Oral motor dysfunction and visual perception

Question 1

What are the phases of normal oral feeding, and when does each start?

Answer 1

preparatory phase- food in mouth
oral phase- food in mouth and labial seal maintained
pharyngeal phase- begins with triggering pharyngeal swallow (when bolus passes anterior faucial arches)
esophageal phase- entry of bolus through cricopharyngeal region (8-20 secs in adults, 3-10 sec in infants)

Question 2

t/f, we tend to use a rotary lateral movement of manipulation and mastication when eating

Answer 2

true, use rotary lateral movements

Question 3

t/f, airway is closed and larynx and pharynx are at rest during the oral phase

Answer 3

false, the airway is still open at this point but the larynx and pharynx ARE at rest

Question 4

the pharygneal swallow is triggered when the food bolus passes the ____ ____ _____

Answer 4

anterior faucial arches

Question 5

During what phase does airway protection occur?

Answer 5

pharygneal phase

Question 6

What three things occur during airway protection?

Answer 6

1. ELEVATION AND ANTERIOR displacement of the larynx to prevent material from entering the airway
2. Epiglottis DESCENDS and covers laryngeal aditus (vocal folds close)
3. respiration stops

Question 7

Passage of bolus through pharynx takes less than ___ second(s)

Answer 7

1 second

Question 8

What are 7 anatomical differences b/w a newborn and adult mouth and pharynx?

Answer 8

1. NB jaw is low, small and retracted
2. tongue fills entire small oral cavity
3. infant inner cheeks contain fatty sucking pads
4. infant tongue movement is forward and backwards -> suckling
5. obligate nose breathers since epiglottis and soft palate are IN CONTACT
6. larynx much higher in NB
7. horizontal eustachian tubes-> increased ear infections

Question 9

What are three suggestions you should give to older adults/ people with dysphagia to maintain safe eating?

Answer 9

1. decrease size of bolus
2. chew more thoroughly
3. minimize distractions

Question 10

_____: difficulty chewing, maintaining lip closure, and clearing food/liquid from spaces in the oral cavity, may also have pre-swallowing aspiration
_____: weakness, slowness, or incoordination of the oral-pharyngeal motor system. Severity varies from inefficient handling of food or liquids to aspiration

Answer 10

oral stage problems
dysphagia

Question 11

t/f, aspirated food contents with acid from GERD are very likely to cause pneumonia and lung damage

Answer 11

true

Question 12

What are 4 symptoms that would indicate reflux/GERD leading to aspiration?

Answer 12

1. arching during feeding
2. bad breath
3. vomiting blood, night vomiting
4. irritability

Question 13

t/f, adults can handle aspirating 10-20% of what we swallow

Answer 13

true

Question 14

t/f, you will see aspiration during or after swallow during the oral phase

Answer 14

false, will only see aspiration before the initiation of the pharyngeal swallow, aspiration during or after occurs in pharyngeal phase

Question 15

What are 5 potential problems that can occur during the oral phase of feeding?

Answer 15

1. reduced labial closure
2. reduced lateral and vertical range of tongue movement (ROM, strength, coordination)
3. reduced buccal tension
4. reduced oral sensitivity
5. oral hypersensitivity

Question 16

What are 5 potential problems that can occur during the pharyngeal phase of feeding?

Answer 16

1. delayed or absent pharyngeal swallow
2. inadequate elevation of soft palate
3. reduced laryngeal closure
4. reduced laryngeal elevation
5. upper esophagus sphincter dysfunction

Question 17

What two potential problems can occur during the esophageal phase?

Answer 17

reflux
reduced peristalsis

Question 18

What are 4 recommendations for optimal swallowing in adults?

Answer 18

1. 90 degrees upright
2. head tilted slightly forward
3. support weaker side so that it is elevated above stronger side if pt is asymmetrical
4. relaxed position, minimize the effect of abnormal tone and reflexes

Question 19

t/f, chin down is a good compensatory posture for pts with delayed pharyngeal swallow

Answer 19

true, this helps protect their airways

Question 20

t/f, head forward is a good compensatory posture for patients with poor lingual motility for posterior bolus transport but that have good airway closure and pharyngeal clearance

Answer 20

false, head BACK helps with this

Question 21

t/f, we want to rotate a pts head TOWARD the side of impairment to prevent bolus transport through the weaker side

Answer 21

true

Question 22

t/f, we want to tip a pts head to the unimpaired side to provide more pharyngeal clearance for a pt with unilateral impairment of the pharynx

Answer 22

true

Question 23

How do you perform the supraglottic swallow?

Answer 23

1. Take a deep breath and hold it.
2. Put a small bite of food or a sip of liquid into your mouth.
3. Swallow (keep holding your breath).
4. Cough right after you swallow.
5. Swallow again.
6. Breathe.

Question 24

At what age do children start rotary chewing?

Answer 24

18-24 months

Question 25

Which visual defect is caused by lesions in tract or unilateral primary visual cortex?

Answer 25

hemianopsia