Oral Motor Anatomy, Oral Motor Skills, Role of OT in Dysphagia Management

Question 1

Role of OT in dysphagia management

Answer 1

• 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

Question 2

areas typically addressed by a pediatric occupational therapist

Answer 2

• 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

Question 3

oral cavity

Answer 3

Contains the food during drinking and chewing and provides for initial mastication before swallowing

Question 4

oral cavity consists of

Answer 4

Hard palate
Soft palate
Fat pads of cheeks
Upper (maxilla) and lower jaw (mandible)
Teeth

Question 5

boundaries of oral cavity

Answer 5

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

Question 6

faucial arches

Answer 6

formed by muscles at the posterior border of the oral cavity. Assists in movement of the soft palate.

Question 7

nasopharynx

Answer 7

• 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.

Question 8

oropharynx

Answer 8

• 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.

Question 9

hypopharynx

Answer 9

• 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

Question 10

a space common to both function of eating and breathing

Answer 10

pharynx

Question 11

pyriform sinuses

Answer 11

2 mucosal pouches on either side of the laryngeal orifice; a common place for food to become trapped

Question 12

larynx

Answer 12

Valve to the trachea that closes during swallowing. Consists of epiglottis and false and true vocal folds/cords – TVF

Question 13

epiglottis

Answer 13

leaf-shaped mucosal covered cartilage, projects over larynx during swallow

Question 14

false vocal cords

Answer 14

mucosal folds superior to the true vocal folds, separated from the true vocal folds by a ventricle

Question 15

hyoid bone

Answer 15

attachment to epiglottis and strap muscle

Question 16

thyroid cartilage

Answer 16

anterior attachment of vocal folds

Question 17

cricoid cartilage

Answer 17

complete ring, articulates with thyroid and arytenoids cartilages

Question 18

arytenoids

Answer 18

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

Question 19

trachea

Answer 19

allows air flow into the bronchi and lungs. It is the tube below the larynx, consists of cartilaginous rings.

Question 20

esophagus

Answer 20

Carries food from the pharynx, through the diaphragm, and into the stomach. It is a thin and muscular tube and at rest it collapses.

Question 21

At the opening of the esophagus there lies the

Answer 21

cricopharyngeal muscle which is also known as the upper esophageal sphincter, which relaxes to allow passage for food from the pharynx into the esophagus

Question 22

At the junction of the esophagus and stomach, there is a ringlike valve closing the passage between the two organs called the

Answer 22

lower esophageal sphincter. As the food approaches the closed ring, the surrounding muscles relax and allow the food to pass.

Question 23

dysphagia

Answer 23

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

Question 24

eating

Answer 24

the ability to keep and manipulate food or fluid in the mouth and swallow it; eating and swallowing are often used interchangeably

Question 25

feeding

Answer 25

the process of setting up, arranging, and bringing food or fluid from the plate or cup to the mouth

Question 26

swallowing

Answer 26

a complicated act where food, fluid, medication, or saliva is moved from the mouth through the pharynx and esophagus into the stomach

Question 27

penetration

Answer 27

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

Question 28

aspiration

Answer 28

when food or liquid passes through the vocal folds, enters the trachea and the lungs

Question 29

infant mouth anatomy

Answer 29

• 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).

Question 30

adult mouth anatomy

Answer 30

• 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.

Question 31

suck/swallow/breathe reflex

Answer 31

reflexive sucking until ~3-4 months

Question 32

gag reflex

Answer 32

develops at 26-27 weeks gestation, persists and is protective in nature

Question 33

rooting reflex

Answer 33

reflexive until ~3-4 months, stimulation to cheek causes turning of head to stimulus, opening or mouth, and accepting of nipple

Question 34

transverse tongue reflex

Answer 34

reflexive until ~3-4 months of age. Stimulus to side of tongue elicits lateral movement towards stimulus. Persistent in children with neurological deficits

Question 35

tonic bite reflex - phasic biting

Answer 35

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.

Question 36

trigeminal - CN V

Answer 36

Sensory-cheek, nose, lips, and teeth

Motor- muscles of mastication

Question 37

facial - CN VII

Answer 37

Sensory- taste receptors on anterior 2/3 of tongue

Motor – facial muscles, muscles for expression and salivary glands

Question 38

glossopharyngeal - CN IX

Answer 38

Sensory- tastes receptors on posterior 1/3 of tongue

Motor – muscles used in swallowing and salivary glands

Question 39

vagus - CN X

Answer 39

Sensory- pharynx, larynx, base of tongue, esophagus, visceral organs

Question 40

spinal accessory - CN XI

Answer 40

Motor – sternocliedomastoid (assists with head turn and chin tuck)

Question 41

hypoglossal - CN XII

Answer 41

Motor – contraction of the muscles of the tongue