
What are the 3 phases of a swallow?
- oral phase
- pharyngeal phase
- esophageal phase
explain oral phase
•Form a bolus in your mouth on the top of your tongue, your lips seal, the tongue holds your food and velopharyngeal port closes
•The food or liquid is closed in your mouth
•This is a very contained phase
-no leakage or pocketing
•Everything stays in your mouth until the pharyngeal phase
explain pharyngeal phase
oIs triggered as the bolus reaches the back of the tongue
•Negative air pressure
•Because you’ve closed the velopharyngeal port and lip seal you have closed off air participating in this swallow
•It helps drive the bolus backwards
Explain esophageal phase
oThe esophagus is supposed to be a one way valve
oCharacterized by even more closure
oOnce food gets into the esophagus we are done
The larynx is quadruple protected…
oThe tongue goes up and the epiglottis closes over the opening of the larynx
oThe epiglottis closes backwards and aryepiglottic folds close in to make the seal
oThe false VF close up
oThe true VS close up
what is the single most important action in the pharynx to the swallow
- Larynx lifts and closes
- Most critical part of the pharynx
- It must pick up because that’s how it closes most tightly
- It is a sphincter action and it has to lift and close = peristaltic motion
What is aspiration?
SOMETHING HAS PENETRATED BELOW THE LEVEL OF THE TRUE VF
what is penetration?
i. The food may be sitting at the level of the true VF
ii. Because the food is in the vestibule
iii. Not below the level of the true—its AT the level
what is residue?
i. What’s left over in the laryngeal area
ii. Can also be what’s left behind in the mouth
1. If it’s sitting on the tongue
what is backflow?
i. Referring to the esophageal phase
ii. Food or liquid has gone into the esophagus and it’s coming back up again—it never got to the stomach
what are extrinsic muscles?
supporting and fixing the larynx into place
•One attachment is outside the larynx and on is inside (to hyoid, thyroid, or thyrohyoid)
What is are suprahyoids? name them
laryngeal elevators & critical swallow muscles digastricus mylohyoid stylohyoid geniohyoid
what do each of them do?
Digastricus: pulls hyoid up and slightly back
mylohyoid: elevates hyoid and moves down a little bit in contraction—anteriorly as well
stylohyoid: lifts hyoid and slightly posteriorly
geniohyoid: lift and pull slightly anteriorly
- ***Geniohyoid, mylohyoid, and anterior belly of digastricus→ pull hyoid bone forward
- **Posterior belly of digastricus and stylohyoid even out the pull a little bit—it pulls it backwards
what are infrahyoids? name them
laryngeal depressors
- Sternohyoid
- Omohyoid
- Thyrohoid
- Sternothyroid
Explain the infrahyoids
laryngeal depressors
1. Sternohyoid
•Strap muscle
•Downward pull of hyoid bone
- Omohyoid
Pull down and back a little bit - Thyrohoid
•A cheating muscle because both attachments are in the larynx
•Looks like a infra but acts like a supra
•When it contracts it pulls larynx up to hyoid bone
oIt is both intrinsic and extrinsic elevators - Sternothyroid
Pull down and back a little bit
What are the risks for dysphagia?
a. Lack of muscle control/function
i. Especially with lack of muscle function goes with lack of sensation
b. Lack of sensation
c. Lack of swallow reflex
i. Cough/clear reflex
What is a screening eval tell you?
Yes/no evaluation for aspiration
i. Typically identifies that the patient is aspirating, but not why.
1. But then you do a study to determine why: what’s happening where?
Name two types of swallow evals
b. Modified Barium swallow (MBS)
1. Laryngeal function
ii. Most popular eval
iii. It is an x ray
iv. Looking at lateral view of how they manipulate the bolus in the oral phase, when the pharyngeal phase triggers, when or does the larynx move up, does the tongue propel the bolus into the pharynx, is does the epiglottis close over?
- FEES (1:24:00)
i. Fibroptic endoscopic eval of swallow
ii. Can be done by a SLP no radiologist necessary
iii. Scope goes through the nose pass/lower to the level of the velopharyngeal port and watch the patient swallow
iv. Anterior, posterior, and lateral view
Both FEES and MBS are designed to do what?
- Where is the abnormality in the anatomy and/or physiology
- And give you an idea for treatment strategies might be
- You can test the structures
a. You can go through a list of treatment strategies and probe to see what works - But remember MBS is an x ray
Signs and symptoms of aspiration
i. Coughing after swallowing
ii. History of pneumonia
iii. Diagnoses that put the patient at greater risk
iv. Food squirting out the tracheostomy
v. Some sort of neuroligcal disease that lead to paralysis, paresis, lessened sensation
vi. Stroke or TBI
