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9633 Swallowing > L3: Swallowing Development and Differences > Flashcards

L3: Swallowing Development and Differences Flashcards

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1
Q

bw birth and 12m healthy infants increase in…

A

length by 50% and weight by 200%

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2
Q

growth is a crude indicator of…

growth occurs when…

A

nutrition

growth occurs when dietary intake is sufficient and feeding skills are sufficient

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3
Q

infancy and childhood are critical times for …

which requires..

what can disrupt this?

A

brain and body development

requires sufficient energy and nutrients to meet growth potential

dysphagia and its associated problems can have lasting effects on dev (ex. stature, dev milestones)

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4
Q

describe fetal gut development

A

fetal gut dev complete at 20 wks GA, but continues to mature physiologically post-natally

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5
Q

describe lung dev

A

must reach a developmental threshold for ex-utero survival

23 wks GA = primitaive alveoli present, can performa basic has exchange

32-34 WKS GA = resp becomes more efficient

37 wks GA = sufficient surfactant production for resp

alveoli continues to inc over first 2 years

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6
Q

how does the CNS mature?

A

matures from the bottom up

1st trimester = spinal cord synapses form

2nd trimester = brainstem begins to mature (breathing, heart rate, blood pressure, digestion, sleep)

3rd trimester = cerebral volume and surface area inc (necessary for functional life)

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7
Q

after neurological development, babies are born with survival reflexes, but still…

A

dependent on caregivers bc cerebral maturation is incomplete

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8
Q

structures of the head and neck of the embryo are …

A

in place by the end of the 1st trimester

frontonasal process (face maxilla)
branchial arches (mandible, tongue, larynx)

further dev takes place during the first year post natally

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9
Q

infants are NOT….

A

small adults

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10
Q

infant head and neck stability is provided…

adult head and neck stability..

A

externally through positioning

provided through internal posture

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11
Q

infants tongues …

adult tongues…

A

fills the oral cavity

drops down and moves back

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12
Q

infant tongue tip…

adult tongue tip…

A

protrudes beyond alveolar ridge

behind alveolar ridge

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13
Q

infant fat pads …

adult fat pads…

A

in cheeks support oral movements

disappear; more lip and cheek movement

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14
Q

infant soft palate..

adult epi…

A

is large and close to epiglottis

moves down and away

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15
Q

infant larynx is …

adult hyoid and larynx..

A

high in neck - after 1st year it descends to adult position by 6-7 years; hyoid and larynx share horizontal plane - movement is anterior

on diff planes - movement forward and superior

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16
Q

infant more penetration…

adult entrance to airway…

A

is possible due to shape of laryngeal inlet, mechanism of laryngeal closure

is more tightly closed

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17
Q

infant valleculae and pyriform sinuses…..

adult valleculae and pyriform sinuses …

A

are shallow; epiglottis is soft

become deeper; epiglottis firmer

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18
Q

in summary, growth during 1st year:

A

downward and forward movement of jaw, enlarging oral cavity and inc length of pharynx

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19
Q

obligate nose breather in infancy shifts…

A

to combination nose and mouth breathing

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20
Q

dentition is dev w/i …

A

the first year

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21
Q

tonsils may be enlarged during…

A

early childhood

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22
Q

soft laryngeal cartilages are…

A

prone to collapse - chin tuck position may not be helpful early on

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23
Q

feeding =

A

any process involving any aspect of eating or drinking, including gathering and preparing food and liquids for intake, sucking or chewing, and swallowing

provides shared opps for comm and social experience that form basis for future interactions

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24
Q

swallowing =

A

complex process of transporting saliva, liuuids, and foods from mouth to stomach while protecting the airway

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25
swallowing behaviours begin in ____ and include:
utero sucking movements, drinking amniotic fluid through digestive tract, thumb to mouth
26
in neonates and infants, all components of swallowing are
involuntary oral phase, trigger pharyngeal swallow, pharyngeal phase, eso phase
27
oral phase comes under voluntary control with
cortical development
28
brain stem mediated reflexes assist with
oral feeding
29
some reflexes persist into later ______, and even ____, others diminish to allow for ______
childhood adulthood food progression
30
2 main types of feeding reflexes
adaptive = prepare and direct feeds into gut protective = keep material out of the airway
31
rooting =
turn head toward tactile stimulation of lips/cheeks, open mouth
32
suckling =
anterior-posterior motion of tongue w tactile stimulation of tongue dorsum
33
tongue protrusion =
push food out of mouth when not mature enough to masticate
34
tongue lateralization =
push food to side of mouth to be held or chewed
35
phasic bite =
crude jaw movements to stimulation of gums
36
gag reflex, coughing, and swallowing are also...
feeding reflexes
37
oral phase in infants differs dramatically from adults in what ways?
sucking = repetitive tongue pumping (2-7 pumps) to express milk depends on flow of milk (low/slow flow requires more tongue pumps to create bolus for oral transport) fluid collects at faucial arches OR in valleculae
38
infant pharyngeal phase is ...
more similar to adults hyolaryngeal excursion is smaller in infants due to proximity of larynx to tongue base greater pharyngeal wall movement in infants
39
describe the typical feeding progression in infants
liquid by nipple for first 4-6m (suckle pattern - gradually shifts to suck) strained smooth food by spoon at 4-6m (able to sit w minimal support) lumpy foods by 10-11m (difficult if delayed until 14-16m) cup drinking bf 12 m - toddler diet of chopped table food by 12-18m
40
drinking from bottle or breast requires both...
compression (pos pressure) and suction (neg pressure) for max efficiency
41
drinking from a bottle or breast, the jaw moves slightly...
downward (inc oral cavity and inc neg pressure)
42
drinking from bottle or breast, the tongue ...
creates an anterior seal w nipple, posterior seal w soft palate anterior tongue elevates and compresses nipple posterior tongue lowers creating neg pressure
43
drinking from bottle or breast requires coordination of....
suck-swallow-breathe patterns appears late in 3rd trimester nutritive suck pattern differs from the non-nutritive suck pattern
44
describe non-nutritive suck pattern (NNS)
short jaw excursions 2 sucks/second rhythm of suck 7-8 sucks per burst w 6-7 sec pause bw suck:swallow ratio is 6:1 - 8:1 resp rate minimally changed bc of infrequent swallowing
45
describe nutritive suck pattern (NS)
wide jaw excursions 1 suck per second rhythm of suck - initially continuous sucking burst for up to 60 sec, then: intermittent sucking bursts of 7-10 sucks w short pauses (2-3 sec); toward end of feed, changes to 2-3 sucks per burst w longer pauses suck:swallow ratio is 1:1 (suck:swallow may be 2:1 to 3:1 at end of feed) suck:swallow:breathe ratio is 1:1:1 (i.e. breathing stops during each swallow, then starts again w the next suck)
46
describe the jaw movements that occur when developing the ability to drink from a cup
wide jaw excursions biting down on edge of cup for external stability no biting, internal jaw support appropriate jaw grading for size of cup
47
describe the tongue movements that occur when developing the ability to drink from a cup
extension-retraction movement during drinking when cup offered tongue protrudes slightly under cup for stability intermittent tongue tip elevation alternates w simple tongue protrusion fairly consistent tongue tip elevation
48
describe the lip movements that occur when developing the ability to drink from a cup
upper lip closes on edge of cup cup held bw lips only; slight lip pursing easy lip closure w cup is removed from lips
49
describe the jaw movements that occur when developing the ability to eat puree from spoon
slight jaw movement w sucking pattern jaw held still and mouth open at presentation
50
describe the tongue movements that occur when developing the ability to eat puree from spoon
sucking pattern as food approaches tongue rests quietly to accept spoon intermittent tongue tip elevation and protrusion fairly consistent tongue tip elevation tongue elevation and depression are independent of jaw tongue moves laterally across lips to clean
51
describe the lip movements that occur when developing the ability to eat puree from spoon
lips dont assist in clearing spoon upper lip moves down to assist in clearing spoon upper and lower lip curl inward in clearing spoon
52
describe the jaw movements that occur when developing the ability to eat solids
munching - mouth open wide; phasic bite munching - mouth closed, feeder breaks off munching - may pull head back to assist rotary - diagonal rotary movement rotary -variation in amount of up-down movement and speed rotary - circular rotary movement
53
describe the tongue movements that occur when developing the ability to eat solids
front-back movement up-down no lateralization gross rolling movements intermittent protrusion-retraction still occurs can transfer food from one side to other without pausing at midline
54
describe the lip/cheek movements that occur when developing the ability to eat solids
lip and cheek tighten asymmetrically lips are active w jaw, close at sides/centre can chew intermittently w lips closed
55
what are the 3 reasons why biomechanics of swallowing change as we age?
structural changes sensory changes motor changes
56
describe the structural changes that occur due to age
ossification of laryngeal cartilages larynx descends lower in the neck incidence of cervical arthritis inc
57
describe the sensory changes that occur due to age
peripheral alterations in sensory perception - touch, taste, smell ex. bolus may advance further into the UADT prior to swallow initiation
58
describe the motor changes that occur due to age
decreased muscle strength - change in mass and contractile properties ex. may need second swallow to clear pharyngeal residue; inc but normal durations
59
when do changes occur due to age?
> 65 years, demonstrable changes can occur after 45 years; may be minor until over 80 years
60
oral changes due to aging: muscle mass and contractibility...
change in muscle mass and contractibility (lips, tongue, jaw, velum)
61
oral changes due to aging: masticatory function...
number of chewing stroke inc w inc age (and altered dental status); jaw biting force dec
62
oral changes due to aging: bolus hold position ...
more "dipper" swallows
63
oral changes due to aging: tongue mobility...
reduced due to fatty deposits and inc connective tissue in the tongue
64
oral changes due to aging: tongue pressures..
mixed evidence, slower rise time to peak
65
oral changes due to aging: slightly longer...
oral transit time (~1sec)
66
oral changes due to aging: less flexible response to ...
altered viscosity (?sensation)
67
pharyngeal changes due to aging: suprahyoid m ....
inc connective tissue hyolaryngeal excursion - reduced max displacement hyoid movement becomes more superior only (anterior movement dec)
68
pharyngeal changes due to aging: UES opening...
reduced opening and duration (2 degree to dec HLAE) lower resting pressure - susceptible to retrograde flow
69
pharyngeal changes due to aging: normal delay in...
initiating pharyngeal phase
70
pharyngeal changes due to aging: pharyngeal constriction may...
be maintained
71
pharyngeal changes due to aging: slightly longer..
pharyngeal transit time (~1sec)
72
pharyngeal changes due to aging: slight increase in...
freq and extent of residue
73
pharyngeal changes due to aging: laryngeal closure ...
penetration into vestibule inc in freq w age, but not inc in aspiration airway closure - inc in duration (inc apnea)
74
esophageal changes due to aging: deteriorates more...
sig than oropharyngeal function
75
esophageal changes due to aging: transit and clearance are...
slower and less efficient motor activity dec w age reduce amplitude of eso contractions due to smooth muscle thickening stasis inc
76
coordination w resp changes due to aging: - lungs lose.. - apneic period ...
elasticity and lung volumes reduce w age inc in age (and w bolus volumes)
77
altho changes in aging are noted, they are still considered...
normal loss of muscle strength (force) and speed results in inc but normal swallow durations vs young
78
possible the younger indvs demonstrate _____ reserve, and ________ is reduced w age
neuromuscular neuromuscular reserve ex. HLAE = more than enough displacement in young, less in older age but still functional
79
possible that younger indvs demonsrate neuromuscular ____ and this _____ is reduced w age
flexibility flexibility ex. UES opening is not affected by bolus volume in older age, but maintained pharyngeal constriction clears bolus relatively well
80
swallowing biomechanics demonstrate sig... including in...
normal variability the timing of events
81
Kendall et al 2000's 4 most stable components of swallow:
onset of arytenoid movement toward epi before UES opening UES opening prior to/simultaneous w bolus head arrival at UES max larynx to hyoid approx always after UES opening max pharyngeal constriction after max UES opening
82
Molfenter et al 2014 2 most stable swallow components:
timing bw laryngeal vestibule closure and UES opening timing bw max laryngeal-hyoid approx and UES opening
83
healthy swallow is characterized by
flexibility and accommodation
84
systematic variability in swallowing by altering...
volume viscosity taste delivery/ingestion method systematic variability w age
85
volume effects oral by...
tongue contour changes to accommodate inc volume tongue to hard palate pressures = no efffect
86
volume effects pharyngeal by...
tongue base retraction - occurs later w inc volume airway closure - longer apneic period w inc volume UES opening = occurs earlier, longer duration w inc volume hyoid displacement (movement) mixed evidence = no diff vs greater displacement w larger volumes (> in males)
87
volume effects coordination by...
oral and pharyngeal phases more simultaneous w inc volumes
88
viscosity effects oral by...
tongue to palate pressures = inc w viscosity tongue musculature = inc activity w inc viscosity
89
viscosity effects pharyngeal by...
tongue base retraction = inc pressure w inc viscosity pharyngeal constriction = inc pressure w inc viscosity VP closure, airway closure, and UES opening = durations inc w inc viscosity
90
viscosity effects coordination by...
initiation of pharyngeal phase = accumulation of bolus in valleculae as mastication of solid continues
91
taste/chemosensory effects oral by...
tongue pressure = inc w sucrose, salt, citric vs water also inc w carbonation +/- taste
92
taste/chemosensory effects pharyngeal by...
hyoid displacement = inc in muscle activation in the suprahyoid m w sour
93
effect of delivery method: sequential cup drinking involves....
anticipatory elevation of the larynx as cup approaches lips
94
effect of delivery method: sequential cup drinking events are...
maintained across all swallows lips maintain seal on cup airway closure maintained across all swallows; happens earlier vs teaspoon delivery VP closure maintained across all sequential swallows
95
effect of delivery method: sequential cup drinking involves repetitive...
events tongue repeatedly propels boluses tongue base retracts to PPW after each bolus
96
during "chug a lug" or chugging a liquid...
larynx is pulled forward, UES opened volitionally, hold breath to close airway dump material from oral cavity into esophagus
97
how does one do straw drinking?
suction (neg pressure) in oral cavity = lip strength to seal around straw = velum lowered against tongue back, and cheek/face and jaw m contract to create suction bolus can accumulate as inferiorly as hypopharynx = airway closure must be maintained across multiple sips/swallows
98
distinguishing bw different from disordered ....
informs SLP practice diagnostic element (candidates for therapy) can be harnessed to bring about purposeful changes in swallowing biomechanics

9633 Swallowing (6 decks)

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