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48 Cards in this Set
- Front
- Back
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What are the 4 stages of swallowing? How does the duration and characteristics of the phases vary? |
Oral preparatory Oral phase Pharyngeal Esophageal Duration and characteristics of phases depend on type, volume, voluntary of food swallowed |
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What is oral preparatory stage? (keep it brief) |
food manipulated, masticated, form into cohesive bolus for swallowing Bolus is chewed, manipulated, mixed with saliva |
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What is oral stage? (keep it brief) |
tongue propels food post until pharyngeal swallowing is triggered |
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What is pharyngeal stage? (keep it brief) |
begins when pharyngeal swallow triggered and bolus moved through pharynx |
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What is esophageal stage? (keep it brief) |
begin when esophageal peristalsis carries bolus through cervical and thoracic esophagus into stomach |
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Swallowing frequency |
Swallowing frequency vary by activity Mean deglutition is approximately 580 swallows per day Some records have shown sleep periods of 20 minutes or more when no swallow occurs |
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When is swallowing frequency the greatest? |
Swallowing frequency greatest during eating and least during sleeping |
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What characteristics does a patient need to have before initiating oral preparatory movement? |
important patient have sensory recognition of food approaching mouth and placed in mouth before oral prep movements can initiate |
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What type of control is oral preparatory phase under? How does it begin? |
Oral preparatory phase of swallow is under volitional control begins with placement of food/liquid in mouth |
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What type of disorder is most likely if patient doesn’t recognize good in mouth? Why? |
Dementia They don’t recognize the food or don’t know what to do with it. |
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What can you do to make patients more aware of the food in their mouth? |
Changing taste, temperature, smell, texture (may recognize more if there is more viscosity), making them hungry, let them feed themselves if possible |
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Why is the labial seal important for oral prep? |
Once food/liquid placed in mouth, labial seal is maintained to keep food/liquid from falling out of oral cavity |
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What happens to the nasal airway during oral preparatory phase? |
Nasal airway MUST be open for breathing while food manipulated |
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What happens to the buccal muscles during the oral preparatory phase? Why is this important? |
Buccal muscles tense to prevent pocketing of food in sulci |
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What happens to the liquid bolus during oral preparatory stage? |
Liquid bolus maintain certain degree of cohesiveness by being held between tongue and anterior hard palate |
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What are the 2 primary ways to main a cohesive bolus for liquids in the oral preparation stage? |
1. Liquid held between midline of tongue and hard palate, tongue elevated and contacting alveolar ridge (tipper)
2. Liquid held on floor of mouth in front of tongue (dipper) Tipper is the more common swallowing method |
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Why does palate close down during oral prep stage? |
1. So you can breath while eating 2. To keep the bolus in the oral cavity as patient is eating |
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Describe the oral manipulation of thicker consistencies in the oral preparatory stage |
Manipulation of thicker consistencies vary by individual Bolus held in tipper or dipper position Some individuals prefer manipulating bolus in mouth, lateralizing it, and masticating it before forming bolus into cohesive mass and initiating swallow |
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What type of movements are required for oral preparatory stage for solids? |
Oral prep requires rotary and lateral movement of mandible and tongue |
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Describe the oral manipulation for solids in the oral preparatory stage |
Tongue positions food on teeth Upper and lower teeth meet and crush solid material Food falls medially towards tongue Tongue moves material back onto teeth as mandible opens Cycle repeated as many times needed to form bolus and initiate swallow |
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During cycle of mastication, what happens to the food breaking down? |
tongue mix food with saliva to assist with breaking food down |
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why is sensory information through the peripheral nervous system important for oral preparatory? |
important in positioning food on teeth and preventing biting of tongue during chewing |
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Describe spillage during oral preparatory stage |
During chewing with solids, soft palate is pulled down and forward to prevent premature spillage Will see premature entry of solid bolus into pharyngeal area and normal on solids only Not normal when swallowing liquids or pudding/paste |
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Why is it normal for solid but not liquids or pudding/paste? |
Solids are going to be larger when forming bolus, so make room by bringing it into pharynx Less risky with solids, not as easy to aspirate with solids vs liquids |
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What is the bolus volume? |
Bolus volume varies depending on viscosity of food Larger vol subdivided into smaller boluses and remaining material stored in sides of mouth for later swallows |
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Why is it better to let the patient drink with their own hand? |
It’s better to hand the patient the cup to see how they drink (by sips or by guzzling?) |
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What happens to the pharynx and larynx during oral preparatory stage? |
During the oral preparatory stage thepharynx and larynx are at rest |
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What happens if thepatient loses bolus control during the oral preparatory stage of the swallow? |
materialdrops into the pharyngeal area and may continue on into the larynx Will aspirate if food spills into larynx (because it’s open and at rest) pharyngeal swallow rarely triggers atthis phaseRD |
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Why are sensory receptors in the oral cavity vital in the oral preparatory stage? |
toprovide information regarding bolus size, volume and shaperningdownloam |
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What is the duration of oral preparatory stage? What happens if food is not prepared properly before swallowing? |
duration of the oral preparatory stage vary with patients If food not prepared properlybefore swallowing, difficulties in other stages of swallowing. patient must have mental andphysical capabilities to prepare food appropriately beforeswallowing |
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When does the oral phase start? |
when tongue begin post movement of bolus Tongue movement is “stripping action”. = midline tongue sequentially squeezes bolus post against hard palate Central groove formed in tongue like ramp where food passes through as it moves posteriorly |
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What happens when viscosity of food thickens? |
more pressure from tongue reqired to propel material cleanly and efficiently through oral cavity Some researchers describe contribiion of negative pressure created by slight inward movement and increased tension of buccal musculature in moving bolus posteriorly |
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How long does the oral phase last? |
less than 1 to 1.5seconds to complete amount of time requiredincreases as the viscosity of the bolusincreases |
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When does the pharyngeal stage begin? |
as the oral stage ends and the tongue’s driving force pushes thebolus into the pharynx |
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What does normal oral pre and oral stage require? List them. |
Intactlabial musculature Intactlingual movement Intactbuccal musculature Normalpalatal muscles Abilityto breathe through the nose. |
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What happens if there are problems with intact labial musculature?
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Straw drinking would be hard Lip seal problems Stuff coming out Have trouble with straw drinking May be drooling |
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What happens if there are problems with intact lingual movement? |
Hard to move tongue back and forth to masticate bolus Transporting bolus back Breaking it down further Tongue isn’t strong enough to clear residue in lateral sulcus Harder to elevate tongue, easier to depress tongue (which makes it harder to manipulate bolus) |
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What happens if there are problems with intact buccal musculature? |
Keeping food in oral cavity (may fall into anterior/lateral sulci) Not have pressure we have to propel bolus posteriorly |
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What happens if there are problems with palatal muscles? |
Breathing Food/liquid can go up to nasal cavity (palate isn’t moving up) Increase risk of aspiration because food goes into pharynx |
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What happens if there are problems with ability to breathe through nose? |
can have something stuck in your airway (COPD patients often have this) |
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What is the difference between oral tongue and pharyngeal tongue? |
Oral - extend from tip to back, adjacent to vellum, function during oral stage Pharyngeal - extends from vellum to hyoid bone and valleculae and functions during pharyngeal stage |
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When does swallowing become a patterned response and less of a volitional control? |
Oncethe bolus reaches the back of the tongue and passes into the pharynx (throughthe faucialarches) |
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When is pharyngeal swallow triggered? |
When oral stage ends and when bolus “head” passes between faucial arches at point where tongue base crosses lower rim of mandible All patients should trigger pharyngeal swallow by the time the bolus head reaches area where themandible crosses tongue base triggered at different points depending on the patient’s age |
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When does pharyngeal swallow trigger for younger people? |
at anterior faucial archand no pause in bolus movement |
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When does pharyngeal swallow trigger for older adults? |
Olderadults over 60 trigger when bolus head reaches middle of the tongue base |
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What components are involved in a normal swallow for pharyngeal stage? |
Both voluntary and reflex components involved in normal swallow. Neither mechanism alone capable of producing swallow with regularity and immediacy, which is necessary during normal process of oral feeding |
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When does pharyngeal swallow begin? |
beginsas the pharyngeal swallow is triggered |
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What controls the triggering of pharyngeal swallow? What are the cranial nerves involved? |
Controlledby the medullary reticular formation or swallowing center in the brainstem Sensory nerves – CN IX, X, and XI Motor nerves – CN IX, X |
