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96 Cards in this Set

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tipper is when the food is held between the ______ of the tongue and _______ with the tongue tip elevated and ______ the anterior alveolar ridge.
midline, hard palate, contacting
dippers hold the food
on the floor of the mouth in front of the tongue
approximately ____ percent of normal swallowers are dippers.
20%
prior to the initiation of the swallow, the material is pulled together in a cohesive ball and held together in either
the tipper or dipper position
the tongue thrust pattern is seen in adults with ______ damage and in children with _____
frontal lobe damage, CP
oral manipulation of thicker consistency - sides and front of the tongue sealed around the _________
maxillary alveolus
for mastication - involves a _____ ______ movement of the mandible and tongue
rotary lateral
When the upper and lower teeth have met and crushed the material, the food falls __________, which moves the material back on the _____ as the mandible _____
medially toward the tongue, teeth, opens
it has been postulated that the rhythmic movements of mastication are controlled by a _____
central pattern generator
_________ feedback is important in positioning the bolus on the teeth and preventing injury to the tongue while chewing
peripheral
tension in the ___ musculature prevents food from falling laterally ino the sulcus
buccal
after chewing, the tongue pulls the food into a _______ bolus or ball before the oral staage of swallow
semicohesive
during active chewing, what does the soft palate do?
it is NOT pulled down and forward and premature spillage is COMMON and NORMAL
premature spillage is normal during active chewing, but it is ________ during the hold phase before swallows of liquid and paste or pudding materials
NOT normal
as the bolus viscosity increases, the maximum volume swallowed
decreases
if larger volumes of thicker foods are placed in the mouth, the tongue ___________ the food after chewing
subdivides
what do the larynx and pharynx do during the oral preperatory stage of the swallow?
nothing, they are at rest.
the pharyngeal swallow _____ _____ in response to material accidentally entering the pharynx
rarely triggers
the oral stage of the swallow is initiated when
the tongue begins posterior movment of the bolus
oral phase - the midline of the tongue sequentially ______ the bolus posteriorly against the hard palate
squeezing
during the oral stage, the sides and tip of the tongue
remain firly anchored against the alveolar ridge.
during the oral phase, a _______ ______ is formed in the tongue
central groove
as food viscosity thickens, the _____ of the oral tongue against the palate _______, requiring
pressure, increases, requiring greater muscle activity
the oral stage of the swallow typically takes less than ___ to ____ seconds to complete.
1, 1.5 sec. it increases slightly as bolus viscosity increases
it is hypothesized that a ____ _____ center in the ______ in the nucleus tractus _______ decodes the incoming sensory information and identifies te swallow stimulus
sensory recognition, medulla, solitarus
this information is sent to the _________ which initiates the pharyngeal swallow motor pattern
nucleus ambiguous
when the leading edge of the bulus passes any point between the ______ and the point where the ______, the oral stage of the swallow is terminated and pharyngeal swallow should be triggered
anterior faucial arches, lower rim of mandible crosses tongue base
in younger individuals the triggering of the pharyngeal swallow ocurs at the
anterior faucial arch
what is the most sensitive place for elicitation of the pharyngeal swallow
the base of the anterior faucial pillars
the motor aspect of swallowing is carried by nerves
IX and X
possible contributers of the afferent portion are
V, VII, XII
abnormal swallowing is observed in patietns after damage to
cortical areas
what are the 6 things that happen when the pharyngeal swallow is triggered?
1. complete closure of the velopharyngeal port 2. elevation and anterior movement of the hyoid and larynx 3. closure of the larynx at all three sphincters 4. opening of the cricopharyngeal sphincter 5. ramping of the base of the tongue 6. progressive top to bottom contraction in the pharyngeal constrictors.
velopharyngeal closure enables the _______ in the pharynx
build up of pressure
the larynx and hyoid bone elevate and move anteriorly by the pull of the _____
floor of the mouth muscles (anterior belly of digastric, mylohyoid, geniohyoid, and the laryngeal elevator, the thyrohyoid)
in young men, the hyoid elevates approximately
2 cm.
the elevation of larynx contributes to the ______, and the forward movment contributes to the _______
closure of the airway entrance, opening of UES
the closure of the larynx is effected from __________, with the contents of the laryngeal vestibule being ______
below upwards, expressed into the pharynx
during closure of the airway, there is a _____ _______ and ____ rocking movement of the arytenoid cartilages, which narrows the laryngeal opening
downward, forward and inward
the elevation of the larynx ________ of the epiglottis
thickens the base, which assists with closure of the laryngeal vestibule
the laryngeal airway is closed for approx ___ during single swallows
1/3 to 2/3 of a second
vocal fold closure occurs when the larynx has elevated to approx ____ percent of its maximum elevation
50%
cicopharyngeal opening - first the tension inthe crigopharyngeal muscle is _____. approx .1 second later, the sphincter _______
released, opened
as teh pharyngeal swallow triggers, the tongue base assumes a ____ _____ directing the food into the pharynx
ramp shape
tongue base retraction and pharyngeal wall contraction occur when the bolus tail reaches the __________
tongue base level
the tongue base and pharyngeal walls should make ______ ________ during the swallow
complete contact
esophageal ______ takes over bolus propulsion
peristalsis
pressure generated by the tongue base retraction and pharytneal wall contraction increases as bolus ________ increases
viscosity
pressure is always applied to the _______ of the bolus
tail
there is no way to voluntarily initiate or modify ________
pharyngeal wall contraction
pharyngeal transit time is generally
1 second or less
the bolus usually divides at the
valleculae
approximately ___ percent of normal subjects swallow down only one side
20%
the purpose of the epiglottis is to
direct food around the airway
the two portions of the bolus join again at about the level of the
opening of the esophagus
normal esophageal transit varies from
8-20 seconds
the UES is a _____ and the LES is a __
musculoskeletal valve, muscular sphinter
in infants the ____ fills the oral cavity, and fat pads in the cheeks narrow the oral cavity
tongue
in infants, the velum
hangs lower
in infants, the uvula often is resting
inside the epiglottis
during the first ___ years of life, the face continues to grow
21
swallowing begins in the
fetus
infant pumps (2-7 pumps) and collects liquid in the
faucial arches or valleculae
for an infant, when a bolus of adequate size has been formed, the
pharygneal swallow triggers
if given small liquid bolus on a spoon, an infant usually produces
an oral then a pharyngeal swallow similar to that of an adult
the pharyngeal swallow of the infant is similar to that of an adult with two exceptions:
1. laryngeal elevation is reduced since larynx is already elevated 2. the posterior pharyngeal wall is seen to move much further anteriorly than adults
bite is achieved at __ months and chewing begins at _____ months
7, 10-12
once the infant moves to discrete swallows of pureed or soft foods, the oral and pharyngeal swallow physiology
is similar to that of an adult
in older individuals, there is an _____ in the number of chewing strokes used to prepare food for swalling
increase
with age _____ of the thyroid and cricoid cartilages and hyoid bone increases
ossificatoin
as adults reach age 70 and beyond, the larynx
may begin to lower in the neck, approaching the 7th vertibrae
arthritic changes in the ______ may impinge on the pharyngeal wall, decreasing its flexibility
cervical vertibrae
older swallowers tend to have a _______ pattern
more of a dipping
the ____ stage of swallowing in the older adults is slightly _____
oral, longer, (as is "normal" delay in triggerig the pharyngeal swallow)
penetration of material into the laryngeal vestibule is reported as ____________ with age, but there is ______ in aspiration in older adults
increasing, no increase
esophageal function with age
it deteriorates more significantly with age so that esophageal transit and clearance are slower and less efficient
in older men it was found that they had
reduced maximal laryngeal and hyoid anterior and vertical movement, indicating reduced neuromuscular reserve
in young men, after cricopharyngeal opening was attained, hyoid and laryngeal elevation _____ but ______ in old men
continued in young men but remained stable in old men
reserve is known as
the difference between necessary movment and actual motion
changes in cricopharyngeal opening from age:
reduced flexibility - less change as volume increased.
taste in elderly
loss of interest in nutritious food may develop in the elderly as taste sensation is affected
apneic period
the airway closure period when there is no respiration
the duration of airway closure tends to _________- as bolus volume increases
increase
the predominant pattern of coordination involves the swallow interrupting the __________ phase of the respiratory cycle
exhalatory
what are the two factors in making changes in teh oropharyngeal swallow?
1. characteristics of the food 2. volitional control
changes in _________ create the greates systematic changes in the oropharyngeal swallow
bolus volume
a large volume swallow is usually characterized by _________ oral and pharyngeal activity
simultaneous
as bolus volume increases, the timing of tongue base retraction to contact the anteriorly and medially moving pharyngeal walls occurs _______ in the swallow
later
as bolus viscosity increases, the pressure generated by teh oral tongue, tongue base, and pharyngeal wall _______
increases and muscular activity increases
cup drinking is characterized by ____ airway closure and some _____ preelevation of the larynx
early, early. airway closure extends across all of the sequential swallows
during cup drinking, the UES
opens repeadedly as each bolus approaches
straw drinking - to create suction -
the soft palate is lowered against the back of the tongue and the muscles of the cheek and face contract and create intraoral suction
in straw drinking - when material has reached the mouth
the suction is discontinued and the soft palate elevates as the oral stage of swallow is initiated by the tongue
it is likely that the patient is straw drinking inappropriately if
if the suction is timed with inhalation
if secretions are collecting in the pharynx or if there is chewing with premature spillage, which is building up in the valleculae and the pyriform sinuses, the individual may produce a ________ with little or no _____
pharyngeal swallow, oral swallow
components that must be present for a good swallow
1. oral propulsion of the bolus into the pharynx 2. airway closure 3. UES opening 4. tongue base - pharyngeal wall propulsion to carry the bolus through the pharynx and into the esophagus