Typical and Aging Swallow Flashcards
What are the 5 stages of swallowing?
Pre-feeding/swallowing Oral Preparatory Oral Pharyngeal Oesophageal
What is the pre-swallowing stage and what needs to be considered?
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)
What happens in the oral preparatory stage?
Mastication: the breakdown and preparation of the bolus for swallowing
What are the key structure in the oral preparatory stage?
Teeth, cheeks, tongue, jaw, palate
What might cause a difficulty in the oral preparatory phase?
CP, VII/XII weakness, HNC - xerostomia (Saliva is really important here), missing dentures, oral thrush, MS, MND, PD, (depending on stages)
What happens in the oral phase?
Propulsion of the food posteriorly until the pharyngeal phase is initiated
What is important in the oral phase?
Good co-ordination and strength of tongue
How would you identify an oral preparatory/oral stage problem?
Look inside the person’s mouth/observe eating
How is the nasopharynx protected in the pharyngeal phase of swallowing?
elevation and retraction of the soft palate (and anterior/medial movement of PPW)
What are the two things the tongue does in the oral stage?
- tongue ramping
2. moves posteriorly to meet the PPW
What are the three ways the airway is protected during the pharyngeal stage?
- anatomical configuration (i.e. epigottis)
- laryngeal elevation (up and forward - floor of mouth muscles and thyrohyoid muscles)
- Laryngeal closure (TVF, FVF, laryngeal vestibule)
What the are 5 stages of the UOS opening?
- Relaxation (message from brainstem)
- Opening (laryngeal elevation drags it open)
- Distention (bolus coming through)
- Collapse
- Closure
How does the bolus move through the oesophagus?
Peristalsis (NB: NOT for pharyngeal stage)
What should you do if there is an oesophageal stage difficulty?
Refer to gastroenterology
What are two factors to consider when looking at swallowing and aging?
- Variably within an age bracket
2. Variability within a person
When do physiological changes to swallowing start to occur?
4th/5th decade
When do physiological changes to swallowing start to have a significant impact?
7th/8th decade
What changes occur to the oral stage in aging?
Reduced tongue mass (and therefore strength and speed of movement)
Reduced oral sensitivity
Reduced dentition affects chewing
increased duration in this (and all) phases
By how much is the pharyngeal swallow delayed in older people?
.6s in older compared to .1-.2 in younger people
What would a lowering in UOS resting pressure cause?
Burbing and acid reflux
What is physiologic reserve?
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’)
Should you consider age in your decision making?
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
How long does it take to go from UOS to LOS
8-20 seconds
