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week5 Flashcards

1
Q

deglutition means

A

swallowing

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2
Q

how many times do we swallow a day

A

500-700 times a day

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3
Q

importance of swallowing

A

malnutrition/dehydration
aspiration/medical complications
choking/death
oral medications
quality of life- enjoyment
activities/participation
- social connection
- cultural significance

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4
Q

swalling ohases

A

oral preparatory phase
oral transpot phase
pharyngeal transport phase
eosophangus transpot phase

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5
Q

Components of nervous system involved in swallowing

A

Cortical structures – primary motor cortex; primary sensory cortex
Subcortical structures - basal ganglia; limbic structures
Brainstem
Cranial nerves

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6
Q

Primary somatosensory cortex
located in receives what

A

postcenteral gyrus
sensory information eg joint position and movement of the jaw information about muscles such as tongue and soft palate;
the lips and oral cavity about bolus size, temperature, shape

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7
Q

Subcortical areas

A

have a role in modifying and monitoring swallowing activity and possibly respond to incoming sensory info

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8
Q

Nucleus ambiguous- brainstem

A

group of motor neurons and celll bodies located in the medulla: CNIX, CNX – consider that they innervate muscles of the soft palate, pharynx and larynx.
These muscles are critical to the function of swallowing (and speech).

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9
Q

Nucleus tractus solitarius- brainstem

A

Is a group of sensory neurons located in the medulla: CN VII, CN IX, CNX
Related to the special sense of taste.

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10
Q

Trigeminal nerve/CNV: mixed nerve
in re to swallowing

A

Motor: muscles of mastication (chewing)
Sensory: facial and mouth sensation

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11
Q

Facial nerve/CNVII: mixed nerve
in re to swallowing

A

Motor: muscles of facial expression, eye closure, and lip closure
Sensory: taste (anterior 2/3 of tongue); saliva production

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12
Q

Glossopharyngeal nerve/CNIX: mixed nerve
in re to swallowing

A

Motor: stylopharyngeus muscle (elevates pharynx and larynx in swallowing)
(recall: via nucleus ambiguous)
Sensory: palate, oropharynx; taste (posterior 1/3 of tongue)

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13
Q

Vagus nerve/CNX: mixed nerve
in re to swallowing

A

Motor: larynx, pharynx and soft palate) (recall: via nucleus ambiguous)
Sensory: pharynx and larynx; taste from epiglottis and pharynx

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14
Q

Hypoglossal nerve/ CNXII: motor nerve
in re to swallowing

A

Motor: muscles of tongue

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15
Q

Olfactory nerve/CNI: sensory nerve in re to swalowing

A

Sensory: relating to the sense of smell.

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16
Q

Facial nerve/CNVII: mixed nerve
in re to swallowing

A

Sensory: taste from anterior 2/3 of tongue.

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17
Q

Glossopharyngeal nerve/CNIX: sensory part only
in re to swalowing

A

Sensory: taste from posterior 1/3 of tongue.

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18
Q

how many cranial nerves are involved in swallowing

A

5 cranial nerves

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19
Q

Voluntary movement

A

complex actions
purposeful, goal-oriented
learnt/ improve with practice

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20
Q

Rhythmic motor patterns movements

A

combines voluntary & reflexive acts: chewing, walking, running
initiation & termination is voluntary
once initiated, are repetitive & reflexive

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21
Q

Reflexes movements

A

involuntary, rapid, stereotyped movements: gag reflex, coughing, knee jerk reflex
triggered by a stimulus
are innate

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22
Q

chewing is what type of movement

A

A process that voluntarily starts and stops
Central Pattern Generator (CPG) (= open/close jaw) maintains movement until voluntarily stop
They are stereotyped movement patterns but can change based on sensory input and feedback,

23
Q

Swallowing- Automatic responses: reflexes

A

Swallowing depends on a CPG located in the medulla of the brain stem.

Involves several motor nuclei of cranial.

The swallowing CPG generates a swallowing pattern or reflex

24
Q

The gag reflex
Automatic responses: reflexes

A

A protective mechanism to prevent unwanted entry of foreign body to respiratory passage which could lead to choking.

Stimulus: sensory from CNIX (from soft palate, pharynx and glossopalatine folds)

Response: muscular from CN X (from Nucleus Ambiguus) to close the glottis, elevate soft palate and gagging.

Pharyngeal stage/phase of swallowing

25
Oral preparatory stage
Lip Closure (CNVII) Facial tone helps labia (lips) seal. Manipulation of bolus - lateral jaw movement (CNV - muscles of mastication) & - lateral tongue movement (CNXII) Anterior pulling of soft palate (CNX – palatoglossus muscle) to rest against the back of the tongue (CNXII) - which is elevated serving to keep material in the oral cavity
26
Oral transit stage
Oral cavity closed anteriorly at lips and via tongue. The food is moved back through the mouth with a front- to-back squeezing action. Beginning: tongue forms a chute mouth of floor raised tip of tongue to palate central area hollows sides of tongue elevated The tongue pushes the bolus against the palate and sweeps it back into the pharynx Tongue anterior  posterior movement
26
Pharyngeal stage
This stage is complex and involves closing off and protecting the airways while moving food through the pharynx Described as involuntary (vs. voluntary oral stage) Precise sensory feedback necessary to correctly coordinate all parts of the process Triggering of the swallowing response occurs at the anterior faucial arch.
27
CN assosiated with oral stage
5,7,9,10,12
28
CN assosiated with pharyngeal/ laryngeal stage
9,10
29
CN assosiated with oesopheageal stage
10
30
damage to cortical structure causes swallowing defict
Difficulty at both oral and pharyngeal stages of swallowing. E.g. weakness of lips making it difficult to close the mouth and food/liquid falls out.
31
damage to subcortical structure causes swallowing deficits seen as
Difficulty at both oral and pharyngeal stages of swallowing. E.g. difficulty chewing impacting bolus formation.
32
damage to cranial nerves has swallowing deficits seen in
Difficulty at both oral and pharyngeal stages of swallowing. E.g. weakness of the tongue making it difficult to prepare the bolus and move it posteriorly in the oral cavity.
33
damage to CN 5 on swallowing
Difficulty chewing food. She needed softer textured foods moving to pureed foods. She needed thickened fluids over time.
34
damage to CN 7 impacts swallwoing hwo
Difficulty achieving lips seal meaning food and fluid escaped when eating and drinking. This became worse over time. She needed softer textured food and thickened fluids over time. Use a cloth to clear residue
35
damage to CN 9&10 impacts swallwoing hwo
Delay in initiating the swallow reflex putting her at risk of aspiration. Weak cough making it hard for her to clear any residue and the strength of her cough reflex. She needed softer textured food and thickened fluids over time.
36
damage to CN 12 impacts swallwoing hwo
Difficulty manipulating the bolus and moving bolus posteriorly in the oral cavity.
37
Location and function of cortical motor areas for speech production
Pre-motor cortex- Role in planning movement. Broca’s area- Role specifically in planning speech movement. Supplementary motor area- Programming movement sequences. Feeds correct motor instructions in correct sequence to the primary motor cortex. Primary motor cortex- Responsible for the EXECUTION of the movement (after plans have been checked).
38
CN V = trigeminal nerve in re to speech
Think jaw movement and articulation/speech intelligibility.
39
CN VII = facial nerve in re to speech
movement of facial muscles. Think lip movement and articulation of bilabial sounds e.g. “m” or rounding of the lips in vowels.
40
CN IX = glossopharyngeal nerve in re to speech
can aid in velopharyngeal closure and possible abnormal nasal air flow/resonance.
41
CNX = vagus nerve in re to speech
primarily responsible for elevation of the soft palate during velopharyngeal closure and possible abnormal nasal air flow/resonance. Responsible for vocal folds and vocal quality.
42
CNXII = hypoglossal nerve in re to speech
muscles of the tongue and articulation of lingual sounds e.g. “l” and “k”
43
Cortical speech planning and programming for speech occurs where
premotor cortex; supplementary motor area; Broca’s area; primary motor cortex
44
Control circuits for speech occurs where
subcortical structures including the basal ganglia control circuit and cerebellar control circuits
44
Direct activation pathway/UPPER MOTOR NEURONES for speech occurs where
corticobulbar tracts (CNs)
45
Final common pathway/LOWER MOTOR NEURONES for speech occurs where
: cranial nerves (CNs: V, VII, IX, X, XII).
46
The Corticobulbar tract (CBT)
* arises from primary motor cortex/M1 * passes through the Internal Capsule * for voluntary control of muscles for speech * known as upper motor neurones (UMNs) * synapses to lower motor neurones (LMNs) in CN nucleus in brainstem * LMNs then innervate muscles for speech: face, tongue, pharynx and larynx.
47
Upper Motor Neuron Lesion
Paralysis/paresis of muscle groups especially voluntary, skilled movements Hyperreflexia Some atrophy generally due to disuse Hypertonia Spastic paralysis
48
Lower Motor Neuron Lesion
Paralysis Hyporeflexia Pronounced atrophy -70-80% Hypotonia Flaccid paralysis
49
DYSARTHRIA
an umbrella term referring to speech movement disorders. Results in an abnormality in different aspects of movement including: strength, range, tone, accuracy of movement. refers to features of speech such as intonation, stress pattern, loudness variations, pausing, and rhythm
50
DYSPRAXIA/APRAXIA OF SPEECH
refers to impairment with the capacity to plan or program speech. - Inconsistent speech sound errors on consonants and vowels - The person may make several attempts to say a word before saying it correctly. - Disrupted and/or lengthened co-articulatory transitions between sounds and syllables. - Impaired prosody (or rhythm of speech) - Can see e groping movements with the jaw, lips or tongue to make the correct movement for speech sounds.
51
Spastic dysarthria
- Strained/strangled/harsh vocal quality - slow speaking rate - monopitch - monoloudness
52
Flaccid dysarthria
Breathy voice - Short phrases - Increased nasal resonance - Imprecise articulation.

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