Lesson 2-Anatomy & Physiology

Question 1

Sequence of Normal Swallowing

Answer 1

Bolus enters the oral cavity and mixes with saliva
Possible mastication
Tongue tip elevates, articulating with the alveolar ridge to occlude anterior oral cavity
Bolus is compressed against the hard palate
Anterior portion of the tongue is retracted and depressed
Respiration ceases
Bolus forced into the upper part of the pharynx
Palatopharyngeal folds are pulled medially to form a slit as food passes through
Soft palate elevates closing nasopharynx
Tongue moves posteriorly to drive the bolus into the pharynx
Larynx is pulled up and forward
Epiglottis depresses and protects the airway
Food directed to either side of the epiglottis
Vocal cords close
UES relaxes and bolus passes through to the esophagus

Question 2

You cannot ________ and swallow at the same time.

Answer 2

breathe

Question 3

MBSImP

Answer 3

training/ certification available through Dr. Bonnie Martin Harris.
17 component swallowing
standardized scale

Question 4

Lip Closure-1

Answer 4

Important for oral containment of the bolus

Loss of the bolus anteriorly

Question 5

Tongue Control During Bolus Hold -2

Answer 5

Integrity of the patient’s ability to seal the tongue to the hard and soft palate.
“Hold the bolus until I tell you to swallow”
Not a natural task during eating/drinking
Significant prognostic and diagnostic information

Question 6

Bolus Prep/Mastication -3

Answer 6

Solid consistencies only
Thorough mastication of the bolus
Collection of pieces of the bolus from the oral cavity into a cohesive bolus prior to the swallow
No swallowing of un-chewed pieces
No continued chewing after the swallow

Question 7

Bolus Transport/Lingual Motion- 4

Answer 7

Smooth transport of the bolus anterior to posterior in the oral cavity

Question 8

Oral Residue -5

Answer 8

Following a swallow of any type of bolus there should be no residue in the oral cavity.

Question 9

Initiation of the Pharyngeal Swallow - 6

Answer 9

Bolus head (leading edge) should be at the posterior angle of the ramus at the time of superior-anterior hyoid trajectory

Question 10

Soft Palate Elevation - 7

Answer 10

Contact between the soft palate and the posterior pharyngeal wall, nasopharyngeal closure.

Question 11

Laryngeal Elevation - 8

Answer 11

Epiglottis inverts
Airway protection
Opening of the PE/UES

Question 12

Anterior Hyoid Excursion - 9

Answer 12

The hyoid bone moving anteriorly and superiorly pulls the larynx upward.
Essential for airway protection

Question 13

Epiglottic Movement -10

Answer 13

Complete inversion is essential for airway protection and guiding of the bolus to the PE/UES

Question 14

Laryngeal Vestibular Closure - 11

Answer 14

Protects the airway from aspiration
VFs adducted at the height of the swallow
No part of the bolus should enter the laryngeal vestibule

Question 15

Pharyngeal Stripping Wave - 12

Answer 15

Essential for moving the bolus through the pharynx
There should be no residue/stasis in the pharynx following the swallow.
Degree of pharyngeal stripping wave movement is dependent on bolus viscosity and swallow effort.

Question 16

Pharyngeal Contraction - 13

Answer 16

A-P view
Complete contraction is symmetrical shortening and contraction of the pharynx depicted by lateral walls that are straight and strip the bolus tail bilaterally.

Question 17

PE/UES Segment Opening - 14

Answer 17

Dependent on laryngeal elevation

Allows passage of the bolus into the esophagus

Question 18

Tongue Base Retraction - 15

Answer 18

Complete retraction results in a merging of the base of tongue with the posterior pharyngeal wall.

Question 19

Tongue Base Retraction - 15

Answer 19

Complete retraction results in a merging of the base of tongue with the posterior pharyngeal wall.

Question 20

Pharyngeal Residue – 16Esophageal Clearance - 17

Answer 20

Following the swallow the pharynx should be free of residue or stasis.
Following the bolus through to the stomach allows for understanding of how the esophageal stage may influence the oral/pharyngeal stage as well as management.

Question 21

Cranial Nerves, Muscles, and Function

Answer 21

Trigeminal, Facial, Vagus, Hypoglossal, Accessory, Glossopharyngeal

Question 22

Motor and Sensory must be functional for a safe swallow

Answer 22

motor sensory

Question 23

Trigeminal - Sensory

Answer 23

Receptive Field

1. Superior alveolus, hard and soft palate
2. Anterior 2/3 of the tongue

Swallowing Function
-Tactile sensation, bolus manipulation, preparation, containment and oral containment