Swallowing Flashcards
swallowing phases
- anticipatory phase
- oral prep phase
- oral phase
- pharyngeal phase
- esophageal phase
anticipatory phase
- food is checked (smell, look, temperature, consistency)
- saliva production
- adapts to optimize feeding and swallowing
oral prep phase
purpose
- optimal bolus positioning
- mastication
duration
- depends on food volume, consistency, and individual’s reaction
requirements
- saliva, clear nasal airway, dentition, cognition
- coordinate lip closure, buccal tone, jaw elevation/depression and rotary/lateral movement, tongue rotary and lateral movement, anterior bulging of soft palate
oral phase
purpose
- clear bolus from oral cavity
- stimulate initiation of the pharyngeal swallow
duration
- 0.3 - 1.0 seconds
requirement
- tongue movement
- velopharyngeal closure
pharyngeal phase
purpose
- transport bolus through pharynx
- nasal and laryngeal airway protection
duration
- 0.5 - 1.5 seconds
requirement
- coordinate velopharyngeal closure, epiglottic tilting, hyolaryngeal excursion, laryngeal closure, pharyngeal peristalsis, relax and open UOS, return to resting position
esophageal phase
purpose
- transport bolus to stomach
duration
- depends on age, bolus volume and consistency
requirements
- active peristalsis
saliva major functions (8)
- protect teeth and gums
- protect oral hygiene
- lubricate food for swallow
- lubricate tongue and lips for speech
- taste
- destroy micro-organisms
- assist in carbohydrate digestion
- regulate acidity in esophagus
saliva production
- salivary glands
- parotid gland
- minor salivary gland
salivary glands
- submandibular
- sublingual
salivary glands innervation
CN 7 (facial nerve)
parotid gland innervation
CN 9 (glossopharyngeal nerve)
minor salivary gland innervation
CN 7 and 9
saliva production percentages
- submandibular (70%, serous and mucoid)
- parotid (25%, serous)
- sublingual (5%, serous and mucoid)
tipper swallow
begins with the tongue tip pressed against the upper incisors and alveolar ridge
dipper swallow
bolus is beneath anterior tongue at onset, tongue scoops the bolus to the supralingual position
airway protection during swallow
- epiglottal descent or inversion
- laryngeal ascent
- vertical approximation of the arytenoids to the base of epiglottis
- adduction of the vocal cords
swallow apnea definition and duration
- respiration ceases during the swallow
- 0.5 - 3.5 seconds
common respiratory patterns
- exhale/swallow, apnea/exhale
- inhale/swallow, apnea/exhale
age-related swallow changes
- presbyphagia
- increased disease prevalence
presbyphagia
- disruption to swallow function without an underlying disease
- minimal to no effect on oral intake, health, and life quality but reduced swallow function reserve
- can progress to dysphagia
acquired factors that affect age-related changes in swallow
- medication use, polypharmacy (impact salivary status, cognitive function, GI tract, and neurological function)
- structural changes (bone density, muscle bulk, dentition, cervical spine)
- decreased appetite
- frailty
- accessory conditions (dementia, stroke)
frailty
- a state of increased vulnerability to poor resolution of homeostasis after a stressor event (infection) which increases the risk of adverse outcomes (fall, delirium, disability)
sarcopenia
progressive loss of skeletal muscle mass, strength, power
phase changes (age-related change in swallowing)
oral prep phase
- decreased tase, smell, oral sensation
- loss of dentition, hyposalivation, and xerostomia
oral phase
- decreased tongue and masticatory muscle strength
- straw drinking and sequential drinking
pharyngeal phase
- initiation of swallow slower with age
- reduced anterior hyoid excursion, pharyngeal stripping, UOS opening, tongue base retraction, hyolaryngeal excursion, and atrophy of pharyngeal musculature leading to reduced pharyngeal pressure
- pharynx volume increases with age
- increased residue in vallecular and pyriform sinuses
- difficulty swallowing large boluses
- longer swallow apnea
esophageal phase
- longer esophageal transit time
- decreased esophageal peristalsis and distal esophageal motility
- intraesophageal stasis and reflux
- esophagitis