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48 Cards in this Set
- Front
- Back
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OTT
Oral Transit Times |
1 - 1.5 seconds
When tongue begins backward mvmt of bolus to when the bolus head reaches the point where the lower edge of the mandible crosses the tongue base |
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PTT
Pharyngeal Transit Time |
.35 - .48 seconds - max 1 second
From trigger of the pharyngeal swallow to when bolus tail passes through the UES |
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Pharyngeal delay time
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Component of PTT
0 - .2 seconds over 60 years old average is .4-.5 sec When bolus head reaches the point where the lower edge of the mandible crosses the tongue base and ends when laryngeal elevation begins |
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ETT
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8-20 seconds
From when the bolus head enters the UES to when the tail of the bolus enters the stomach via the lower esophageal sphincter |
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Modified Barium Swallow
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Examines oral cavity, pharynx & larynx
Contrast btwn cavities See food transit Identifies disorders of the swallow mechanism Test different consistencies Identify treatment strategies |
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Barium Swallow
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Designed to examine transit of bolus from UES to LES
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Symptom
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Patient Experience
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Anatomic or neuromuscular disorders
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actual disorders that cause the symptoms
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Penetration
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Occurs when bolus enters the laryngeal vestibule but does not go through the true VF
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Aspiration
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Bolus enters the airway and goes below the true VF
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Oral Prep Stage
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food is mixed with saliva and brought into a cohesive ball (bolus) ready for the swallow
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Oral stage
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Tongue moves the bolus posteriorly in the mouth
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Oral Phase Swallowing Disorders
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Includes Oral Prep Phase and Oral Phase
Reduced oral sensation Apraxia of swallow Reduced lip closure Recuded buccal tension |
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Oral Phase Disorders
Lingual Impairments |
Reduced lateral tongue mvmt
Reduced tongue elevation Reduced tongue control/lingual shaping Reduced anterior-posterior tongue mvmt Decreased tongue ROM, coordination or strength Abnormal hold position Lingual discoordination Repetitive lingual rocking-rolling actions Piecemeal deglutition |
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Oral Phase Swallowing Disorders
Reduced Oral sensation |
Delay in initiating oral phase of swallow
Hold bolus: little/no tongue mvmt Lack recognition that something must be swallowed OR reduced oral sensatoin |
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Oral Phase Swallowing D/O
Apraxia of Swallow |
May be accompanied by severe oral apraxia
Searching mvmts by tongue Good ROM but unable to organize front to back lingual and bolus mvmt May hold bolus without initiating mvmts for swallow |
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Oral phase swallowing d/o
Reduced Lip closure |
May see food falling out of mouth, material falling into anterior sulcus
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Oral phase swallowing d/o
Reduced Buccal Tone |
Material may fall into lateral sulcus
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Oral phase Lingual D/O
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Any change in tongue action may result in penetration/aspiration before swallow
Struggling action results in food being spread throughout oral cavity, sometimes into pharynx & airway before swallow is triggered |
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Oral phase Lingual D/O
Abnormal hold position |
Holding bolus against teeth or on floor of mouth
Tongue Thrust- loose food anteriorly b/c bolus is held against front teeth |
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Oral phase Lingual D/O
Reduced Tongue Lateralization |
Patient difficulty lateralizing tongue to move bolus side to side in the oral cavity
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Oral phase Lingual D/O
Reduced Tongue elevation/strength |
May result in food clinging to roof of mouth, tongue, floor of mouth, or spreading throughout oral cavity
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Oral phase Lingual D/O
Reduced Tongue control/ Lingual Shaping & Fine motor control/ Reduced Linguavelar Seal |
Food falling onto floor of mouth or prematurely into pharynx
If pt is unable to shape tongue around bolus |
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Oral phase Lingual D/O
Decreased Tongue ROM, Coordination, or Strength |
Difficulty forming cohesive bolus with resultant loss into oral cavity
Foor may sit on tongue surface or hard palate and remain Reduced a-p tongue mvmt |
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Oral phase Lingual D/O
Lingual Discoordination |
When smooth front to back action is disrupted or broken in multiple small tongue movements
reduced a-p tongue mvmt inability to sequentially move food back against palate |
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Oral phase Lingual D/O
Repetitive lingual rocking-rolling action |
Parkinson's patients
Tip of tongue initiates swallow, but back of tongue doesn't lower to allow food to pass Bolus rolls forward, swallow is reinitiated and fails again |
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Oral phase Lingual D/O
Piecemeal Deglutition |
Pt swallows only one portion of bolus at a time (2-3 swallows to clear)
Sometimes normal if bolus is large (20-30 ml) May indicate fear of swallowing |
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Pharyngeal Swallow Delay
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Neuromuscular components begin when the bolus head reaches the point where the mandible crosses the base of the tongue
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Delayed Pharyngeal swallow
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Thin liquids more difficult
Vallecular/pyriform residue Risk for aspiration before and during the swallow |
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Pharyngeal Swallow Delay
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How to time delay:
Start when bolus head passes the point where the lower edge of the mandible crosses the tongue base and end when the sallow is triggered Delay of > 2 seconds is abnormal Young adult 0-.2 seconds Over 60 .4-.5 |
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Pharyngeal Stage D/Os
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Reduced velopharyngeal closure
Reduced laryngeal elevation Reduced airway/laryngeal closure Reduced pharyngeal contraction Reduced tongue base posterior mvmt Cervical osteophytes Unilateral pharyngeal wall weakness Scar tissue Delayed or absent swallowing reflex Cricopharyngeal dysfunction |
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Pharyngeal Stage D/Os
Delayed or absent swallow reflex |
When head of bolus enters pharynx and swallow has not been triggered
Food is often seen pooling in valleculae and or pyriforms Abnormal delay of 2 seconds Before: pooling After: residue |
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Pharyngeal Stage D/Os
Reduced VP Closure |
Nasal penetration during swallow
Food can backflow into nose if velum does not make contact with pharyngeal wall Can occur with reflux |
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Pharyngeal Stage D/Os
Cervical Osterphytes |
Bony outgrowths from cervical vertebrae
Narrow pharynx or may direct bolus toward airway Feelings of discomfort or as if "something is stuck" |
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Pharyngeal Stage D/Os
Unilateral pharyngeal wall weakness |
Residue on one side of the pharynx and pyriforms
Caused by food clinging to weak side Seen in A-P view |
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Pharyngeal Stage D/Os
Reduced pharyngeal contraction |
Coating on the pharyngeal walls after swallow caused by reduced contraction
Patient is at risk for aspirating pharyngeal residue |
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Pharyngeal Stage D/Os
Reduced Tongue base posterior mvmt |
Vallecular residue after swallow
Tongue base should normally move post to contact bulging pharyngeal wall If not, residue can stick in valleculae |
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Pharyngeal Stage D/Os
Scar tissue |
Coating in a depression on the pharyngeal wall
Fistula's often heal as a scar Risk for aspiration after swallow |
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Pharyngeal Stage D/Os
Reduced laryngeal elevation |
Causes residue at top of airway
Normally when swallow triggers, larynx elevated and moves ant to tuck itself under tongue base If larynx is in low position, pharyngeal contraction can't clear all of material from top of airway |
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Pharyngeal Stage D/Os
Reduced airway closure |
Caused by:
Larynx lifts inadequately Arytenoids fails to tilt forward Larynx lifts too slowly Delay in triggering of swalllow Causes penetration and aspiration after swallow |
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Pharyngeal Stage D/Os
Reduced airway/laryngeal closure |
If larynx doesn't close during swallow, material enters airway during the swallow
Causes aspiration during the swallow |
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Pharyngeal Stage D/Os
Cricopharyngeal dysfunction |
Residue in the pyriforms
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Esophageal Stage D/Os
Esophageal to pharyngeal backflow |
Achalasia-failure of the LES to relax
Tumor- within or outside esophagus (pressure, narrowing) Stenosis (narrowing or) |
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Esophageal Stage D/Os
GERD |
Aspirating gastric contents is more irritating to the lungs than food or saliva
Redness in arytenoid area, burning sensation, gagging or coughing after the swallow |
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Esophageal Stage D/Os
TE Fistula |
Hole btwn trachea and esophagus
Usually located 1st to 3rd thoracic vertebrae Food enters the esophagus and goes through hole into the trachea |
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Zenker's Diverticulum
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Side pocket that forms when the crichpharyngeus muscle herniates
Food collects in the pocket |
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Age related swallowing changes
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Oral stage: Loss of muscle tone, slowness in manipulation of bolus, tooth loss, reduced, desensitivity of taste, loss of appetite
Pharyngeal stage: Might take a little more time for the message to get to brain. Subtle- strength of contraction not as strong; decreased duration of CP opening Esophageal stage: Decreased peristalsis, presbyesophagus |
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General summary of when aspiration occurs
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Asp Before swallow:
Reduced tongue control Delayed swallow reflex Asp During Reduced laryngeal closure Asp After Residue Reflux |
