LectureReading Flashcards
According to the lecture, what are the three different kinds of dysphagia?
- oropharyngeal, 2. pharyngeal, 3. esophageal
What is the difference between a swallowing disorder, a feeding disorder, and an eating disorder?
swallowing disorder: impairment in any of the structures that allow for swallowing, from the oral cavity through the esophagus; feeding disorder: an impairment in the process of food transport outside of the alimentary system; eating disorder: mental health disorder that does not, necessarily, involve impaired anatomy
Name some populations were dysphagia is common
stroke patients; patients with head and neck cancer; patients with neurodegenerative disorders (Parkinson’s, ALS, Myasthenia Gravis, etc.); prematurely born infants
(not a comprehensive list)
Name some individuals that can be a part of the collaborative team to treat patients with dysphagia
respiratory specialist (trach and vent management), OT (for feeding issues in the oral prep phase), dentist, radiologist (MBS, chest xrays, CT scans), neurologist, nurse, SLP (usually the team lead), otolaryngologist (head and neck cancer, trach tubes), dietician
Why would a patient receive subacute care?
step down from acute; these patients are usually not ready for rehabilitation services; for example, someone on a ventilator that needs some level of acute care and is not ready to be released
What kind of care is a person in rehab receiving?
this is in-patient care, but comes after dismissal from the hospital
What are the 4 stages of swallowing? In adults, which are volitional and which are automatic?
1) Oral preparatory- volitional
2) Oral- volitional
3) Pharyngeal- automatic
4) Esophageal- automatic
In babies, which of the swallowing phases are volitional and which are automatic?
they are all automatic
What is the oral preparatory phase of swallowing?
taking material into mouth, preparing for swallow
What is the oral phase of swallowing?
when the tongue starts to work the bolus by elevating it and rolling it posteriorly
What is the type of motion with which the tongue moves the bolus?
peristaltic
How long does it take the oral phase to occur?
0.7-1.2 seconds
What are the MBS IMP components in the oral phase?
- Lip closure
- Tongue control during bolus hold
- Bolus prep and mastication
- Bolus transport and lingual motion
- Oral Residue
- Initiation of the pharyngeal swallow
When does the pharyngeal phase begin?
after the bolus passes the facial pillars
How long does the pharyngeal phase last?
0.6 seconds
What are the MBS IMP components of the pharyngeal phase?
- Soft palate elevation
- Laryngeal elevation
- Anterior hyoid excursion
- Epiglottic movement
- Laryngeal vestibular closure
- Pharyngeal stripping wave
- Pharyngeal contraction
- PES opening
- Tongue base retraction
- Pharyngeal residue
What is the esophageal phase?
the phase that begins when the bolus passes the cricopharyngeus
How long does the esophageal phase last?
6-10 seconds
The cricopharyngeus is part of which pharyngeal constrictor muscle?
the inferior pharyngeal constrictor
Which cranial nerve provides general sensory to the anterior 2/3 of the tongue?
CN V (trigeminal)
Which muscle is in charge of vocal fold abduction?
posterior cricoarytenoid muscle
Which muscle is credited with initiating hyolaryngeal movement?
geniohyoid muscle
Which CN is responsible for the pharyngeal stripping wave?
pharyngeal plexus
A patient demonstrating oral escape of liquids most likely has a damage to which CN?
CN VII (facial)
A patient experiencing difficulty retracting and elevating their tongue, might have an impairment in which muscle?
styloglossus
A patient struggling to manipulate a bolus might have an impairment to which CN?
CN XII (hypoglossal)
Which nerve is responsible for VF approximation during a swallow?
recurrent laryngeal nerve
Name some anatomical differences between infant and adult patients
oral cavity, jaw, stomach, and esophagus are smaller; tongue is relatively larger; the uvula and the epiglottis are in contact already because the epiglottis is higher in infants and starts to descend by the time they are 2 years old
How can infants compensate for having a larger tongue to oral cavity size ratio than their adult counterparts?
they can breathe through their noses while they eat
What is the best suck : swallow : breath ratio for infants?
1:1:1
What is the rooting instinct in infants?
when infants experience tactile stimulation to the side of their face or near their mouth, they instinctively turn their head towards it and open their mouth
What is the difference between nutritive and nonnutritive suckling?
nutritive suckling is for feeding and nonnutritive suckling is for soothing
How long is a normal human gestation period?
40 weeks
What is a tongue tie and how does it interfere with infant feeding?
a restricted frenulum can cause latching challenges
What is a feeding side effect of a cleft lip/palate?
an inability to create a good seal and suck
How do neurological conditions like CP or DS affect infant feeding?
can result in low muscle tone
How do cardiac problems impact infant feeding?
reduced endurance
What is the phenomenon of normal age-related changes in the aerodigestive tract called?
presbyphagia
How does frailty put an older adult at risk for dysphagia?
change in muscle strength, cognitive decline, etc.
What is it called when an older adult has reduced lean skeletal muscles mass with a marked loss of strength and speed of movement?
sarcopenia
What are some age-related physical changes in the oral phase?
dental changes; more fat and atrophy in lingual muscles; decline in perception of spatial tactile recognition in the lips and tongue, and of viscosity in the oral cavity; decline in taste perception; longer oral transit time; increase in oral residue (might be functional, still)
What are some age-related changes in the pharyngeal phase?
reduced amplitude of hyoid elevation and excursion, increased pharyngeal transit duration, less powerful pharyngeal constriction, delay in swallow onset, atrophied thyroarytenoid muscles
What are some age-related changes that affect the esophageal phase?
weaker UES closure, lower amplitudes of peristaltic movement, esophageal dysmobility
What percentage of individuals over 65 experience presbyphagia?
40%
What are some clinical issues that can arise from dysphagia?
malnutrition, dehydration, morbidity, mortality, hospitalization, respiratory complications, social isolation
Where does the swallow trigger?
research says that about 80% of swallows do not trigger until after the head of the bolus pass the ramus of the mandible; many swallows trigger after the head of the bolus is at the level of the valleculae or pyriform sinuses
