Midterm Flashcards
Mandible function
provides lateral and rotary movement for chewing
Function of the cheek
keeps food on the tongue and the tension keeps the bolus together
Function of the gums
cheeks push up against the gums to keep the food on the tongue
Function of the lips
includes pressure during closure to remove food from the utensil; maintain closure to keep food in mouth when chewing
Function of the teeth
masticates food
Function of the tongue
forms food into a bolus, propels bolus backwards, and assists in triggering the pharyngeal swallow reflex
Hard palate
bony part of the roof of the mouth
Soft palate function
lifts up to close the nasal cavity
Faucial Arches function
triggers the swallow when bolus passes them
Uvula
structure that hands from the soft palate
Vallaculae
spaces located between the base of the tongue and epiglottis where food may collect
Function of the epiglottis
covers the opening of the airway during the swallow
Pyriform sinuses
base of pharynx, food can collect here
Function of the larynx
protects airway and houses the vocal folds
Laryngeal Vestibule
area in the larynx above the true vocal folds
Trachea
airway/windpipe
Oral Prep stage
involves formation of food/liquid into a cohesive bolus
Oral stage
involves the transport of the bolus from the front to the back of the oral cavity to the point of entry int other pharynx and intimating the swallow response
Oropharyngeal stage
overlap between oral and pharyngeal stages
Pharyngeal stage
involves the movement of the bolus through the pharynx into the esophagus; includes the swallow reflex: squeezing motion of the pharyngeal constrictors, airway protection, and the relaxation of the esophagus to permit entry of the bolus
Esophageal stage
food moves into the esophagus
Does aspiration risk increase if the patient is being fed by someone else?
Yes
Which way does the larynx move
Up and forward
Aspiration
entry of material into the airway below the level of the vocal folds
Penetration
material at the level of the vocal folds
Cough definition
brainstem reflex protecting the entrance of the airway from foreign material
Deglutition
acts associated with bolus transfer and transport of food from the mouth to the stomach
pharyngeal pocketing
food lodging/remaining in the pharynx after the swallow reflex is completed
swallow response
a one second coordinated action that momentarily stops respiration; closes off airway and permits opening of the esophagus for the entry of the bolus
Importance of oral health
good oral hygiene prevents bacteria, saliva is very important in this, reduces risk of aspiration pneumonia
Oral health risks
dysphagia, dependency on others for oral care, number of decayed teeth, and tube feeding
Continuum of care
- Referral/screening
- Bedside Assessment
- Instrumental assessment
- Identify and implement elements of treatment both habilitative/rehabilitative techniques and compensatory strategies
- Monitor progress via periodic reassessment
- Train others in safe oral intake procedures
- Discharge from active treatment
8.Continue to monitor progress and safety in PO intake
silent aspiration vs overt aspiration
silent- no signs or symptoms of aspiration
overt- obvious signs of aspiration
mylohyoid function
elevates hyoid and floor of mouth
geniohyoid function
elevates hyoid and larynx and depresses mandible
digastric function
elevates hyoid and larynx; depresses the mandible
Palataglossus function
elevates posterior tongue
Palatopharyngeus function
constricts oropharynx to channel bolus
Stylopharyngeus muscle
raises larynx
Typical outcomes of lesions in the lower brainstem
significant oropharyngeal impairments
1st week post stroke: absent pharyngeal swallow
2nd week post stroke: delay of 10-15 seconds, reduced laryngeal elevation and anterior movement with reduced cricopharyngeal opening
3rd week post stroke: sufficient recovery for functional swallow and full oral intake with modified diet
Typical outcomes of subcortical stroke
-mild delays in oral transit time (3-5 seconds)
-mild delays in initiating swallow response
-mild to moderate impairments in timing neuromuscular control in the pharynx
-recovery to full oral intake may take 3-6 weeks
Typical outcomes of cortical stroke: Left hemisphere
-may result in apraxia of the swallow
-mild oral transit delays
-mild delays in initiating the pharyngeal swallow
Typical outcomes of cortical stroke: Right hemisphere
-mild oral transit delays (2-3 seconds)
-pharyngeal delays
-once swallow is initiated, slight delay in laryngeal elevation
-slower recovery than left CVA
TBI outcomes
-poor bolus control
-abnormal reflexes
-reduced laryngeal elevation
Other considerations of TBI
-impulsivity
-cognitive difficulties
-reduced sensation
Agnosia
don’t recognize food as food
Apraxia
feeding- difficulty using utensils
swallowing-holding food in mouth, unable to initiate the swallow response
Other factors of Alzheimer’s that impact feeding
-reduced laryngeal elevation
-decreased lateral tongue motion for chewing
-reduced tongue base retraction
Corticospinal tract ALS impact on swallowing
-slow to develop swallowing problems
-reduced pharyngeal wall contraction
Corticobulbar tract ALS impact on swallowing
-decreased tongue mobility
-reduced velar function
-respiratory compromise
Parkinson’s impact on swallow
-slight delay initiating swallowing response
-decreased tongue base retraction
-reduced laryngeal closure
Nerves involved with MS
-hypoglossal XII- reduced lingual control of bolus, reduced control of chewing and oral transport
-vagus X- reduced tongue based movement, reduced pharyngeal wall movement
-glossopharyngeal IX- reduced triggering of pharyngeal swallow
Myotonic dystrophy
prolonged contraction and difficulty relaxing involved muscles, reduced pharyngeal wall contraction
COPD effects on swallow
-airflow limitations
-more GERD
Oral swallowing concerns
-apraxia of swallow
-trismus- reduced mouth opening
-reduced lip strength
-poor dental status
Pharyngeal swallowing concerns
-reduced velopharyngeal strength
-reduced tongue based retraction
-reduced vocal fold closure
Esophageal swallowing concerns
-TEF
-aclasia- lower esophageal sphincter fails to relax
-GERD
