Typical and Aging Swallow

Question 1

What are the 5 stages of swallowing?

Answer 1

Pre-feeding/swallowing
Oral Preparatory 
Oral 
Pharyngeal 
Oesophageal

Question 2

What is the pre-swallowing stage and what needs to be considered?

Answer 2

The anticipation of food, hunger, smell, sight, eating, environmental, utensils

(can be particularly relevant for older people and people with cognitive difficulties; e.g. dementia)

Question 3

What happens in the oral preparatory stage?

Answer 3

Mastication: the breakdown and preparation of the bolus for swallowing

Question 4

What are the key structure in the oral preparatory stage?

Answer 4

Teeth, cheeks, tongue, jaw, palate

Question 5

What might cause a difficulty in the oral preparatory phase?

Answer 5

CP, VII/XII weakness, HNC - xerostomia (Saliva is really important here), missing dentures, oral thrush, MS, MND, PD, (depending on stages)

Question 6

What happens in the oral phase?

Answer 6

Propulsion of the food posteriorly until the pharyngeal phase is initiated

Question 7

What is important in the oral phase?

Answer 7

Good co-ordination and strength of tongue

Question 8

How would you identify an oral preparatory/oral stage problem?

Answer 8

Look inside the person’s mouth/observe eating

Question 9

How is the nasopharynx protected in the pharyngeal phase of swallowing?

Answer 9

elevation and retraction of the soft palate (and anterior/medial movement of PPW)

Question 10

What are the two things the tongue does in the oral stage?

Answer 10

1. tongue ramping

2. moves posteriorly to meet the PPW

Question 11

What are the three ways the airway is protected during the pharyngeal stage?

Answer 11

1. anatomical configuration (i.e. epigottis)
2. laryngeal elevation (up and forward - floor of mouth muscles and thyrohyoid muscles)
3. Laryngeal closure (TVF, FVF, laryngeal vestibule)

Question 12

What the are 5 stages of the UOS opening?

Answer 12

1. Relaxation (message from brainstem)
2. Opening (laryngeal elevation drags it open)
3. Distention (bolus coming through)
4. Collapse
5. Closure

Question 13

How does the bolus move through the oesophagus?

Answer 13

Peristalsis (NB: NOT for pharyngeal stage)

Question 14

What should you do if there is an oesophageal stage difficulty?

Answer 14

Refer to gastroenterology

Question 15

What are two factors to consider when looking at swallowing and aging?

Answer 15

1. Variably within an age bracket

2. Variability within a person

Question 16

When do physiological changes to swallowing start to occur?

Answer 16

4th/5th decade

Question 17

When do physiological changes to swallowing start to have a significant impact?

Answer 17

7th/8th decade

Question 18

What changes occur to the oral stage in aging?

Answer 18

Reduced tongue mass (and therefore strength and speed of movement)
Reduced oral sensitivity
Reduced dentition affects chewing
increased duration in this (and all) phases

Question 19

By how much is the pharyngeal swallow delayed in older people?

Answer 19

.6s in older compared to .1-.2 in younger people

Question 20

What would a lowering in UOS resting pressure cause?

Answer 20

Burbing and acid reflux

Question 21

What is physiologic reserve?

Answer 21

It’s about the amount of energy you have and the ability to draw on reserves and resources in the body (i.e. ‘what’s left in the tank’)

Question 22

Should you consider age in your decision making?

Answer 22

There is no clear guidelines on this. Pre-morbid abilities is much more important (this will inform your goals) but you might not expect the same sort of recovery in an older person due to physiologic reserve

Question 23

How long does it take to go from UOS to LOS

Answer 23

8-20 seconds