Introduction to Dysphagia Flashcards
Dysphagia
problems swallowing safely
Aphagia
Inability to swallow
Penetration
Food residue left in the vestibule above the vocal folds
Aspiration
When food falls into trachea/lungs due to reflux or ingesting
Feeding
Happens before swallowing initiated and assumes that client can swallow safely. Just have to work on food reluctance/ fear/ aversion/ motivation to swallow
Danger Signs of Dysphagia
Coughing, gurgly voice, weight loss, recurrent pnemonia, weakness, inability to recognize food( dementia), drooling, secretions, inability to control food in the mouth
Aspiration pneumonia
infection of the lungs due to aspirating
Effects of Dysphagia
Weight loss, aspiration pneumonia, weakness, depression, dehydration
Dysphagia assessment gold standard
small amounts of food or liquid to prevent aspiration pneumonia/ do not feed the patient, instead observe naturally or give small sips of water.
40% of patients silent aspiration missed @ screening. Modified Barium Best
Stages of Swallowing
Oral Preparatory, Oral, Pharyngeal, Esophageal
Oral Preparatory Stage
Chewing(mastication), adding saliva, forming a bolus
Mastication
Complicated process- chewing control center- in Pons/ Cortical controls make adjustments due to sensory feedback
Tongue
Both intrinsic (originate/insert inside tongue)/extrinsic (originate/insert outside tongue)
SILL
Intrinsic muscles: superior longitudinal, inferior longitudinal, Lingua transverse, Lingua verticales
Superior Longitudinal
raises the tongue tip
Inferior Longitudinal
lowers the tongue tip
Lingua transverse
elongates the tonge
Lingua verticalis
flattens the tongue
Gen
Hyoga
Senku
Petrification
Extrinsic Muscles: Genioglossus Hyoglossus Styloglossus Palatoglossus
Extrinsic Muscles
Gen
Hyoga
Senku
Petrification
Genioglossus
Most of tongue/protrusion&depression
Hypoglossus
depress&retract tongue
Styloglossus
retract the tongue
Palatoglossus
depresses the soft palate and moves the faucial pillars toward midline
Mastication Muscles
Primary-attach mandible to skull
Secondary- attach mandible to anything else like hyoid/thyroid
Close the Mouth
Temporalis
Masseter
Medial pterygoid
Open the mouth
gravity & lateral pterygoid
anterior/ventral
front
posterior/dorsal
back
superior
top
inferior
bottom
Anterior Movement of the Jaw
- Masseter
- Medial pterygoid
- Lateral pterygoid
Posterior Movement of the Jaw
Temporalis
Oral Stage
Bolus starts to move from tongue through faucial pillars. Tongue lift to hard palate, Tongue peristaltic movement, Hyoid bone to lift and larynx lifts and tilts
Epiglosttis
laryngeal cartilage/ falls down over larynx to prevent food from falling into trachea
Cricopharyngeus>PE Segment> UES
upper part of the esophagus- muscle that allows food to go through to esophagus
Pyriform Sinuses
pockets at the rear lateral edge of the larynx
Larynx
upper portion of trachea, vocal box, contains vocal cords
Pharynx
tube from behind faucial pillars to UES & Larynx (nasopharynx, oropharynx, laryngopharynx)
Pharyngeal Stage
takes less than a second. Bolus travels from top of the pharynx to UES. Lift/tilt of larynx causes UES to stretch open, epiglottis to fall down ontop of larynx and aretynoids to move forward creating a seal over the trachea
Pharyngeal Muscles
superior, medial, inferior constrictors
Esophageal Stage
Eight to twenty seconds, movement of bolus through UES and down into lower sphincter and stomach. Involuntary
Swallowing can be initiated
Pressure, liquid against pharynx, tactil stimulation
Swallowing
respiration stopped, caused by stimulating pre-motor area, neurons needed for pharyngeal/esophageal stages in Brain stem
Swallowing continued
Brainstem-neurons necessary
Cortex- initiation and neuromuscular activity
Pons
when stimulated can activate swallowing and chewing
