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110 Cards in this Set

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What are the three muscles that make up the floor of the mouth?
Mylohyoid, Geniohyoid, Anterior Belly of the Digastric
The oral tongue is the portion of the tongue from the tip to the…
Circumvallate Papillae (or under the uvula if you have to visualize it on X-Ray)
Why separate the oral tongue and base of tongue when discussing them?
Because they are controlled differently. The oral tongue is cortically controlled and innervated by CN XII (hypoglossal) and the base of tongue is controlled by the brainstem and innervated by CN X (Vagus)
The brainstem has portions for the sensory and motor innervation of the muscles of swallowing. What are they?
Both in the Medulla: Sensory - Nucleus Tractus Solitarus Motor - Nucleus Ambiguus
Why do we say that the epiglottis is controlled by biomechanical forces?
Because it's movement is due to the movement of other structures. The lifting of the larynx pinches the base of the epiglottis and tongue base retraction forces it to fold over.
What are the motions of the arytenoids when you swallow?
They rotate in to adduct the vocal folds. They also tilt forward to come into contact with the base of the epiglottis. This scrunches the aryepiglottic folds and false vocal folds together to close the entrance to the airway.
How far does the larynx lift during swallowing in young adults? As you age?
In men - about 2 cm In women - about 1.5 cm As you age, it lifts less and less (you lose your reserve...to about 1.5 cm in men)
What are the three levels of airway protection in order of occurrence? What is the most important?
1. Adduction of true vocal folds (most important!) 2. Closure of airway entrance (false vocal folds and aryepiglottic folds) 3. Epiglottic descent
What types of things protect your body if you penetrate? Aspirate?
1. Penetration - you may not aspirate because the larynx closes from the bottom up. If some material makes it to the true folds, it is often pushed back up and out by this closure pattern. 2. Aspiration - you may be able to cough the material out if you feel it. Otherwise, ciliary action may move material up to a level where you can cough it out. Finally, some of it gets resorbed in the lungs.
Why is the Glossopharyngeus important for swallowing?
It is the lowest part of the pharyngeal constrictor muscle and is responsible for anterior movement of the pharyngeal wall as well as tongue base contraction. 2/3 of this movement is done by the tongue base.
What is the different between tippers and dippers?
Tippers hold the bolus on their tongue and propel it back by sequential compression of the tongue against the hard palate in a backward direction. Dippers hold the bolus on the floor of their mouth. At the initiation of the oral stage of the swallow, the tongue tip scoops under it and propels it back in a smooth movement. About 20% of normal swallowers are dippers - this percentage increases with age.
Explain tongue base retraction - when and how does it happen?
The tongue base retracts to meet the anteriorly moving posterior pharyngeal wall once the tail of the bolus reaches the base of the tongue. This is accomplished by contraction of the glossopharyngeal muscle. It happens later and later with increasing bolus volume because you don't want to shoot the food in the wrong direction.
What are the steps in opening the UES?
1. The Cricopharyngeal Muscle relaxed (remember, it is tonically contracted during waking hours) 2. The larynx elevates and moves forward pulling the spincter open 3. As the bolus head enters the UES, it widens the opening further
Why isn't myotomy a perfect solution for patients who have trouble opening the UES?
Because in many patients, relaxation of the muscle isn't actually the main problem. They may have problems with laryngeal elevation. A myotomy only gets you part of the way there - by decreasing the tension of the CP muscle. Unfortunately, this also means that the CP can no longer serve as a valve and air will get into the esophagus as well as food coming back out.
Which stages of swallowing are volitional? What about the other stages?
The oral preparatory and oral stages of swallowing. While the pharyngeal stage is controlled by the brainstem, you can take some voluntary control over it. For example, you can do a Mendelsohn Maneuver, you can inject air to use for esophageal speech, etc. But we REALLY can't see to take volitional control over the pharyngeal walls.
What is the most important pressure generator in the pharyngeal swallow?
The tongue base
Why do we call the UES a biomechanical valve? What about the LES?
The UES is a biomechanical valve because it is physically PULLED open by movement of other structures. The LES is a muscular valve - a circle of muscles differentiating the esophagus and the stomach.
In the pharynx, we don't call it peristalsis, we call it ____________. Why?
Sequential Contraction or Pharyngeal Stripping Wave. It is not peristalsis because the pharynx is not a muscular tube. The constrictor muscles attach to other structures in the front instead of forming and inclusive tube.
How does chewing develop?
Children start by vertical mashing and vertical tongue motion. Then, as you age, you develop rotary action of the tongue and jaw.
The two major symptoms of swallowing disorders are…
Aspiration and Residue
Why is residue a problem?
1. You can aspirate on residue after the swallow 2. You have to swallow several times in order to get the same amount of food you should get from one swallow - this means it is more work. You will eat less and won't get adequate nutrition.
What are the changes of swallowing that occur with age?
1. You lose laryngeal reserve (women seem to preserve it better than men) 2. You lose strength - we see a bit more residue in those over 60 3. The Swallow slows down - longer transit times 4. Slower reaction times - leads to delay in triggering pharyngeal swallow.
What is the trigger point of the pharyngeal swallow?
The point where the bottom of the mandible crosses the base of the tongue. When the bolus head reaches this point, a pharyngeal swallow should be triggered as evidenced by elevation of the hyoid and the rest of the swallow. If not, it is said to be delayed. A short delay is normal in older individuals.
Where are the locations of tonsil tissue in the head and neck?
1. Lingual Tonsils - at the base of the tongue. They resorb as you age. 2. Palatine Tonsils - Between the anterior and posterior faucial arches (what we call the tonsils) 3. Adenoids - At the pharyngeal wall about the level of the soft palate. Likely help with velopharyngeal closure - when they are removed you may be hypernasal at first but people tend to adjust quickly
Rank the three functions of the larynx in order of what is most physiologically necessary. Why is this important to think about?
1. Respiration 2. Swallowing 3. Phonation This is vital because you worry about them in that order. If a patient cannot breathe, that is the primary concern and you hold on the other two. Likewise, swallowing should be addressed before speech.
What is the name for a bony structure sticking out of the vertebrae? Does it affect swallowing?
An osteophyte (usually we see Cervical Osteophytes) - it MAY get in the way of the bolus. It is generally left alone unless it is posing a problem - then try postural changes or surgery if needed.
People normally close their mouths when they chew. If your patient does not, what do you need to do?
Check to see if they can breathe through their nose.
Once you put the food in your mouth, the tongue organizes it for the following possibilities:
1. Swallow (liquids) 2. Chew and swallow (non-liquids) 3. Divide and swallow (large volumes of liquid) 4. Chew, divide, and swallow (large volumes of non-liquid)
What happens to volume when viscosity increases?
When bolus viscosity increases, the amount you swallow at one time decreases. For instance, you MAY swallow about 20 ml of liquid at once, but generally only about 5 cc of pudding.
What is our natural protection about swallowing too much at once?
The Gag Reflex
In addition from swallowing too big of a bolus at once, the gag reflex protects us against…
Reflux - if you wake in the night gagging or coughing you may have reflux. Great to ask parents about how their child is sleeping - it is a red flag for reflux.
The Pharyngeal Swallow is triggered by the Medulla and what happens?
1. Velopharyngeal Closure - brief period as bolus passes by the velum into the pharynx. 2. Relaxation of the Cricopharyngeus Muscle. 3. Hyoid and larynx move up and forward 3. UES is pulled open by biomechanical forces 4. Airway closure (three levels) 5. Epiglottic descent directs bolus AROUND airway 6. Tail of bolus reaches base of tongue 7. Tongue base retraction / pharyngeal wall mov't 8. Bolus driven through UES widening it
What are the three options for material in the pharynx before a pharyngeal Swallow is triggered? What helps determine where it goes?
1. It may stall in the valleculae 2. It may go down into the pyriform sinuses 3. It may fall into the open airway (Depends on head position, volume, and viscosity)
Factors in Pharyngeal Delay
1. Seen more in older individuals as reaction time slows - but does not continue to worsen with age 2. Seen in patients with tongue resection - less sensory input to trigger the swallow? 3. Delay may be related to brainstem only or cortex as well - we don't know yet. 4. A common symptom - more problems with liquids but not thicker foods.
More difficulty with liquids rather than thicker foods is a symptom of what?
Delay triggering the pharyngeal swallow
What happens if the bolus slides into the pyriform sinuses before the pharyngeal swallow is triggered?
As the larynx elevates, the pyriform sinuses are shortened and material may spill out of them into the airway.
Why is aspiration such a big issue with the elderly population?
Pneumonia is the most common cause of death for elderly folks and aspiration is the most common cause of pneumonia.
What happens in sequential cup drinking?
You keep your airway closed and swallow repeatedly - need to have good lungs for this because you're holding your breath a little while.
What happens in chugging?
You voluntarily open the UES, keep it open, and just dump the liquid down.
What changes occur with larger volumes?
1. Longer airway closure 2. Longer transit time 3. Longer UES opening 4. Progressively wider opening of the UES 5. Volume is a bigger issue than viscosity.
What changes occur with increased viscosity?
1. Slower transit time as material gets thicker 2. Wider opening of the UES 3. As viscosity increases, the volume swallowed at once decreases
What percentage of people evaluated are silent aspirators?
40-50%
What does Dysphagia care include?
Screening, diagnosis, and therapy
What is a screening?
Screening is identifying people at high risk for dysphagia
What is diagnosis?
Diagnosis defines anatomic/physiologic abnormalities and assesses treatment
The Oral Stage of swallowing takes _____ (time) and involves what?
1 second. Sequential anterior to posterior contact of the midline of the tongue with palate - this propels the bolus backward to pharynx. Tongue tip and lateral margins of the tongue maintain contact with anterior and lateral alveolar ridge sealing bolus on the midline of the tongue.
SIGNS/SYMPTOMS: Tongue pushes food forward No aspiration (What stage is this? What is the disorder?)
Oral Prep or Oral Stage. DISORDER: Abnormal Hold Position; Tongue Thrust (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Loss of Material From the Mouth No aspiration (What stage is this? What is the disorder?)
Oral Prep or Oral Stage. DISORDER: Reduction in lip closure (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Loss of material in lateral sulcus No aspiration (What stage is this? What is the disorder?)
Oral Prep or Oral Stage. DISORDER: Reduction in cheek tension; paralysis/scarring of cheeks (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Food sitting in the mouth No aspiration (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Delay in Initiating Oral Swallow (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Tongue Struggling Action Aspiration possible before swallow (What stage is this? What is the disorder?)
Oral Prep or Oral Stage. DISORDER: Reduced Tongue Tip Stabilization (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Inability to lateralize food/chew Aspiration possible before swallow (What stage is this? What is the disorder?)
Oral Prep or Oral Stage. DISORDER: Reduction in ROM of Tongue Movement Laterally (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Reduced anterior to posterior tongue movement. Aspiration possible before swallow. (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Reduced Range of Anterior-Posterior Tongue Movement (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Lingual Pumping / Rocking Aspiration possible before swallow (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Abnormal Pattern of Tongue Movement: Parkinson's Disease (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Flat Tongue Posture/Minimal Movement Aspiration possible before swallow (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Abnormal Pattern of Tongue Movement: Dementia (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Incomplete tongue to palate contact, residue on tongue or HP, disturbed lingual peristalsis, material falls into anterior/lateral sulcus. Aspiration possible before swallow (What stage is this? What is the disorder?)
Oral Prep or Oral Stage. DISORDER: Reduced Tongue Elevation (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Delayed Onset of Oral Transit, Material Remains in Mouth Aspiration possible (before) (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Reduction in Oral Sensitivity (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Random Discoordinated Tongue Mov't, Difficulty Initiating Oral Stage Aspiration possible before swallow (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Apraxia of Swallow (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Residue left on palate increasing as bolus viscosity increases No aspiration (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Reduced Tongue Strength (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Normal range of motion but tongue movement is disrupted (like in CP) Aspiration possible before the swallow (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Reduction in Tongue Coordination (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Depression collecting material which worsens with tongue movement No aspiration (What stage is this? What is the disorder?)
Oral Stage. DISORDER: Tongue Scarring (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Material passes base of tongue and no pharyngeal swallow is triggered Aspiration possible before swallow (What stage is this? What is the disorder?)
Triggering the Pharyngeal Stage. DISORDER: Delayed or Absent Pharyngeal Swallow (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Food comes out the nose No aspiration unless something is going on lower down as well... (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Reduced Velopharyngeal Closure (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Reduced bolus propulsion, residue in valleculae, multiple swallows per bolus Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Reduced Posterior Base of Tongue Movement (Glossopharyngeus!) (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Residue on one side of valleculae and pyriform sinus, Multiple swallows/bolus Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Unilateral Pharyngeal Wall Dysfunction (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Residue on pharyngeal walls and pyriform sinus, multiple swallows/ bolus Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Reduced Pharyngeal Wall Constriction (Bilateral) (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Residue on top of airway (under epiglottis, on top of arytenoid), multiple swallows per bolus Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Reduced Laryngeal Elevation (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Residue in laryngeal vestibule Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Reduced Closure of Laryngeal Vestibule (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Coughing, Throat Clearing, Material entering airway unimpeded. Aspiration possible DURING the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Reduced Laryngeal Closure (Reduced Adduction or Unequal Height of VF) (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Coughing, Throat Clearing, Material pooling in pyriform sinuses. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Cricopharyngeal Dysfunction; Reduced Anterior Laryngeal Movement (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Bony outgrowth from cervical spine resulting in narrowing of pharynx at the level of the osteophyte/arthritis (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Cervical Osteophyte or Cervical Arthritis (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Reduced pharyngeal contraction and residual material in pharyngeal recesses. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Scar Tissue on Pharyngeal Wall (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Pocket where food collects and enlarges with swallow - in total laryngectomee (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Pseudo-epiglottis (following total laryngectomee) (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Enlargement of arytenoid; Residue in pharynx. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Rheumatoid Arthritis of Crycoarytenoid Joint (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Collection of material into diverticulum with later backflow into pharynx or esophagus. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Zenker's Diverticulum (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Perception of "something in the throat" (What stage is this? What is the disorder?)
Pharyngeal Stage. DISORDER: Swelling in valleculae (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Material flowing from esophagus through fistula into trachea. Coughing my occur after swallow. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Esophageal Stage DISORDER: Tracheoesophageal Fistula (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Failure of LES to relax, collection of food in esophagus creating air/fluid level in esophagus; backflow of food from esophagus into pharynx. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Esophageal Stage DISORDER: Achalasia (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Failure of LES to remain CLOSED. Food reenters esophagus from stomach; may lead to backflow of food from esophagus to pharynx. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Esophageal Stage DISORDER: Reflux Disease (What are the signs/symptoms? Will aspiration occur and when?)
SIGNS/SYMPTOMS: Narrowed area of the esophagus, material sits in esophagus about stenoisis. Aspiration possible after the swallow (What stage is this? What is the disorder?)
Esophageal Stage DISORDER: Esophageal Stenosis (What are the signs/symptoms? Will aspiration occur and when?)
What types of things cause esophageal stenosis?
Chemo-radiation, drinking caustic substances, or congenital
How do you achieve velopharyngeal closure?
1) Upward / backward movement of the soft palate 2) Forward motion of posterior pharyngeal wall 3) Inward movement of lateral pharyngeal wall 4) Adenoid pads 5) Passivants Pad
Why should you always ask your patients if their diet has changed / if they are eating everything?
Because sometimes they will begin elimitating foods from their diet when they are having trouble. Example - patients with ALS will eliminate thicker foods (they take more work!!) moving to progressively thinner and thinner foods.
When would you call a swallow "absent"?
If you wait for 30 seconds once the bolus has passed the trigger point, and no pharyngeal swallow occurs. But remember that after 10 seconds you are running the risk of aspiration because the patient needs to BREATHE!
How do we rate the severity of a pharyngeal delay?
1-2 second delay - may be WNL for older patients Up to 5 seconds - Mild 6-10 seconds - Moderate 11+ seconds - Severe
What is generally the ONLY cause of aspiration DURING the swallow?
Reduced laryngeal closure - reduced adduction or unequal height of vocal folds
What is a red flag for reflux in infants?
When they aren't sleeping well
How do we modify volume in the cookie swallow test?
We go from a small volume to bigger and bigger - you move up if there is not too much residue / no aspiration. 1 ml - 3 ml - 5 ml - 10 ml Finally, cup-drinking (With pudding, we just do 3 ml - remember you swallow less when food is thicker) Finally two pieces of 1/4 of a Lorna Doone Cookies
How many swallows do we have total in the basic cookie swallow test?
14 - 10 with liquid, 2 with pudding, 2 with cookies
If your patient is aspirating, what are some things you can change?
1) Sensory Heightening - temp or texture 2) Postural Techniques 3) Voluntary changes - like Mendelsohn Maneuver 4) Viscosity - the last choice. Patients don't like it and remember that thicker foods are harder to get out!
What are the two main objectives of a cookie swallow test after you determine what the disorder is?
1) What can we do for the patient to eat safely NOW 2) What is the plan for improving swallowing so they won't have to use those modifications forever.
What are the two types of disorders for which SENSORY STRATEGIES are useful? Why?
Oral transit / patient recognizing food; Triggering the Pharyngeal Swallow. This is because these parts of the swallow are sensory in nature. Once the pharyngeal swallow is triggered, the sensory portion is done and motor takes over.
What are the five postures?
Chin tuck/down; head rotated; head tilted; chin up; lying down
Explain the Chin Tuck posture and why you would use it…
You touch your chin to the front of your neck. This brings the tongue base to rest closer to the pharyngeal wall and also widens the valleculae (more storage!). This will help with patients with reduced tongue base motion. Also narrows airway so it may help with patients who have trouble with airway closure.
Explain the Head Rotated posture and why you would use it…
When you have a unilateral laryngeal or pharyngeal weakness, you rotate toward the DAMAGED side. This will close off the damaged side and force the food down the intact side.
Explain the Head Tilted posture and why you would use it…
The patient tilts their head to the better side. Gravity will then pull the bolus to the better side. This works for unilateral weakness of the both the mouth and pharynx.
Explain the Chin Up posture and why you would use it…
* Be cautious first - this lines you airway up so it would be easier to aspirate. This is fine as long as the airway is protected. Use this with patients who have trouble with tongue function and can't propel the food back. They need to have a functional pharyngeal swallow. Tell the patient to hold their breathe, toss head back, and swallow.
Explain the Lying Down posture and why you would use it…
SO, with patients who have reduced laryngeal lifting food ends up sitting on the larynx. If the patient is laying down, the residue will slide off the top of the airway (or at least not fall down into it). Then you can try another swallow to clear it.
What were the major findings of Kirchner (1967) - Pharyngeal and Esophageal Dysfunction?
(Who found the following?) That you need to remember that disorders of swallowing can occur anywhere along the track (oral to pharyngeal to esophageal tract). Also that the X-Ray is one of the best things you can do. Found that usually the patient can localize the level of the disorder with guidance (except some other studies contradict that).
What were the major findings of Jones et al. (1985) - Pharyngoesophageal Interrelationships: Observations and Working Concepts?
(Who found the following?) Patients are NOT generally able to pinpoint site of lesion when the esophagus is involved (may claim it is the pharynx). Also, there are often simultaneous conditions of pharynx and larynx. A cricopharyngeal prominence may signal esophageal abnormalities - segmental spasm, GERD, partial obstruction. Other issues with GERD include: laryngeal granuloma, posterior laryngitis, contact ulcers.
What were the major findings of Kahrilas, Dodds, Dent, Logemann, and Shaker (1988) - Upper Esophageal Sphincter Function During Deglutition?
(Who found the following?) The high pressure zone of the UES is the area of the Cricopharyngeaus Muscle. This sphincter moves 2-2.5 cm orally during swallowing. Maximum diameter is 0.9-1.5 cm (related to volume swallowed). UES is open longer with larger volumes. Larger bolus = longer and wider opening
What were the major findings of Jacob, Kahrilas, Logemann, Shah, & Ha (1989) - Upper Esophageal Sphincter Opening and Modulation During Swallowing?
(Who found the following?) Relaxation of the CP occurs about 0.1 s before opening. Opening occurs as hyoid pulls up and forward. Distension is modulated by intrabolus pressures - larger bolus = increased velocity and pressure. The sphincter opens as a result of BIOMECHANICAL FORCES. Transport of larger boluses are accomplished by 1) Modulating diameter, 2) Prolonged opening, and 3) Bolus head velocity/flow rate.
What were the major findings of Kahrilas, Logemann, Lin, & Ergun (1992) - Pharyngeal Clearance During Swallowing: A combined manometric and videofluoroscopic study?
(Who found the following?) Two major forces during the pharyngeal swallow are: 1) Pharyngeal shortening (stylopharyngeus and hyoid elevators) - brings the UES close to the base of the tongue. 2) Horizontal wall contraction - when the tail passes the base of the tongue. The base of the tongue contracts. Mostly for residue clearance. (Bolus propulsion more the job of the oral tongue pushing...)
What were the major findings of Reimer-Neils, Logemann, and Larson (1994) - Viscosity Effects on EMG Activity in Normal Swallow?
(Who found the following?) High Bolus Viscosity leads to a delay in oral and pharyngeal bolus transit, decrease in velocity of lingual peristalsis, increase in the duration of the pharyngeal stripping wave, prolongation of UES opening, greater maximum and average EMG activity - ITS MORE WORK when things are thicker. (Submental muscles tend to initiate a swallow and infrahyoids end it...)
What were the findings of Logemann, Pauloski, Rademaker, Colangelo, Kahrilas, and Smith (2000) - Temporal and Biomechanical Characteristics of Oropharyngeal Swallow in Younger and Older Men?
(Who found the following?) After 80, men show longer pharyngeal delay (0.6-0.7 seconds) but does not continue to worsen with age. Also have reduced maximum vertical and anterior hyoid movement - LOSS OF RESERVE, and less UES flexibility.
What were the findings of Logemann, Pauloski, Rademaker, & Kahrilas (In Press) - Oropharyngeal Swallow in Younger and Older Women?
(Who found the following?) Older women tend to use increase ROM when compared to younger women. They do have less tongue base motion. UES opening is longer in women over 80, they close their larynx earlier, and their movement increases - PRESERVATION OF RESERVE. Longer airway closure as well.
What were the findings of Langmore, Schatz, & Olsen (1988) - Fiberoptic Endoscopic Examination of Swallowing Safety: A New Procedure?
(Who discussed the following?) The idea that over 40% of patients are silent aspirators, and we need to be able to identify them QUICKLY and in a cost-effective way. Using Dyed bolus, you can see whether aspiration occurs prior to swallow or if residue remains. You can also test for sensitivity to predict who would be a silent aspirator. Also - no radiation hazard!!
What were the findings of Stone and Shawker (1986) - An Ultrasound Examination of Tongue Movement During Swallowing?
(Who found the following?) Can use ultrasound to evaluate tongue movement / oral stage of swallowing. There is no radiation and you can see the actual movement of the tongue surface (not just the bolus). Can watch transverse and longitudinal wave movements. The Tongue blade is most active during the hyoid's ascent.
What were the findings of Splaingard, Hutchins, Sulton, & Chaudhuri (1988) - Aspiration in Rehabilitation Patients: Videofluoroscopy Vs. Bedside Clinical Assessment
(Who found the following?) Remember than many are SILENT aspirators. But even though videofluoroscopy is expensive, it identifies patients at risk for aspiration. In 25% of cases, bedside eval led to patient being allowed to eat a consistency he aspirated on X-ray. Bedside eval is not specific or sensitive to detecting aspiration in rehab setting.
What were the findings of Martin-Harris, Logemann, McMahon, Schleicher, & Sandidge (2000) - Clinical Utility of the Modified Barium Swallow?
(Who found the following?) MBS good for identifying swallowing pathophysiology. Gives information about the nature of the impairment, timing of aspiration, and therapeutic strategies to help. Also gives information needed to make referrals, develop compensatory strategies, make decisions about nutritional intake abilities, make diet recommendations, make therapy recommedations.