Swallowing Disorders Flashcards
1
Q
Anatomy Overview
A
- Oral Cavity: all structures have sensory receptors that are important in stimulating a swallowing response (not a reflex)
- Location of the larynx in an adult compared to an infant – how high the larynx raises during a swallow
- *Valleculae is a space not a structure *
- Cricopharyngeus (UES – upper esophageal sphincter) – very top of the esophagus, has to open or close for food to go down the esophagus
2
Q
Swallowing Phases
A
- Oral Preparatory (not a have-to phase)
- Oral
- Pharyngeal
- Esophageal
3
Q
Oral Preparatory Phase (early)
A
- Foodstuff (bolus) – likely masticated (vary patterns)
- we don’t normally prepare liquid bolus – so this phase gets skip
- Liquid or pureed – may be manipulated in mouth
- Labial seal maintained
- Mastication
4
Q
Mastication
A
- Tongue moves food into position
- Adult: rotary mastication
- Food falls medially and is moved laterally (falls in the middle of the tongue, then it’s moved back to the teeth)
- Buccal tension keeps food falling medially (instead of the sulcus)
- Food pulled into a bolus (may be piecemeal – we don’t chew food all at once)
5
Q
Oral Phase
A
- Begins when the food bolus moves posteriorly (toward the valleculae and epiglottis) – you have to have an oral phase
- Elevated and grooved tongue with bolus (cradles the food bolus in the tongue “bowl” – tongue is elevated on the sides and front covered by the top of the mouth to carry bolus back)
- Buccal tension: negative pressure (lingual movement: higher air pressure in the front, lower in the back – sucking the food backward)
- Phase timing: approx. 1 second
- Sensory Receptors
6
Q
Sensory Receptors
A
- Swallowing center in the brainstem (high activity is not necessary for swallowing)
- When enough receptor responses are sent to the brainstem, a swallow is initiated (Delayed Swallow – delay in receptors to initiate)
- Mechanoreceptors
- Senses presence of food bolus (tactile)
- Proprioceptor in the muscles themselves (back of tongue)
- Chemoreceptors (Sensitive to the change in the chemical
- Thermoreceptors (Sensitive to changes in temperature – sends message to swallow center to initiate a swallow – swallow patients are more sensitive to cold/sour foods)
- Mechanoreceptors
7
Q
Pharyngeal Phase (simultaneous action)
A
- When you have a swallow response is the beginning of this phase
- Elevation and retraction of velum and closure of VP port
- Elevation (hyolaryngeal/excursion: 1. Protection from bolus – pulls larynx up and forward, 2. Epiglottal movement – epiglottis connected, 3. UES opening – muscles have a certain amount of tone at all times, opens by neurological transmission from brainstem causing it to relax, opens by excursion due to a pull) to hyoid bone and closure of pharynx/larynx
- Tongue base retraction and initiation of pharyngeal peristalsis
- Pharyngeal phase timing: approx.. 1 sec
When the head of the bolus entering the esophagus is the end of the pharyngeal phase
8
Q
Lines of Defense within the Oral Cavity
A
- Epiglottis/aryepiglottic folds
- False vocal folds
- True vocal folds
9
Q
Tongue base retraction
A
hard push against the back wall of the pharynx to push food through – primary method)
10
Q
Peristalsis
A
constrict in a sequence/ “wave”; can have unilateral damage in the tube
11
Q
Esophageal Phase
A
- When the head of the bolus entering the esophagus is the beginning of the esophageal phase
- Phase timing: varies 8-20 sec.
12
Q
Differences in Pediatric and Adult Swallowing
A
- Normal reflexes in newborn assist with airway protection and feeling and are inhibited throughout the first year (can resurface after TBI)
- gag (protective; gag is forward during first 6 months)
- phasic bite (bite reflex that protects the airway)
- tongue thrust (pushes food out)
- rooting (survival reflex; move head towards the touch (stimulus)
- suckle (back and forth instead of up and down movement; physiological flexion – in a ball, can’t pull their neck up yet, hard to move the )
13
Q
Structural Differences in Pediatric and Adult Swallowing
A
- Physiological flexion predominates early and antigravity extension increases as newborn ages
- Larynx positioned high in pharynx (little laryngeal elevation observed)
14
Q
Changes in Pediatric Swallowing
A
- Dentition begins to erupt
- Tongue thrust is inhibited
- Gag begins to move backward
- Primitive chewing/munching (up and down not rotary)
- Beyond 6 months (36 months)
- complex state of events the develop through approx. 3 years of age (more adult-like)
- Disorders that effect the normal swallow can create long-tern deficits in the pediatric population
- sensory issues
- oral-motor development
- speech development
15
Q
Changes in Older Adults
A
- Ossification of bone and cartilage
- Laryngeal joint dysfunction due to arthritis
- Slightly longer oral phase with mild delay in triggering pharyngeal response
- Less cleaning of residue
- Penetration increases but not aspiration
- Vocal fold bowing
- Decreases in taste and smell
- Decreases (indiv variation) in amount of liquids and foods
