Oral Motor Anatomy, Oral Motor Skills, Role of OT in Dysphagia Management Flashcards
Role of OT in dysphagia management
- eating is an essential occupation
- nutrition and social experience, trust
- OTs need to understand occupational performance of self-feeding and mechanics of eating to recognize/understanding feeding problems (dysphagia)
- OTs assess and treat problems with feeding and eating
areas typically addressed by a pediatric occupational therapist
- pre-feeding skills
- bottle/breast feeding
- sucking patterns
- choking hazards
- textures, aversions, sensory
- interest in eating
- feeding tubes to oral
- utensils/self-feeding
- education/training for parents
oral cavity
Contains the food during drinking and chewing and provides for initial mastication before swallowing
oral cavity consists of
Hard palate Soft palate Fat pads of cheeks Upper (maxilla) and lower jaw (mandible) Teeth
boundaries of oral cavity
Anterior – lips (labia)
Posterior – anterior tonsillar pillars and faucial arch
Roof – hard and soft palate
Floor – mucosa overlying sublingual and submandibular glands
Walls buccal mucosa
faucial arches
formed by muscles at the posterior border of the oral cavity. Assists in movement of the soft palate.
nasopharynx
- Extends from the posterior portion of the nose to the soft palate.
- Contains adenoid tissue and the orifices of the Eustachian tubes.
- Can only be inspected by mirrors of optical instruments, no direct inspection.
oropharynx
- The portion that is visible via the mouth.
- Extends from the soft palate superiorly to the vallecula posteriorly.
- Posterior and lateral walls are formed by the superior and middle pharyngeal constrictors.
- Funnels food into the esophagus and allows food and air to share space
- Consists of the base of the tongue, buccinator, orophaynx, tendons, and hyoid bone.
hypopharynx
- The portion of the pharynx that lies inferior to the tip of the epiglottis.
- The posterior and lateral walls are formed by middle and inferior pharyngeal constrictors.
- It extends inferiorly to the cricopharyngeus, where the pharynx empties into the cervical esophagus.
- Anteriorly, it extends from the valleculae.
- Lateral to the larynx are the pyriform sinuses
a space common to both function of eating and breathing
pharynx
pyriform sinuses
2 mucosal pouches on either side of the laryngeal orifice; a common place for food to become trapped
larynx
Valve to the trachea that closes during swallowing. Consists of epiglottis and false and true vocal folds/cords – TVF
epiglottis
leaf-shaped mucosal covered cartilage, projects over larynx during swallow
false vocal cords
mucosal folds superior to the true vocal folds, separated from the true vocal folds by a ventricle
hyoid bone
attachment to epiglottis and strap muscle
thyroid cartilage
anterior attachment of vocal folds
cricoid cartilage
complete ring, articulates with thyroid and arytenoids cartilages
arytenoids
2 cartilages which glide along the posterior cricoid and attach to the posterior end of the vocal folds. Motion of the arytenoids effects abduction and adduction of the larynx. The vocal folds abduct for inspiration and adduct for phonation and cough
trachea
allows air flow into the bronchi and lungs. It is the tube below the larynx, consists of cartilaginous rings.
esophagus
Carries food from the pharynx, through the diaphragm, and into the stomach. It is a thin and muscular tube and at rest it collapses.
At the opening of the esophagus there lies the
cricopharyngeal muscle which is also known as the upper esophageal sphincter, which relaxes to allow passage for food from the pharynx into the esophagus
At the junction of the esophagus and stomach, there is a ringlike valve closing the passage between the two organs called the
lower esophageal sphincter. As the food approaches the closed ring, the surrounding muscles relax and allow the food to pass.
dysphagia
difficulty with any stage of swallowing; dysfunction in any stage or process of eating; includes in the passage of food/liquid/medicine that impairs the client’s ability to swallow independently or safely
eating
the ability to keep and manipulate food or fluid in the mouth and swallow it; eating and swallowing are often used interchangeably
feeding
the process of setting up, arranging, and bringing food or fluid from the plate or cup to the mouth
swallowing
a complicated act where food, fluid, medication, or saliva is moved from the mouth through the pharynx and esophagus into the stomach
penetration
when food or liquid hits the vocal folds during the swallow phase of eating. food or liquid is cleared from the larynx (typically by a cough) and DOES NOT move pass the vocal folds into the lungs
aspiration
when food or liquid passes through the vocal folds, enters the trachea and the lungs
infant mouth anatomy
- Tongue filled oral cavity, tongue contacts all border of the cavity and hard palate is pear shaped
- Fatty cheeks that stabilize the oral cavity/jaw
- The lack of space in the oral cavity is critical for successful nipple feeding.
- Structure in the infant’s throat (pharynx and larynx) are compressed and in close proximity to each other. The epiglottis almost touches the soft palate.
- During swallowing the larynx elevates (hyoid bone) and the epiglottis falls over to protect the trachea.
- Aspiration is unlikely before 4 months of age (when structures elongate in the cervical spine).
adult mouth anatomy
- First transition at 3-4 months of age: Sucking reflex diminishes, cervical spine elongates, oral cavity becomes larger and more open. Fat pads in cheeks diminish. New sucking patterns emerge to enable infant to handle nipple feeding without structural advantages of infancy.
- 12 months: hyoid, epiglottis, and larynx descend, creating space between these structures and the base of the tongue and become more mobile during swallowing
- Increased tongue movement occurs with greater tongue lateralization and jaw movement. Tongue is key in mastication.
suck/swallow/breathe reflex
reflexive sucking until ~3-4 months
gag reflex
develops at 26-27 weeks gestation, persists and is protective in nature
rooting reflex
reflexive until ~3-4 months, stimulation to cheek causes turning of head to stimulus, opening or mouth, and accepting of nipple
transverse tongue reflex
reflexive until ~3-4 months of age. Stimulus to side of tongue elicits lateral movement towards stimulus. Persistent in children with neurological deficits
tonic bite reflex - phasic biting
This primitive normal jaw pattern is characterized by rapid rhythmical up and down movement of the jaw. No lateral movement of the jaw is seen. It may occur following stimulation of cheek, gums, or molars.
trigeminal - CN V
Sensory-cheek, nose, lips, and teeth
Motor- muscles of mastication
facial - CN VII
Sensory- taste receptors on anterior 2/3 of tongue
Motor – facial muscles, muscles for expression and salivary glands
glossopharyngeal - CN IX
Sensory- tastes receptors on posterior 1/3 of tongue
Motor – muscles used in swallowing and salivary glands
vagus - CN X
Sensory- pharynx, larynx, base of tongue, esophagus, visceral organs
spinal accessory - CN XI
Motor – sternocliedomastoid (assists with head turn and chin tuck)
hypoglossal - CN XII
Motor – contraction of the muscles of the tongue
