Unit 1 Flashcards
(158 cards)
1
Q
Prevalence of dysphagia in acute care?
A
33%
2
Q
Prevalence of dysphagia in rehab facility?
A
42%
3
Q
Prevalence of dysphagia in chronic care setting?
A
60%
4
Q
Primary function of the larynx?
A
Protect the airway
5
Q
Prevalence of dysphagia based on cause…
A
Stroke - 49%
TBI - 19.5%
Spinal cord injury/brain tumors - 6.8%
Progressive neurological disorders - 5.2%
6
Q
Dysphagia
A
A swallowing disorder
7
Q
Oral intake
A
Placement of food in the mouth for nutrition and hydration
8
Q
Bolus
A
The food, liquid, or other material placed in the mouth for ingestion
9
Q
Aspiration
A
Occurs when food/liquid penetrates the airway below the true VFs
10
Q
Laryngeal Penetration
A
Occurs when food/liquid penetrates the portion of the airway above the true VFs
11
Q
Functional Swallow
A
A swallow which may be abnormal but does not result in aspiration
12
Q
Ingestion/Swallow
A
Refers to all processes associated with bolus introduction, preparation, transfer, and transport
13
Q
deglutition
A
Refers only to acts associated with bolus transfer and transport
14
Q
NPO
A
not eating by mouth
15
Q
Anatomic structures of the oral cavity used for swallowing
A
lips teeth hard palate soft palate (uvula) mandible floor of mouth tongue faucial arches
16
Q
what are the faucial arches
A
arch on either side of the uvula when looking into the mouth
17
Q
Muscles that squeeze the bolus down
A
pharyngeal constrictors
18
Q
Three pharyngeal constrictors
A
superior, medial, and inferior
19
Q
Cricopharyngeus muscle AKA
A
upper esophageal sphincter (UES), pharyngoesophageal juncture, P-R segment
20
Q
Is the cricopharyngeus natrually open or closed? Why?
A
Closed. It prevents air from entering the esophagus during respiration and prevents material from refluxing into the pharynx
21
Q
When is the cricopharyngeus open?
A
When we swallow - it opens and allows the bolus into the esophagus
22
Q
What/where are the pyriform sinuses?
A
a spaced formed between the fibers which attach the inferior pharyngeal constrictor to the thyroid cartilage
Space created by the inferior constrictors when they contract
23
Q
What is at the top of the esophagus?
A
UES
24
Q
What is at the bottom of the esophagus?
A
LES
25
Layers of the esophagus
2 layers of muscle
- inner is circular
- outer is longitudinal
26
what are the layers of the muscles of the esophagus made up of?
upper third - striated
middle third - striated and smooth
lower third - smooth
27
Lower esophageal sphincter (LES) AKA
gastroesophageal juncture
28
What happens after the LES passes bolus into the stomach?
It closes to prevent reflux
29
Top most structure of the larynx that rests against the base of the tongue
epiglottis
30
Web-shaped space by the base of the tongue and the epiglottis
Valleculae**
31
Opening to the top of the layrnx
Laryngeal cestibule
32
Laryngeal vestibule AKA
laryngeal aditus
33
Suspended from the base of the tongue
Hyoid bone
34
The only free-floating bone in the body
hyoid bone
35
Pharyngeal recesses
the valleculae and the pyriform sinuses
36
Why are the pharyngeal recesses important?
In an inefficient swallow, residue is often seen here**
37
What are the 5 stages of swallowing?**
1. Anticipatory stage
2. Oral preparatory stage
3. Oral stage
4. Pharyngeal stage
5. Esophageal stage
38
Anticipatory stage of swallowing
make cognitive judgments about oral intake (e.g., rate, temperature, size of bite)
39
Oral prep stage of swallowing
Breakdown food and mix it with saliva
40
In which stage of swallowing is lip seal maintained, mastication occurs, buccal musculature tension is maintained, food collected into a bolus, etc.?
Oral prep stage
41
what are the 10 components of the oral prep stage
1. Lip seal is maintained
2. mastication occurs
3. buccal musculature tension is maintained
4. food is collected into a bolus
5. Bolus is held anteriorly and laterally by the tongue against the hard palate
6. linguavelar seal
7. airway is open
8. larynx and pharynx are at rest
9. movements vary depending on amount and consistency of food
10. this stage is under voluntary control
42
Where is buccal musculature tension held?
In cheeks
43
Linguavelar seal
Back of the tongue is elevated and soft palate is pulled anteriorly against tongue to keep material in the oral cavity
44
How long is the oral prep stage?
Depends what we are eating (e.g., steak vs. water)
45
Tongue against the soft palate
Linguavelar seal
46
Soft palate against the wall of the pharynx
Velopharyngeal seal
47
What are the 4 components of the Oral Stage?
1. Tongue propels food posteriorly with a rolling or stripping action.
2. Normal transit time is 1 second.
3. Oral stage terminates when the bolus passes the anterior faucial arches and the pharyngeal response is triggered
4. This stage is under voluntary control (Cranial nerves V, VII, XII)
48
3 reasons the pharyngeal stage is considered physiologically most important
1. Airway protection (when the larynx elevates, the valves of the larynx close)
2. opening of the esophagus
3. Downward propulsion of the bolus into the esophagus (due to contraction of the pharyngeal constrictors)
49
4 components of the pharyngeal stage of swallowing
1. Begins with triggering of the pharyngeal response
2. When the response triggers, a number of physiological activities occur simultaneously
2a. Tongue base move posteriorly to contact the anteriorly moving posterior pharyngeal wall
2b. velum elevates to achieve VP closure
2c. Pharyngeal contraction begins (squeezing action of the constrictors)
2d. Elevation and anterior displacement of the larynx occurs with laryngeal closure at three levels (aryepliglottic folds, false folds, true folds)
2e. opening of the cricopharyngeus as a result of relaxation of UES, elevation of larynx, and pulsion force of the bolus
3. Transit time is 1 second
4. This stage is involuntary
50
5 components of the esophageal stage of swallowing
1. Transit time is appx 8-20 seconds
2. Commences with lowering of the larynx, contraction of the cricopharyngeus to prevent regurgitation , and resumption of respiration
3. Esophageal peristalsis begins
3a. Primary peristalsis is initiated by the pharyngeal response (when laryngeal elevation occurs) - which opens the UES
3b. secondary peristalsis is initiated in response to local distention
4. at the lower end of the esophagus, the LES relaxes prior to arrival of the esophageal peristalic wave to allow passage of the bolus into the stomach. The LES is otherwise closed to prevent gastroesophageal reflux
5. This stage is involuntary
51
Peristalsis
A rhythmic contraction of muscles to move things through a tube
52
The ability to introduce bolus to the mouth
Feeding
53
Movement of the bolus from the oral cavity to the esophagus
Deglutition
54
Swallow vs. Gag reflex*
1. No physiologic or protective relationship between swallow response and gag reflex
2. Gag is triggered by noxious or foreign stimulus
3. Purpose of gag: eliminate foreign stimuli from the mouth or pharynx
4. The neuromuscular response that characterizes gagging involves sudden and strong contractions of pharyngeal walls, soft palate, and larynx to squeeze from the pharynx the stimuli that elicited the gag.
5. Gag is not protective for swallowing.
6. The cough reflex is the protective reflex for the swallow
7. Gag cannot predict presence or adequacy of swallow because the force of the gag is the opposite of the swallow and normal subjects exhibit no gag reflex but have a normal and intact swallow.
8. Gag is useful for observing pharyngeal and palatal contraction.
55
What is the purpose of the gag?
To eliminate foreign stimuli from the mouth or pharynx
56
What is the protective reflex for the swallow?
The cough reflex
57
How can we tell if someone has unilateral pharyngeal weakness?
By the way they gag
58
What is the curtain effect?
Everything gets pulled to one side in unilateral weakness
59
What is it called when bolus comes up through the nasal cavity?
Nasal regurgitation
60
What is the most important cough? Why?
Reflexive cough - it prevents aspiration
61
9 anatomical differences between the adult and newborn mouth?
1. size of oral space
2. size of lower jaw - child is also retracted
3. infants have sucking pads
4. Tongue takes up most of oral cavity
5. child's tongue is restricted
6. newborns - nose breathers
7. epiglottis and soft palate approximate
8. larynx is higher in newborn
9. eustachian tube is horizontal in newborn
62
Swallow apnea
cessation of respiration during the swallow
63
Adaptive reflexes
assist in the acquisition of food
64
Protective reflexes
designed to protect the airway
65
Rooting reflex
- Used to find food
- Touch corner of mouth, baby turns its face that direction
- birth to three months
- adaptive reflex
66
Transverse Tongue Reflex
- elicated by touch/taste stimulation applied to the lateral border of tongue
- important for developing the chew
- AKA lateral tongue reflex
67
Phasic Bite Reflex
Rhythmic closing and opening of jaws in response to stimulation
- Assists with positive pressure sucking
- E.g. put your finger in the infants mouth and they begin sucking
68
Gag reflex
- Serves a protective function in infants, preventing infant from ingesting food for which its not ready
- Present throughout life (but integrates into our system)
69
Suckling is a....
reflexive movement
70
Sucking is a...
voluntary movement
71
Positive pressure suck
Push tongue against the nipple and liquid squirts into mouth (suckling)
72
Negative pressure suck
- what we do
| - Seal lips around straw and drop back of tongue in order to decrease the pressure
73
Tonic Bite Reflex
- Abnormal bite
| - bite down on object in mouth hard and wont let go
74
Babkin and Grasp Reflexes
Show the neurological and functional connections between the hand and the mouth
- little relevance for human survival
- building blocks for future development of self-feeding skills
75
Grasp reflexes
If you press on the baby's pal,, will grasp
76
Babkin reflex
occurs when you press both of the baby's palms - their eyes close, the mouth opens, and the head turns to one side
77
Reflexes can tell us what about a child?
neurological maturity
78
Purpose of nutritive sucking
Obtain nourishment
79
Purpose of non-nutritive sucking
State regulation, satisfy sucking desire, exploration
80
rhythm of nutritive sucking
Initial continuous sucking burst, moving to intermittent sucking bursts with bursts becoming shorter and pauses longer over the course of the feeding
81
rhythm of non-nutritive sucking
repetitive patterns of bursts and pauses; stable number of sucks per burst and duration of pauses
82
Has a rate of one suck/second and is constant over the course of feeding
Nutritive sucking
83
Have a rate of about 2 sucks/second
Non-nutritive sucking
84
Ratio is 1:1 to 3:1
Nutritive SSB
85
Ratio is 6:1 to 8:1
Non-nutritive SSB
86
When have swallowing and breathing movements been documented in infants (age)
18-19 weeks gestation
87
Two biochemical methods of nutritive sucking
1. Positive pressure (suckling)
| 2. Negative pressure (suck)
88
Pressure is put on the nipple that expresses the liquid
Positive pressure method
89
The lips seal around the nipple and then the back of the tongue is depressed
Negative pressure method
90
Strength and control of the tongue develops from...
back to front
91
When does the larynx dissend in infants?
After about 3 months
92
What do we change while feeding infants once the larynx dissends?
move them to a more vertical feeding position
93
Swallow apnea
Cessation of respiration during swallow to prevent aspiration
94
Which takes prescendence, swallowing or respiration?
respiration - if child has trouble with SSB, they tend to choke - they will breathe first, not feed
95
What is Aspiration
Action of material penetrating thte larynx and entering the airway BELOW the level of the true VFs
96
Once material is in the airway, it may be expectorated...
patient mush have intact cough reflex and adequate laryngeal and respiratory control
97
Once material is in the airway, it may be silently aspirated...
if patient does not have a cough reflex, the material remains in the trachea and bronchial tree; may result in aspiration pneumonia
98
When food enters the airway, but stays above the true VFs
Penetration
99
How do we describe the timing of ASPIRATION?
Before, during or after (when aspiration occurs in relation to when the pharyngeal response occurs)
100
For materials to be aspirated, what three valves must it penetrate?
- Aryepiglottic folds
- False Folds
- True Folds
101
Aspiration when the larynx has not yet elevated to close the airway
Aspiration before
102
Aspiration when the laryngeal valves are not functioning adequately
Aspiration during
103
Aspiration when the larynx lowers and opens for inhalation
Aspiration after
104
How do we know when the pharyngeal response occurs?
Hyoid and larynx elevate
105
Is aspiration a swallowing problem?
No, it is a symptom
106
Why does it help to know the timing of aspiration?
Can help to rule in/out certain disorders
107
How do we treat aspiration?
treat the CAUSE of the problem
108
Reduced lip closure.
Oral Prep Phase Disorder
| -results in food falling from the mouth anteriorally
109
Reduce range of tongue motion of coordination.
Oral Prep Phase Disorder
| -Results in inability to form a bolus
110
Reduced tongue shaping and coordination.
Oral Prep Phase Disorder
| -Results in difficulty holding a bolus and risk of aspiration BEFORE the swallow
111
Reduced labial tension or tone.
Oral Prep Phase Disorder
| -Results in material falling into the anterior sulcus
112
Reduces buccal tension or tone.
Oral Prep Phase Disorder
| -Results in material falling into the lateral sulcus
113
Tongue thrust; reduced tongue control.
Oral Prep Phase Disorder
| -Results in abnormal hold position
114
Reduced mandibular movement.
Oral Prep Phrase Disorder
| -Results in inability to align teeth and difficulty chewing
115
Where is the anterior/lateral sulcus
Between the gums/teeth and the cheeks
116
Where is the floor of the mouth?
Under the tongue
117
reduced tongue lateralization.
Oral Prep Phase Disorder
| -Results in inability to lateralize material with tongue to place onto teeth
118
Reduced tongue elevation.
Oral Prep Phase Disorder
| -Results in inability to mash materials
119
Reduced tongue control.
Oral Prep Phase Disorder
| -Results in material falling to the floor of the mouth
120
Apraxia of swallow.
Oral Phase Disorder
| -Results in delayed oral onset of swallow and/or searching motion/inability to organize tongue movements
121
Reduced oral sensation.
Oral Phase Disorder
-Results in delayed oral onset of swallow. Bolus may be held with no lingual movement due to lack of recognition of the bolus as something to be swallowed
122
Tongue thrust.
Oral Phase Disorder
| -Results in tongue moving forward to start the swallow and possible pushing food from the mouth
123
Reduced labial tension.
Oral Phase Disorder
| -results in residue (stasis) in the anterior sulcus
124
Reduced buccal tension or tone.
Oral Phase Disorder
| -Results in residue (stasis) in the lateral sulcus
125
Reduces tongue shaping or coordination.
Oral Phase Disorder
| -Results in residue (stasis) on the floor of the mouth
126
Scar tissue in tongue.
Oral Phase Disorder
| -Results in residue (stasis) in a midtongue depression
127
Reduced tongue ROM.
Oral Phase Disorder
| -Results in residue (stasis) of food on the tongue
128
Lingual discoordination.
Oral Phase Disorder
| -Results in disturbed lingual contraction (peristalsis)
129
Reduced tongue elevation.
Oral Phase Disorder
| -Results in incomplete tongue-to-palate contact and adherence (residue) of food on the hard palate
130
Reduced lingual strength.
Oral Phase Disorder
-Results in adherence of food on the hard palate. Distinguished from above because of build-up of food collecting on the palate as more viscous food is presented
131
Repetitive lingual rolling.
Oral Phase Disorder
- typical in pts. with Parkinsons
- Characterized by a repetitive upward and backward movement of the central portion of the tongue
132
Reduced tongue control.
Oral Phase Disorder
-Results in uncontrolled bolus or premature loss of liquid or pudding consistent into the pharynx with a risk of aspiration BEFORE the swallow
133
Reduced linguavelar seal.
Oral Phase Disorder
| -Results in same as reduced tongue control
134
Piecemeal deglutition.
Oral Phase Disorder
| -Characterized by two, three, or more repeated swallows to empty the oral cavity
135
Delayed pharyngeal swallow.
Disorder in Triggering the Pharyngeal Swallow
-occurs when the head of the bolus enters the pharynx and the pharyngeal swallow has not been triggered. Risk of aspiration is BEFORE the pharyngeal swallow response triggers.
136
Look at slide 55 and 56
Has info about item that will be on test...
137
How do you time a delayed pharyngeal swallow?
The delay is timed from the point where the bolus head passes the point where the lower edge of the mandible crosses the tongue base until the pharyngeal swallow is initiated (where laryngeal and hyoid elevation begin as part of the pharyngeal swallow)***
138
When is a pharyngeal swallow response determined to be absent?
a pharyngeal response delay of greater than 10 seconds*** (because it wont work for the purpose of ingesting food orally)
139
what is the delay of the pharyngeal response measured in?
Seconds
140
Reduced velopharyngeal closure.
Pharyngeal Stage Disorder
| -results in nasal penetration during the swallow
141
Fold of mucosa at the base of the tongue.
Pharyngeal Stage Disorder
| -results in pseudoepiglottis (after total laryngectomy)
142
Cervical osteophytes.
Pharyngeal Stage Disorder
-bony outgrowth from the cervical vertebrae that can be large enough to interfere with the swallow by narrowing the pharynx
143
Reduced pharyngeal contraction bilaterally.
Pharyngeal Stage Disorder
-results in coating on the pharyngeal walls after the swallow and presents a risk of aspiration AFTER the pharyngeal response when the pt. inhales
144
Reduced posterior movement of the tongue base (retraction).
Pharyngeal Stage Disorder
| -results in vallecular residue bilaterally and a risk of aspiration AFTER…
145
Pharyngeal pouch/scar tissue.
Pharyngeal Stage Disorder
| -results in coating in a depression on the pharyngeal wall and a risk of aspiration AFTER...
146
Residue AKA
Stasis
147
Diverticulum AKA
Pharyngeal Pouch (bad breath is a symptom of this)
148
Reduced laryngeal elevation.
Pharyngeal Stage Disorder
- results in residue at the top of the airway and a risk of aspiration AFTER…
- If the larynx doesn't fully elevate, then the epiglottis wont fully invert
149
Reduced closure of the airway entrance (arytenoid to base of epiglottis).
Pharyngeal Stage Disorder
-results in laryngeal penetration and, depending if the penetrated material remains in the larynx, aspiration AFTER the swallow upon inhalation
150
Reduced laryngeal closure.
Pharyngeal Stage Disorder
| -results in aspiration DURING the pharyngeal swallow response (this is the only one that is during)***
151
Reduced anterior/superior laryngeal movement.
Pharyngeal Stage Disorder
| -results in stasis or a residue in both pyriform sinuses and a risk of aspiration AFTER…
152
Cricopharyngeal dysfunction.
Pharyngeal Stage Disorder
| -results in residue in both pyriform sinuses and a risk of aspiration AFTER…
153
Generalized reduction in pharyngeal contraction.
Pharyngeal Stage Disorder
| -results in residue throughout the pharynx and a risk of aspiration AFTER…
154
Where are the pyriform sinuses located in relation to the USE?
Just superior
155
If the pyriform sinuses are just above the UES, why would reduced laryngeal elevation result in residue in the pyriforms?
Because the UES doesn't open
156
Unilateral damage to posterior movement of the tongue base.
Pharyngeal Stage Disorder
| -results in unilateral vallecular residue and risk of aspiration AFTER…
157
Unilateral pharyngeal wall damage.
Pharyngeal Stage Disorder
| -results in residue in one pyriform sinus and risk of aspiration AFTER…
158
Unequal height of the vocal folds.
Pharyngeal Stage Disorder
| -results in inadequate vocal fold closure and a risk of aspiration DURING...
