D1 Part 2

Front 1

tipper is when the food is held between the ______ of the tongue and _______ with the tongue tip elevated and ______ the anterior alveolar ridge.

Back 1

midline, hard palate, contacting

Front 2

dippers hold the food

Back 2

on the floor of the mouth in front of the tongue

Front 3

approximately ____ percent of normal swallowers are dippers.

Back 3

20%

Front 4

prior to the initiation of the swallow, the material is pulled together in a cohesive ball and held together in either

Back 4

the tipper or dipper position

Front 5

the tongue thrust pattern is seen in adults with ______ damage and in children with _____

Back 5

frontal lobe damage, CP

Front 6

oral manipulation of thicker consistency - sides and front of the tongue sealed around the _________

Back 6

maxillary alveolus

Front 7

for mastication - involves a _____ ______ movement of the mandible and tongue

Back 7

rotary lateral

Front 8

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 _____

Back 8

medially toward the tongue, teeth, opens

Front 9

it has been postulated that the rhythmic movements of mastication are controlled by a _____

Back 9

central pattern generator

Front 10

_________ feedback is important in positioning the bolus on the teeth and preventing injury to the tongue while chewing

Back 10

peripheral

Front 11

tension in the ___ musculature prevents food from falling laterally ino the sulcus

Back 11

buccal

Front 12

after chewing, the tongue pulls the food into a _______ bolus or ball before the oral staage of swallow

Back 12

semicohesive

Front 13

during active chewing, what does the soft palate do?

Back 13

it is NOT pulled down and forward and premature spillage is COMMON and NORMAL

Front 14

premature spillage is normal during active chewing, but it is ________ during the hold phase before swallows of liquid and paste or pudding materials

Back 14

NOT normal

Front 15

as the bolus viscosity increases, the maximum volume swallowed

Back 15

decreases

Front 16

if larger volumes of thicker foods are placed in the mouth, the tongue ___________ the food after chewing

Back 16

subdivides

Front 17

what do the larynx and pharynx do during the oral preperatory stage of the swallow?

Back 17

nothing, they are at rest.

Front 18

the pharyngeal swallow _____ _____ in response to material accidentally entering the pharynx

Back 18

rarely triggers

Front 19

the oral stage of the swallow is initiated when

Back 19

the tongue begins posterior movment of the bolus

Front 20

oral phase - the midline of the tongue sequentially ______ the bolus posteriorly against the hard palate

Back 20

squeezing

Front 21

during the oral stage, the sides and tip of the tongue

Back 21

remain firly anchored against the alveolar ridge.

Front 22

during the oral phase, a _______ ______ is formed in the tongue

Back 22

central groove

Front 23

as food viscosity thickens, the _____ of the oral tongue against the palate _______, requiring

Back 23

pressure, increases, requiring greater muscle activity

Front 24

the oral stage of the swallow typically takes less than ___ to ____ seconds to complete.

Back 24

1, 1.5 sec. it increases slightly as bolus viscosity increases

Front 25

it is hypothesized that a ____ _____ center in the ______ in the nucleus tractus _______ decodes the incoming sensory information and identifies te swallow stimulus

Back 25

sensory recognition, medulla, solitarus

Front 26

this information is sent to the _________ which initiates the pharyngeal swallow motor pattern

Back 26

nucleus ambiguous

Front 27

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

Back 27

anterior faucial arches, lower rim of mandible crosses tongue base

Front 28

in younger individuals the triggering of the pharyngeal swallow ocurs at the

Back 28

anterior faucial arch

Front 29

what is the most sensitive place for elicitation of the pharyngeal swallow

Back 29

the base of the anterior faucial pillars

Front 30

the motor aspect of swallowing is carried by nerves

Back 30

IX and X

Front 31

possible contributers of the afferent portion are

Back 31

V, VII, XII

Front 32

abnormal swallowing is observed in patietns after damage to

Back 32

cortical areas

Front 33

what are the 6 things that happen when the pharyngeal swallow is triggered?

Back 33

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.

Front 34

velopharyngeal closure enables the _______ in the pharynx

Back 34

build up of pressure

Front 35

the larynx and hyoid bone elevate and move anteriorly by the pull of the _____

Back 35

floor of the mouth muscles (anterior belly of digastric, mylohyoid, geniohyoid, and the laryngeal elevator, the thyrohyoid)

Front 36

in young men, the hyoid elevates approximately

Back 36

2 cm.

Front 37

the elevation of larynx contributes to the ______, and the forward movment contributes to the _______

Back 37

closure of the airway entrance, opening of UES

Front 38

the closure of the larynx is effected from __________, with the contents of the laryngeal vestibule being ______

Back 38

below upwards, expressed into the pharynx

Front 39

during closure of the airway, there is a _____ _______ and ____ rocking movement of the arytenoid cartilages, which narrows the laryngeal opening

Back 39

downward, forward and inward

Front 40

the elevation of the larynx ________ of the epiglottis

Back 40

thickens the base, which assists with closure of the laryngeal vestibule

Front 41

the laryngeal airway is closed for approx ___ during single swallows

Back 41

1/3 to 2/3 of a second

Front 42

vocal fold closure occurs when the larynx has elevated to approx ____ percent of its maximum elevation

Back 42

50%

Front 43

cicopharyngeal opening - first the tension inthe crigopharyngeal muscle is _____. approx .1 second later, the sphincter _______

Back 43

released, opened

Front 44

as teh pharyngeal swallow triggers, the tongue base assumes a ____ _____ directing the food into the pharynx

Back 44

ramp shape

Front 45

tongue base retraction and pharyngeal wall contraction occur when the bolus tail reaches the __________

Back 45

tongue base level

Front 46

the tongue base and pharyngeal walls should make ______ ________ during the swallow

Back 46

complete contact

Front 47

esophageal ______ takes over bolus propulsion

Back 47

peristalsis

Front 48

pressure generated by the tongue base retraction and pharytneal wall contraction increases as bolus ________ increases

Back 48

viscosity

Front 49

pressure is always applied to the _______ of the bolus

Back 49

tail

Front 50

there is no way to voluntarily initiate or modify ________

Back 50

pharyngeal wall contraction

Front 51

pharyngeal transit time is generally

Back 51

1 second or less

Front 52

the bolus usually divides at the

Back 52

valleculae

Front 53

approximately ___ percent of normal subjects swallow down only one side

Back 53

20%

Front 54

the purpose of the epiglottis is to

Back 54

direct food around the airway

Front 55

the two portions of the bolus join again at about the level of the

Back 55

opening of the esophagus

Front 56

normal esophageal transit varies from

Back 56

8-20 seconds

Front 57

the UES is a _____ and the LES is a __

Back 57

musculoskeletal valve, muscular sphinter

Front 58

in infants the ____ fills the oral cavity, and fat pads in the cheeks narrow the oral cavity

Back 58

tongue

Front 59

in infants, the velum

Back 59

hangs lower

Front 60

in infants, the uvula often is resting

Back 60

inside the epiglottis

Front 61

during the first ___ years of life, the face continues to grow

Back 61

21

Front 62

swallowing begins in the

Back 62

fetus

Front 63

infant pumps (2-7 pumps) and collects liquid in the

Back 63

faucial arches or valleculae

Front 64

for an infant, when a bolus of adequate size has been formed, the

Back 64

pharygneal swallow triggers

Front 65

if given small liquid bolus on a spoon, an infant usually produces

Back 65

an oral then a pharyngeal swallow similar to that of an adult

Front 66

the pharyngeal swallow of the infant is similar to that of an adult with two exceptions:

Back 66

1. laryngeal elevation is reduced since larynx is already elevated 2. the posterior pharyngeal wall is seen to move much further anteriorly than adults

Front 67

bite is achieved at __ months and chewing begins at _____ months

Back 67

7, 10-12

Front 68

once the infant moves to discrete swallows of pureed or soft foods, the oral and pharyngeal swallow physiology

Back 68

is similar to that of an adult

Front 69

in older individuals, there is an _____ in the number of chewing strokes used to prepare food for swalling

Back 69

increase

Front 70

with age _____ of the thyroid and cricoid cartilages and hyoid bone increases

Back 70

ossificatoin

Front 71

as adults reach age 70 and beyond, the larynx

Back 71

may begin to lower in the neck, approaching the 7th vertibrae

Front 72

arthritic changes in the ______ may impinge on the pharyngeal wall, decreasing its flexibility

Back 72

cervical vertibrae

Front 73

older swallowers tend to have a _______ pattern

Back 73

more of a dipping

Front 74

the ____ stage of swallowing in the older adults is slightly _____

Back 74

oral, longer, (as is "normal" delay in triggerig the pharyngeal swallow)

Front 75

penetration of material into the laryngeal vestibule is reported as ____________ with age, but there is ______ in aspiration in older adults

Back 75

increasing, no increase

Front 76

esophageal function with age

Back 76

it deteriorates more significantly with age so that esophageal transit and clearance are slower and less efficient

Front 77

in older men it was found that they had

Back 77

reduced maximal laryngeal and hyoid anterior and vertical movement, indicating reduced neuromuscular reserve

Front 78

in young men, after cricopharyngeal opening was attained, hyoid and laryngeal elevation _____ but ______ in old men

Back 78

continued in young men but remained stable in old men

Front 79

reserve is known as

Back 79

the difference between necessary movment and actual motion

Front 80

changes in cricopharyngeal opening from age:

Back 80

reduced flexibility - less change as volume increased.

Front 81

taste in elderly

Back 81

loss of interest in nutritious food may develop in the elderly as taste sensation is affected

Front 82

apneic period

Back 82

the airway closure period when there is no respiration

Front 83

the duration of airway closure tends to _________- as bolus volume increases

Back 83

increase

Front 84

the predominant pattern of coordination involves the swallow interrupting the __________ phase of the respiratory cycle

Back 84

exhalatory

Front 85

what are the two factors in making changes in teh oropharyngeal swallow?

Back 85

1. characteristics of the food 2. volitional control

Front 86

changes in _________ create the greates systematic changes in the oropharyngeal swallow

Back 86

bolus volume

Front 87

a large volume swallow is usually characterized by _________ oral and pharyngeal activity

Back 87

simultaneous

Front 88

as bolus volume increases, the timing of tongue base retraction to contact the anteriorly and medially moving pharyngeal walls occurs _______ in the swallow

Back 88

later

Front 89

as bolus viscosity increases, the pressure generated by teh oral tongue, tongue base, and pharyngeal wall _______

Back 89

increases and muscular activity increases

Front 90

cup drinking is characterized by ____ airway closure and some _____ preelevation of the larynx

Back 90

early, early. airway closure extends across all of the sequential swallows

Front 91

during cup drinking, the UES

Back 91

opens repeadedly as each bolus approaches

Front 92

straw drinking - to create suction -

Back 92

the soft palate is lowered against the back of the tongue and the muscles of the cheek and face contract and create intraoral suction

Front 93

in straw drinking - when material has reached the mouth

Back 93

the suction is discontinued and the soft palate elevates as the oral stage of swallow is initiated by the tongue

Front 94

it is likely that the patient is straw drinking inappropriately if

Back 94

if the suction is timed with inhalation

Front 95

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 _____

Back 95

pharyngeal swallow, oral swallow

Front 96

components that must be present for a good swallow

Back 96

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