Variations in the swallow

Question 1

What are the two types of Swallow

Answer 1

Volitional and Spontaneous

Question 2

Describe a Volitional swallow

Answer 2

A Volitional Swallow occurs when we eat and drink. This happens when we position the bolus within the oral cavity which is followed by a
reflexive ‘pharyngeal swallow’

Question 3

Describe a Spontaneuous Involuntary swallow

Answer 3

An example of Spontaneous Swallow is secretion management. During sleep this serves as a protective reflex. It is thought that this swallow is initiated in the pharyngeal area e.g. the vallecula or the pyriform sinus

Question 4

What factors can change the swallow

Answer 4

Volume and Viscosity of the bolus

Question 5

Describe some of the volume bolus changes which can affect the swallow

Answer 5

The oral and pharyngeal cavity will change to accommodate boluses of different sizes.

The relationship between breathing and swallowing will also change with larger boluses - the UES remains open for longer and you are not breathing for longer with a larger bolus. This is clinically significant for people with respiratory conditions

Question 6

Describe some of the viscosity bolus changes which can affect the swallow

Answer 6

There is greater tongue pressure needed to transport thicker boluses from the oral cavity

Tongue base to pharyngeal wall pressure increases in order to pull the bolus down into the pharynx

Boluses with higher viscosity will have a longer pharyngeal transit time

Question 7

What happens in a Consecutive Swallow

Answer 7

In a consecutive swallow there is a longer airway closure (5-10 seconds)

There is longer velopharyngeal closure (so the velum (Soft palate) is closed off to protect food or fluid to go into the nasal cavity)

The Hyoid and the Larynx only partially lower after each sequential swallow - conservation of energy

There is also a merge of the bolus in the hypopharynx and therefore the UES is open for a shorter time

This is clinically significant for people with respiratory problems - the airway is significantly compromised when we take consecutive swallows let alone with another resp problem on top of that

Question 8

What happens in a Consecutive Swallow

Answer 8

We need to ensure that the client is sucking and not inhaling the liquid. This because the bolus is propelled into the posterior part of the oral cavity via suction . The soft palate lowers against the back of the tongue whilst muscles of the face and cheek pull the bolus into the mouth. The majority of swallows are initiated below the level of the vallecula. This is clinically significant because is someone has significant weakness in the oral muscles if the person is not ready to initiate swallow then the bolus can go down into the airway