SM_25b: Swallowing Flashcards
___, ___, ___, ___, and ___ nerves are involved in swallowing
Trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and hypoglossal (XII) nerves are involved in swallowing
- All are motor
- Trigeminal, facial, glossopharyngeal, and vagus are sensory
Medulla oblongata is the ___, while the central pattern generator is ___
Medulla oblongata is the swallowing center, while the central pattern generator is a series of neurons that control the patterned swallow response
Afferent pathway of swallowing involves the ___ via ___ and ___ primarily
Afferent pathway of swallowing involves the nucleus tractus solitarius via glossopharyngeal (CN IX) and vagus (X) nerves primarily
Efferent pathway of swallowing involves the ____ via ____, ____, and ____ primarily
Efferent pathway of swallowing involves the nucleus ambiguus via glossopharyngeal (IX), vagus (X), and hypoglossal (XII) nerves primarily
Difficulty eliciting a swallow (unable to initiate patterned motor response for swallowing) indicates damage to the ____
Difficulty eliciting a swallow (unable to initiate patterned motor response for swallowing) indicates damage to the nucleus ambiguus
Swallowing has elements of a ____ and ____
Swallowing has elements of a reflex and patterned response
- Patterned response: motor activity, exhibiting elements of reflexive subconscious programming and repetition but in which the programming can be overridden voluntarily
- Once the bolus reaches a critical point, a swallow will occur
- There are aspects of the swallow continuum under voluntary control
A normal swallow is a ____ driven event and requires muscles of the ____, ____, ____, and ____
A normal swallow is a positive-pressure driven event and involves muscles of the oral cavity, pharynx, larynx, and esophagus
- Innervated by CN V, VII, IX, X, and XII
Three phases of swallowing are ____, ____, and ____
Three phases of swallowing are oral, pharyngeal, and esophageal
Describe the oral phase of swallowing
Oral phase of swallowing
- Bolus placed into oral cavity
- Tongue contacts hard palate to prevent loss of bolus anteriorly
- Soft palate contracts posterior tongue to prevent loss of bolus posteriorly
- Bolus transport begins when the bolus is prepared
Describe the pharyngeal phase of swallowing
Pharyngeal phase of swallowing
- Initiation of the reflexive swallow response
- Pharynx shortens
- True and false vocal folds contract
- Upper esophageal sphincter opens
Describe the esophageal phase of swallowing
Esophageal phase of swallowing
- Esophageal peristalsis transports food bolus to the stomach
- Not under voluntary control, unlike portions of oral and pharyngeal phases
____ phase of swallowing is NOT under voluntary control
Esophageal phase of swallowing is NOT under voluntary control
In actuality, events during oral and pharyngeal components of swallowing ____
In actuality, events during oral and pharyngeal components of swallowing overlap
Tubes and valves function in swallowing to ____ and ____
Tubes and valves function in swallowing to keep bolus moving downwards through applied pressure and maintain bolus control at certain points of the swallow process
Describe airway protection during swallowing
Airway protection during swallowing
- Hyolaryngeal complex moves forward and upward
- Epiglottis inverts
- Bolus moves around laryngeal vestibule along aryepiglottic folds
- Tongue base retraction
- Vocal folds close (false and true)
Initiation of reflexive swallowing response occurs during the ____ phase
Initiation of reflexive swallowing response occurs during the pharyngeal phase
Dysphagia is ___ that commonly presents as ___, ___, and ___
Dysphagia is trouble swallowing that commonly presents as coughing when eating / drinking, wet / gurgly sounding voice during or after eating / drinking, or throat clear during or after eating or drinking
Describe the general impact of dysphagia
General impact of dysphagia
- Aspiration: occurs when ingested material falls below the level of true vocal folds (silent aspiration: patient does not respond to aspiration event)
- Dehydration: insufficient water in body
- Malnutrition: insufficient nutrients in the body
- Weight loss
- Aspiration pneumonia
Penetration is ingested material ____ level of ____
Penetration is ingested material above the level of true vocal folds
Aspiration is ingested material ____ level of ____
Aspiration is ingested material below the level of true vocal folds
Aging, neurological disease, COPD, head and neck cancer, and presence of artificial airways can lead to ____
Aging, neurological disease, COPD, head and neck cancer, and presence of artificial airways can lead to respiratory-swallow incoordination
____ commonly coincides with oropharyngeal dysphagia
Cricopharyngeal bar commonly coincides with oropharyngeal dysphagia
Dysphagia can be evaluated with ____ or ____
Dysphagia can be evaluated with modified barium swallow study or fiberoptic endoscopic evaluation of swallowing
Modified barium swallow study is an ____ that ____
Modified barium swallow study is an evaluation of oropharyngeal and esophageal swallowing physiology in lateral and AP views that goes beyond aspiration/penetration
Fiberoptic endoscopic evaluation of swallowing allows the provider to ____ and ____
Fiberoptic endoscopic evaluation of swallowing allows provider to objectively identify / diagnose dysphagia and aspiration and formulate treatment plans for rehabilitation at the bedside
Dysphagia management involves ____, ____, ____, and ____
Dysphagia management involves targeted exercised based on specific swallowing impairments, postural changes / positioning techniques, strategies to maximize safety or efficiency, and diet modification
