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Organic & Neurogenic Comm Disorders > Swallowing & Dysphagia > Flashcards

Flashcards in Swallowing & Dysphagia Deck (20)
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Normal Swallow Anatomy

Nasal cavity
-Velopharyngeal valve

Oral cavity
-Oral tongue
-Tongue base

-Valleculae (space btwn tongue base & epiglottis)

-True vocal folds
-False vocal folds
-Epiglottis & aryepiglottic folds

-Pyriform sinuses (superior, medial, inferior pharyngeal constrictors)
-Pharyngeal recesses (pyriform sinus combined w velleculae - complete surround)

Upper esophageal sphincter (UES) - AKA cricopharyngeal muscle
-tightly closed at rest
-opens to allow food to pass


System of Valves

Lips – keep food in the mouth

Tongue – can close off the oral cavity by touching the roof of the mouth

Velopharyngeal valve


Epiglottis & aryepiglottic folds

False vocal folds

True vocal folds

Cricopharyngeus muscle (UES)


Stages of the Normal Swallow

Four phases:

Oral preparation stage

Oral stage

Pharyngeal stage

Esophageal stage


Oral Prep Stage

Beginning of oral prep
-Tongue, teeth, and jaws masticate food
-Soft palate
-Usually down when swallowing liquids

End of oral prep
-Tongue tip holds bolus against the alveolar ridge or
-Tongue tip holds the bolus on the floor of the mouth behind the teeth


Oral Stage

Begins when the bolus is positioned for swallowing

Midline of tongue pushes the bolus posterior to the faucial arches

Movement of the bolus sends sensory information to the brainstem which triggers the swallow


Pharyngeal Stage

Hyoid bone and larynx move up and forward

Velopharyngeal valve closes

Tongue base pushes back

Lateral and posterior pharyngeal walls move inward to meet the tongue base

Airway is closed

UES opens - Opened further by bolus

Peristalsis - wavelike motion that pushed the bolus through the pharynx and esophagus


Apnic pause

Normal process of swallowing

A temporary cessation of breathing while the epiglottis is closed for a swallow

0.3-0.7 seconds long


Swallowing in Infants

Tongue and jaw move together and then independently

Liquid collects in the valleculae

Liquid collects in the esophagus

Frequent backflow


Swallowing in Senior Adults

60 years and older:
-Oral prep - bolus is held behind the teeth
-Delayed pharyngeal swallow

80 years and older:
-Reduced laryngeal movement


Bolus Variations

Larger bolus – oral and pharyngeal stages overlap

Larger bolus – airway closure and UES opening time increase

As viscosity increases – muscle activity and pressure on the bolus increases


Oropharyngeal Swallowing Disorder

Can be:
Unilateral or bilateral

Structural, functional, and/or sensory deficits
-Can affect any one (or more) systems we previously discussed

Oral prep phase
Oral phase
Pharyngeal stage
Esophageal stage


Symptoms of a Swallowing Disorder

-Food enters the airway below the level of the true vocal folds
-Can result in aspiration pneumonia

-Food enters the airway, but doesn’t go past the level of the true vocal folds

-Food sits in or coats the oral cavity or pharynx


Causes of Swallowing Disorders

Neurologic diseases
Multiple sclerosis
Trauma – head or spine
Children with cerebral palsy


Dysphagia Evaluation

Step 1: Bedside or clinical assessment
-Case history
-Physical exam (oral mechanism evaluation)
-Assess either dry or food/liquid swallows

Step 2: Imaging


Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Can view the pharynx – before and after the swallow
Camera behind soft palate: can see
Base of tongue
Pharyngeal walls
Camera lower than sift palate: can see


Videofluoroscopic swallow study (VFSS)

Moving x-ray; exposes clinician and patient to low level of radiation

-Can view all stages except esophageal
-Give patient variety of food types: thin liquid, thick liquid, pudding, and chewable
-SLP and radiology present and read study results
-Barium is added to the food
-Patient viewed in lateral plane (sagittal)
-Swallow impairment also viewed anterior-posterior (front to back)
-Swallowing strategies are tested
-Goals of VFSS assess swallow and test treatment strategies


Treatment - Compensatory

-Strategies to improve safety of swallow

-Used when individual is expected to spontaneously regain normal function
Example: early recovery period from trauma

-Allows patient to eat orally until full functioning is restored

-Are controlled by the clinician

-Can be used with young children and cognitively impaired adults

-Require little to no effort from patient

-Include changes in posture, head or body position, stimulation (sensory) or changes in bolus volume and/or viscosity


Treatment - Postural Changes

Chin-down – narrows the airway entrance
-Valleculae widens and pushes the tongue base and epiglottis toward the pharyngeal wall

Chin-up – gravity pulls bolus towards the esophagus

Head rotation weak side – squeezes weak side directing food to strong side

Tilt head towards stronger side of the mouth – food flows to side of mouth that can control food better

Lying on back or side – keeps residue from falling into airway


Treatment - Swallowing Maneuvers

Supraglottic swallow – hold breath before and after swallow
-Closes true vocal folds before and after swallow- protects airway

Super-supraglottic swallow – hold breath with effort or while bearing down before and during the swallow
-Closes airway between arytenoid and base of epiglottis and false folds – added airway protection

Effortful swallow – using muscular effort while swallowing
-Increases posterior tongue base movement and increases pressure on the bolus

Mendelson maneuver – longer larynx elevated during the swallow


Treatment - Restorative

Restorative – strategies to improve swallow function

Swallowing exercises
Exercise improve range-of-motion and or coordination

Range-of-motion: lips, tongue, jaw, vocal folds, and laryngeal elevation

Coordination: tongue and jaw while chewing

When possible, start with compensatory and then use restorative