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March 1, 2012
Terms in this set (53)
Gag reflex, respiration, swallowing
Oral Preparatory Phase
Looking at and reaching for food
Lip opening and closing
Food enters mouth, mix with saliva
What structure protects airway?
The airway is open when what two structures are at rest?
larynx and pharynx
Tongue propels bolus backwards
Approximately 1 sec for liquids,
slightly longer for thick liquids
Swallow reflex is triggered
When is the swallow reflex triggered?
When bolus is at the back of the tongue
What is the voluntary phase of swallowing?
Pharyngeal phase (swallow phase)
Bolus passes anterior to pharynx, once it starts continues until bolus movement is complete
What is the pharyngeal phase controlled by?
Medulla oblongata (brainstem)
What phase is the start of the involuntary phase?
Pharyngeal phase (swallow phase)
Movement of bolus
-Velum elevates and retracts (close nose)
-Tongue base elevates (propels into pharynx)
-Pharynx elevates and contracts from top to bottom (pushes into esophagus)
-Must be quicks and efficient to minimize interruption to respiration
-UES relaxes and opens
-Bolus reforms into whole at tope of esophagus, passes through it
(happens in one two seconds)
Larynx elevates and protects airway:
Breathing stops, soft palate elevation and retraction, laryngeal displacement anterior and superior, epiglottis closes, true vocal folds
Bolus enters esophagus through cricopharyngeal juncture, then moves through esophagus via peristalsis
How many seconds does it take for food to move from mouth to stomach?
Safe and Efficient swallow
Must have both voluntary and involuntary components
What happens if swallow response doesn't occur?
physiological function will also not occur
Effects of cranial nerve damage for preparatory and oral phase
CN5: trigeminal nerve- motor (chewing)
CN7: facial nerve- motor (mouth and lip closed)
CN12: hypoglossal nerve (controls bolus, lip and mouth coordination)
Effects of cranial nerve damage for pharyngeal phase
CN9: glossopharyngeal- sensory (delayed triggering of swallow reflex)
CN10: vagus nerve-motor (loss of laryngeal closure)
Evaluation of Swallowing (ST)
-Chewing and swallowing of solids
-Sipping, sucking, and swallowing of liquids
-Safety and efficiency of swallowing
Evaluation components of swallowing
Oral-motor strength, ROM, tone, control
Variety of consistencies
Evaluation of Feeding (OT)
-Maintaining posture (90 degrees
-Seeing food, reaching for food, manipulating food
-Transport of food to mouth
-Manipulation of food/liquid in mouth
Evaluation components of feeding
Posture; head and trunk control
UE ROM, strength, tone
Grip and release
Cognitive attention, safety judgement
What are the deficits in diagnosis of CVA, TBI, or CP?
Deficits in strength, ROM, tone, cognition, perception, sensation
What are the deficits in diagnosis of ALS, GBS, MS, SCI?
Decrease in strength and endurance
May be temporary or permanent
What are diagnosis involved with deficits in feeding/swallowing?
CVA, TBI, CP
ALS, GBS, MS, SCI
Role of OT vs SLP
-Both require additional training for competence in dysphagia eval. and treating
-Responsibilities vary in settings, policies, population, staffing, etc
Assessment of Swallowing
Bedside Swallow Evaluation
What does and oral motor assessment include?
outer- appearance,sensation, muscle strength, tone, and oral reflexes, inner- teeth, tongue movement
What does swallowing assessment include?
observation- self feeding, manipulation of silverware, drinking, signs of deficits
Modified Barium Swallow Study (MBSS)
Various consistencies of liquid barium and solid food coated with barium
Identify occurrence and cause of aspiration
Where would a videofluoroscopic exam take place? and who is it conducted or reviewed by?
Conducted or reviewed by radiologist
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Endoscopic viewing of oral and pharyngeal structures
Direct observation of swallowing mechanism
May use normal food consistencies
Who conducts a FEES? Where is it done?
A trained therapist, in a patient room or therapy department
The nutritional services department is usually concerned with what?
ability to chew
The Therapeutic Feeding team is concerned with what?
ability to handle bolus and swallow safety
Firm liquid (pudding)
Soft liquid (honey)
Syrup-like liquid (nootar, buttermilk)
Thin liquid and Normal (no thickening add)
Why are straws bad?
makes the liquid go down faster
List Solid food consistencies
NPO, Pureed, Modified Puree, Mechanical, Soft, Normal
No food by mouth
Pureed and Modified Puree
Requires minimal gumming or chewing
Modified- requires more active gumming (ex. oatmeal)
Soft textured items that are easy to chew, swallow, digest
Easy to chew, swallow, digest
Normal diet, may have other restrictions
Passage of liquid or solid material into the lungs (could lead to pneumonia)
Signs and Symptoms of Aspiration
coughing, wet gurgly voice, choking, slurred speech, crackly lungs, fever
Cultural Context of swallowing
Beliefs and customs regarding when, what, how they eat. Ex. eating in front of tv vs. eating at table
Social Context of swallowing
Eating as part of a social event, eating socially appropriately in public. Ex. eating with friends, family, at events
-Client does not want to eat or be fed
-Family wants to feed client, in violation of swallowing precautions
-When other health care professionals do not adhere to swallowing precautions
When will a doctor order a feeding tube?
If person does not have sufficient caloric intake
What occurs with appetite when give a feeding tube?
Person is continuously being fed, so always is full, thus has no appetite. This leads to person not eating enough to satisfy caloric need, so tube cannot be removed. This cycle is hard to break.
What can you try to break the continuous feeding tube cycle?
Better for person to have a bolus tube feeding rather than continuos, can try postponing one feeding at a time.
large or weighted utensils
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