MIDTERM Flashcards
Oral prep explanations
Saliva is created. Bolus is prepared. Need a labial seal, increased buccal/facial tone, and lateral motion of jaw and tongue.
Cranial nerves involved in oral prep
CN V (trigeminal) VII (facial) XII (hypoglossal)
Oral phase explanation
Anterior to posterior bolus transit
Cranial nerves in oral phase
V (trigeminal) VII (facial) X (vagus) XII (hypoglossal)
Pharyngeal phase explanation
Velopharyngeal closure.
Forward hyoid movement.
Tongue base retraction to contact posterior pharyngeal wall.
Laryngeal elevation.
Closure of larynx (apneic period)
Arytenoids tilt forward. Epiglottic inversion. True vocal folds adduct.
Pharyngeal constriction.
UES relaxes and opens (brainstem sends signal to relax; hyolaryngeal excursion provides traction)
Pharyngeal phase cranial nerves
IX (glossopharyngeal) X (vagus) XI (accessory)
Esophageal phase explanation
Paristalsis (wavelike muscular contractions) moves bolus through esophagus
Esophageal phase cranial nerves
X (vagus)
Where is the main neural control of swallowing located?
Brainstem; specifically the medulla & pons
Cranial nerves of medulla
IX (glossopharyngeal) X (vagus) XI (accessory) XII (hypoglossal)
Cranial nerves of pons
V (trigeminal) VII (facial)
Medical consequences of pharyngeal dysphagia
Aspirational pneumonia
Dehydration/malnutrition
Costly
Social isolation
Rehab options following acute care
Inpatient rehab
SNF
Outpatient
Home health
Long term acute care
Normal changes of swallowing oral prep stage
Decreased lingual movement and strength
Normal changes of swallowing oral stage
Increased mastication time
Normal changes of swallowing pharyngeal stage
Decreased laryngeal excursion
Longer airway closure time
More residue
Slowed pharyngeal transit
Penetration is common
Aspiration occurs more often
Normal changes of swallowing in esophageal stage
Slower time for UES to relax
Esophageal transit may be delayed
What is the difference between penetration and aspiration?
Penetration - food/liquid at the vocal folds or above
Aspiration - food/liquid that falls below the true vocal folds
Changes of healthy aging
Decreased taste, smell, vision
Dentition changes
Voice, respiratory, musculoskeletal, and GI system changes
Sarcopenia (gradual loss of muscle mass, strength, function)
What clinical and instrumental methods do we use to evaluate swallowing?
Clinical swallow eval (bedside)
MBS (modified barium swallow)
FEES (fiberoptic endoscopic evaluation of swallowing)
Purpose of clinical swallow eval
Develop hypothesis of swallowing dysfunction
Determine if instrumental swallowing evaluation is warranted
Determine if patient can follow swallowing strategies
Importance of case history during clinical swallow eval
How current and previous medical conditions can impact function
Patient’s subjective complaints
Obtain info on gross motor/cognition/communication
Role of UES (upper esophageal sphincter)
Opens when larynx closes to protect airway and prevent aspiration
Signal from brainstem allows it to relax/open and further pulled open via traction from hyolaryngeal excursion/elevation
Main muscle of UES
Cricopharyngeus
Why are the normal healthy elderly at risk for swallowing problems?
Overall reduction in reserve anatomical/physiological changes
Poor reserve to tolerate age related changes in addition to illness
Penetration and possibly trace aspiration may be normal
Oral mech cranial nerves lingual movement, strength, coordination
XII hypoglossal - motor
movement - range lateralization elevation
stick out your tongue, move side to side, now quickly, move up and down
push tongue into cheek then other cheek
push tongue on outside of cheek, push against patient tongue
DDK phrase
Oral mech cranial nerves jaw
V trigeminal
jaw opening to resistance, jaw lateralization
Oral mech cranial nerves lips
VII facial V trigeminal
assess labial seal - close your mouth and fill cheeks with air
Oral mech cranial nerves oral cavity
velum/soft palate assessment - X vagus V trigeminal
movement/elevation; open mouth and say ahh (note hypernasality, use tongue depressor)
Oral mech cranial nerves face
VII facial V trigeminal
facial symmetry - smile, pucker
oral mech cranial nerves gag
IX glossopharyngeal X vagus
use tongue depressor to lightly contact posterior tongue or anterior faucial pillars
contraction?
1/3 of normal people do not have gag reflex
oral mech cranial nerves larynx
X vagus
cough strength quality and productivity
voice strength quality and productivity
breath support?
oral mech cranial nerve taste
VII facial IX glossopharyngeal
Viscosities for clinical swallow eval
liquids, puree, solids
ex. water, applesauce/pudding, crackers
use ice chip as appropriate and mixed consistencies
Volumes for clinical swallow eval
small sip, normal drink, large drink, consecutive drink
gradually increase volume
1/2 teaspoon, full teaspoon, small bite, large bite
look at self-feeding & do multiple trials
