Speech, Language and Oral Motor Development Flashcards
What are the muscles of respiration?
Diaphragm
Intercostals
Abdominals
Accessory Muscles
What type of shape does the rib cage resemble during infancy?
Triangle!
Only occupies the upper 3rd of the thoracic cavity
What force/activities all the rib cage too descend?
Gravity!
More upright postures allow the intercostal spaces to expand and the rib cage becomes more rectangle in shape
What is the diaphragms origins and insertions?
Origin: Upper 2 3 lumbar vertebrae, Inner surface of the xiphoid process (sternum), Inner surfaces of the lower 6 ribs and costal
cartilages
Insertion: Central tendon
What does the diaphragm do during inspiration?
Descends/flattens during inspiration
Assist moving contents from the stomach into the bowels (motility via lower esophageal sphincter)
Also to provides the pressure right at that juncture so that food and liquid may not come up into the esophagus
How does a bell shaped rib cage impact the diaphragm?
Much more flattened diaphragm. In that way, it may not be as effective in approximating the lower esophageal sphincter and also in helping to move food and liquids through the stomach into the bowels
What makes up the oral cavity?
Lips
Jaw
Palate
Tongue
Cheeks
What is oral phase of the “anatomy of the swallow” and what anatomy is involved?
The lips, the tongue, and the jaw are all involved in the oral phase of the anatomy of the swallow
They collect the bolus or the food or liquid that is in the mouth, they process it, they help chew, the cheeks keep tension, and the lips close, and you are able to then gather the bolus into one lump where you can transport it back and initiate a swallow
What is pharyngeal phase of the “anatomy of the swallow”?
The initiation of the swallow, where the food and the liquid go into the nasal pharynx and the pharyngeal cavity
That pharyngeal phase is not volitional instead it is all inertia based on the tongue pushing the bolus down into the pharyngeal area and then pressures that are present there between the swallow and the initial opening of the upper esophageal sphincter
What can go wrong during the pharyngeal phase?
Food may go up to the nose through the nasal pharynx if there is an inadequate palatal rise of the soft palate to close off that part of the anatomy or the bolus may also flow into the airway from there if the individual swallowing doesn’t have adequate propulsion or good collection of the bolus or coordinated swallowing
What is the airway protection phase of the “anatomy of the swallow” and what anatomy is involved?
The larynx is involved in airway protection as is the epiglottis
The airway is adjacent to the esophagus therefore, the airway is right in front of the esophagus
The epiglottis tips over the esophagus over the larynx in order to protect the airway
What is the esophageal phase of the “anatomy of the swallow” and what anatomy is involved?
Once you get through the pharynx, there is a constriction of the muscles that help move the bolus through the esophagus past the lower esophageal sphincter and into the stomach
This is called peristalsis - it’s a wave that moves from the top to the bottom
How can peristalsis go wrong?
When the esophagus gets overstretched, the airway closes, peristalsis stops, and you have a moment of apnea
Also a cause of reflux
What is the last phase of the “anatomy of the swallow” and what anatomy is involved?
GI
includes the stomach and the bowels
What are the four parts of the “anatomy of vocalization”?
Larynx
Voice production
Resonance
Pronunciation
What anatomy is included in the larynx phase of the “anatomy of vocalization”?
3 Single cartilages:
Cricoid (base of larynx and forms a ring)
Thyroid (largest and forms Adam’s apple)
Epiglottis (folds down over the laryngeal opening during swallowing to protect it from penetration)
3 Paired cartilages:
Arytenoids (allow the vocal folds to close and open)
Corniculate & Cuneiform (provide structural support to the mucous membranes of the larynx and assist with airway protection)
Vocal folds: Open/close/alter tension
How does a child’s anatomy impact their ability to swallow?
The tongue is much larger and takes up a larger part of the oral cavity further, the structures are much more close together
As we age the structures spread out more and the need for control increases
What does the glottis do?
helps close the airway down to create increased pressure in the lungs that provides stiffness and stability to the rib cage
When the glottis closes and allows you to build up that pressure, it allows you to build up enough pressure for when it opens a forceful exhalation of air, which is essential to a cough
What are the typical developments in utero?
Finger Buds/Hands to Mouth 12-14 weeks gestation (self soothing and increases innervation at mouth)
Pharyngeal swallow comes in at 10-14 weeks gestation (non volitional part)
Suckling at 18-24 weeks gestation
Tongue Cupping 28 weeks gestation
Ability to orally feed adequately for growth 34-37 weeks gestation (requirement for feed tube is born before)
What are some normal respiration & vocalization presentations at birth?
Ribcage shape is rounded
Triangular and elevated
Ribs are horizontaland close together
Diaphragm pulls on ribcage - retraction and paradoxical, abdominal breathing pattern
Obligatory nose breather - Normal RR=30-60 BPM with decreased tidal volume
Crying open vowel, short
Vocalizations are tied to mvmt and nasal in quality
Vegetative sounds clicks/friction
What are some normal oral motor & feeding presentations at birth?
Strong rooting response (looking for food)
Phasic Bite response (“munching pattern”)
Gag present
Suck/Suckle pattern
Cheek fat pads = stability
Tongue fills oral cavity
No tongue-jaw dissociation
Tongue Cupping
2-6 ounces every 3-4 hours
Spillage common but drooling is minimal
