Week 3

Question 1

normal swallow physiology

Answer 1

highly variable and influenced by bolus, rate, environment
-relates to the efficient and appropriate movement of food/liquid thru the upper aero digestive tract

Question 2

factors affecting oral preparation of food/liquid

Answer 2

saliva (produced by different activation glands (salivary glands) that are important in maintaining oral hygiene by controlling microorganisms
-taste/smell
-visual appearance
-dentition
-oral condition (lesions, sores)
-anatomy and physiology in mouth region
-food characteristics (rheology- flow)

Question 3

roles of the tongue

Answer 3

-containment of bolus
-transit (tip of tongue pushes hard palate and provides as a slides so bolus can go to back of tongue where it pushes bolus towards the PES so bolus can enter pharynx
-clearance: important for dorsal surface of tongue to maintain contact with pharyngeal area and hard palate

Question 4

additional characteristics of oral stage

Answer 4

-apnea: seizing of airflow
-nasal separation: palate elevates and separates nasal pharynx from oropharynx to hypopharynx to prevent material into nasal cavities
-hyolaryngeal excursion: hyoid and larynx start to elevate and take a pre swallow posture
-pressure changes: food moves from high pressure areas to lower pressure areas

Question 5

pharyngeal stage

Answer 5

begins when bolus arrives at valleculae and ends when PES closes

Question 6

basic physiology of pharyngeal stage

Answer 6

-pharyngeal shortening
-airway closure
-hyolaryngeal excursion
-pharyngeal constriction
-PES opening/closing

Question 7

respiration and swallowing

Answer 7

the foodway and airway cross
-during swallows= respiration ceases=apnea

Question 8

duration of the apnea

Answer 8

0.75 to 1.25 seconds (normal)
-most common pattern (inhale-brief exhale-swallow apnea-finish exhale)

Question 9

cervical auscultation

Answer 9

used to monitor respiratory patterns associated with swallowing

Question 10

peristalsis

Answer 10

orderly ring like muscular contractions that push material through the esophagus (solids take about 20 to 30 seconds)
-liquids may be too fast for this and appear to be held up in distal esophagus

Question 11

primary peristalsis

Answer 11

initiated when bolus enters the esophagus (peristaltic waves are rhythmic and regular)

Question 12

secondary peristalsis

Answer 12

assists in solid boluses
-initiated by bolus distention (bulging) of esophagus at any location

Question 13

tertiary contractions (not orderly)

Answer 13

occurs independent of swallowing and may disrupt bolus transit

Question 14

manometric tracing of primary esophageal peristalsis

Answer 14

the manometer will record pressure and the contraction force in the cervical esophagus is the strongest and pressure decreases as you move towards the LES

Question 15

bolus characteristics

Answer 15

sensory inputs alter swallowing (volume, texture, taste)
-change degree of movement or timing of the swallow (aka bolus accommodation)

Question 16

straw drinking

Answer 16

requires lip closure/strength and intraoral pressure to draw the fluid into oral cavity
-velum or soft palate remains closed against posterior pharyngeal wall

Question 17

aging factors: oral preparatory and oral stage

Answer 17

sensory change (smell, taste, xerostomia-dry mouth)
-muscle changes: sarcopenia: age related loss of mass, strength, and function
-lingual weakness and physiologic reserve is reduced

Question 18

physiologic reserve

Answer 18

maximum pressure-sub maximum pressure

Question 19

what happens in older adults when it comes to physiologic reserves

Answer 19

-maximum pressure decreases
-submaximum pressure doesn’t change because swallowing doesn’t need a full effort

Question 20

aging factors: pharyngeal stage

Answer 20

-movement and strength changes
-reduced hyolaryngeal excursion (floor of mouth muscles are too weak to pull up the pharynx/larynx
-pharyngeal constriction does not change
-reduced PES opening and shorter open time
-more airway compromise (as young as 50)
-reduction of esophageal contractions and delay in emptying and increase in peristaltic contractions