Swallowing Stages
As bolus viscosity ___________, bolus volume swallowed ___________.
As bolus viscosity increases, bolus volume swallowed decreases.
Which of the following instrumental assessment tools provides the most direct dynamic view of velopharyngeal movement during speech?
A. Nasopharyngoscopy
B. FEES
C. MBS
D. Manometric assessment
a. Nasopharyngoscopy
What cranial nerve is responsible for the labial seal?
Cranial Nerve 7- Facial
Obicularis oris muscle
Which of the following is not a disorder of the pharyngeal phase of the swallow?
a. decreased laryngeal elevation
b. reduced tongue base retraction
c. decreased upper esophageal sphincter (UES) opening
d. premature spillage over the base of the tongue
D
What step did Daniels & Huckabee add to the normal swallow?
Pre-Oral stage
**anticipatory stage
What are the stages to the normal swallow? Give a brief explanation of what happens in each.
1. Oral Prep: labial seal, open VP port, mastication
2. Oral transit: tongue to hard palate, tip and sides maintain firm with alveolar ridge, central groove formed, velar elevation, tongue ramp begins
3. Pharyngeal phase: vp closure, tongue base ramps and retracts, posterior pharyngeal wall bulging/pharyngeal stripping, hyolaryngeal elevation, laryngeal vestibule closure, UES opening
4. Esophageal: UES to LES
Which of the following is considered an exercise with dysphagia and should not be performed with food?
A. Masako maneuver
B. Supraglottic swallow
C. Mendelsohn maneuver
D. Effortful swallow
A. Masakao maneuver
What cranial nerves are responsible for opening the VP port?
CN 5 Trigeminal- tensor veli palatine, general sensory
CN 10 Vagus- muscularis uvuale
CN 9 glossopharyngeal- special sensation (taste), general sensation
For which of the following swallowing disorders would it be inappropriate to recommend tilting the head to the strong side?
a. unilateral weak pharyngeal constriction
b. decreased laryngeal elevation
c. decreased UES opening
d. incomplete epiglottic inversion
A.
If a patient has unilateral weak pharyngeal constriction, it would be more appropriate to recommend that they turn their head to the weak side, rather than tilting it to the strong side.
Which cranial nerves are involved with swallowing?
5, 7, 9, 10, 12
Trigeminal, facial, glossopharyngeal, vagus, hypoglossal
Which stages are automatic and which stages are reflexive?
Automatic: oral
Reflexive: pharyngeal, esophageal
What treatment strategy is used to elevate the larynx and widen the cricopharyngeal opening?
a. mendelson maneuver
b. effortful swallow
c. super-supraglottic swallow
d. masakao maneuver
mendelson maneuver
How would damage to cranial nerve 10 effect the oral transit stage?
Which of the following would be inappropriate to recommend for a patient with dysphagia due to poor-base-of tongue retraction?
a. use of the chin tuck strategy
b. swallowing multiple times for one bolus
c. lingual sweep of lateral sulci
d. effortful swallow
c.
instructing the patient to sweep their tongue in their lateral sucli would be appropriate if the patient had oral residue in the sulci due to reduced buccal tension, not if the patient has poor base-of-tongue retraction
What are the two types of swallows?
volitional
involuntary
What is the powerhouse of the swallow? Where does it get input from?
Nucleus Tractus Solitarius
Input from: cranial nerves, cortex, nucleus ambiguous
What tx strategy helps increase the posterior motion of the tongue and increase pharyngeal pressure?
effortful swallow
What CN is responsible for the UES opening?
CN 10 - Vagus
For a patient with potential pharyngeal phase dysphagia and pooling of secretions following open-heart surgery with suspected recurrent laryngeal nerve damage, which instrumental examinations for swallowing provides the most direct view for evaluating the patient based on history and suspected difficulties?
FEES
The head lift exercise published by Shaker et al. (2002) was designed to produce what changes in swallow biomechanics?
Increase in diameter and duration of the upper esophageal sphincter (UESU E S) opening
In which phase does the tongue move anteriorly-to-posteriorly and the bolus move toward the back of the mouth?
oral transit
An elderly patient with multiple diagnoses including Parkinson's disease (PD) presents to a home health SLP for treatment. The SLP recommends that the patient follow a mechanical soft diet with thin liquids, alternate bites and sips, take small bites, and have supervision when eating. Throughout the course of treatment, the patient exhibits a 12 percent weight loss with variable intake levels. To which of the following professionals is it most appropriate for the SLP to refer the patient?
a. neurologist
b. psychologist
c. dietitian
d. teacher
dietitian
What CNs are responsible for tongue base ramping and retraction + posterior pharyngeal wall bulging? What stage is this?
Pharyngeal stage
CN 12- Hypoglossal- styloglossus and genioglossus
CN 10- Vagus
CN 9- Glossopharyngeal
Patient is a 77-year-old female with a left hemisphere stroke. Sensorimotor clinical examination revealed right lower facial droop, impaired oral sensation, absence of dentition, need for frequent prompts to engage the patient in evaluation procedures, and aphasia. Bedside swallow evaluation with pureed food and nectar-thick liquids revealed food remnants in right lateral sulcus, drooling from the right oral cavity, and intermittent cough that was not present before the swallow evaluation. Prior medical history includes COPDC O P D, diabetes, and congestive heart failure. Patient does not want an instrumental examination.
Based on the data above, which of the following is most likely to lead to a clinically significant dysphagia-related adverse event?
Impaired levels of alterness
The commonly used chin-down posture was initially developed to eliminate thin-liquid aspiration in people with delayed pharyngeal stage onset after having a stroke, and when its efficacy was investigated, it was found to be 50% effective. For whom is the chin-down posture ineffective at eliminating thin-liquid aspiration?
People who aspirate residue from the pyriform sinuses
Shanahan et al. (1993) found that 50 percent of people with stroke- and swallowing-related aspiration due to delayed onset of the pharyngeal response continued to aspirate from the pyriform sinuses using the chin-down posture. Moreover, Eisenhuber et al. (2002) found that people with a pyriform sinus residue with a height that was less than 50 percent of the pyriform sinus height aspirated significantly more than those with less or no pyriform sinus residue.