Week 3 Flashcards
(20 cards)
normal swallow physiology
highly variable and influenced by bolus, rate, environment
-relates to the efficient and appropriate movement of food/liquid thru the upper aero digestive tract
factors affecting oral preparation of food/liquid
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)
roles of the tongue
-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
additional characteristics of oral stage
-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
pharyngeal stage
begins when bolus arrives at valleculae and ends when PES closes
basic physiology of pharyngeal stage
-pharyngeal shortening
-airway closure
-hyolaryngeal excursion
-pharyngeal constriction
-PES opening/closing
respiration and swallowing
the foodway and airway cross
-during swallows= respiration ceases=apnea
duration of the apnea
0.75 to 1.25 seconds (normal)
-most common pattern (inhale-brief exhale-swallow apnea-finish exhale)
cervical auscultation
used to monitor respiratory patterns associated with swallowing
peristalsis
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
primary peristalsis
initiated when bolus enters the esophagus (peristaltic waves are rhythmic and regular)
secondary peristalsis
assists in solid boluses
-initiated by bolus distention (bulging) of esophagus at any location
tertiary contractions (not orderly)
occurs independent of swallowing and may disrupt bolus transit
manometric tracing of primary esophageal peristalsis
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
bolus characteristics
sensory inputs alter swallowing (volume, texture, taste)
-change degree of movement or timing of the swallow (aka bolus accommodation)
straw drinking
requires lip closure/strength and intraoral pressure to draw the fluid into oral cavity
-velum or soft palate remains closed against posterior pharyngeal wall
aging factors: oral preparatory and oral stage
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
physiologic reserve
maximum pressure-sub maximum pressure
what happens in older adults when it comes to physiologic reserves
-maximum pressure decreases
-submaximum pressure doesn’t change because swallowing doesn’t need a full effort
aging factors: pharyngeal stage
-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
