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MBSImP Components

Terms in this set (37)

Oral Impairment Components
1) Lip Closure
2) Tongue Control During Bolus Hold
3) Bolus Preparation/ Mastication
4) Bolus Transport/ Lingual Motion
5) Oral Residue
6) Initiation of Pharyngeal Swallow
Pharyngeal Impairment Components
7) Soft Palate Elevation
8) Laryngeal Elevation
9) Anterior Hyoid Excursion
10) Epiglottic Movement
11) Laryngeal Vestibular Closure
12) Pharyngeal Stripping Wave
13) Pharyngeal Contraction
14) Pharyngoesophageal Segment Opening
15) Tongue Base (TB) Retraction
16) Pharyngeal Residue
Esophageal Impairment Components
17) Esophageal Clearance Upright Position
Component 1
Lip Closure
-judge at any point during the swallow-
*assesses ability to seal the bolus within the oral cavity at the anterior dimension*
0) no labial escape
1) interlabial escape; no progression to anterior lip (would resemble trace of barium between the lips)
2) escape from interlabial space or lateral juncture; no extension beyond vermillion border
3) escape progressing to mid-chin
4) escape beyond mid-chin- profuse escape between open lips
Muscles, Innervation, Action of Lip Closure
component one= lip closure
functional group name: Lips
muscles associated with component one: ORBICULARIS ORIS, levator labii superioris, levator anguli oris, zygomaticus minor, zygomaticus major, risorius, depressor anguli oris, depressor labii inferioris, mentalis
innervation: CN VII
action: lip seal, anterior oral containment
Component 2
Tongue Control during Bolus Hold
-judge on held liquid boluses only and prior to productive tongue movement-
ability to seal the tongue to the hard and soft palate
0=Cohesive bolus between tongue to palatal seal (anteriorly, posteriorly, laterally)
1= escape to lateral buccal cavity/floor of mouth (FOM)
2= Posterior escape of less than half of bolus
3= Posterior escape of greater than half a bolus
Tongue Control during Bolus Hold Muscles, Innervation and Action
muscles: intrinsic tongue muscles (superior longitudinal, inferior longitudinal, transverse, vertical), soft palate muscle (tensor veli palatini), extrinsic muscles of the tongue (palatoglossus, genioglossus), suprahyoid muscles (geniohyoid, mylohyoid)
Innveration: CN XII, CN V, CN X
action: shapes the tongue to hold and control bolus (instrinsic), stiffens the soft palate and facilitates posterior oral containment (soft palate), raises tongue and drawing down the palate to form glossopalatal seal (extrinsic), stabilizies the floor of the mouth (suprahyoid)
Component 3
Bolus Preparation/Mastication
-judge only during presentation of 1/2 shortbread cookie coated in pudding-
0= Timely and efficient chewing and mashing
1= Slow prolonged chewing/mashing with complete re-collection
2= disorganized chewing/mashing with solid pieces of bolus unchewed (vertical munching type behavior)
3= minimal chewing/mashing with majority of bolus unchewed OR cookie is withheld because of safety concerns related to oral portion
Bolus Preparation/Mastication Muscles, Innervation, Action
muscles of mastication, intrinsic muscles of the tongue, extrinsic muscles of the tongue, facial muscle, suprahyoid muscles, muscles of the lips
Innervation: CN V, CN XII, CN X, CN V, CN VII
action: see training manual for full list --> elevates mandible, depresses tongue, depresses mandible to open the mouth, stablizes ​flor of mouth, lip seal, anterior oral containment
Component 4
Bolus Transport/Lingual Motion
- judge after first productive tongue movement for oral bolus transport-
0= brisk tongue motion
1= delayed initiation of tongue motion
2= slowed tongue motion
3= repetitive/disorganized tongue motion
4= minimal to no tongue motion
Bolus Transport/Lingual Motion Muscles, Innervation, Action
muscles: intrinsic muscles of the tongue, extrinsic muscles of the tongue, suprahyoid muscles
innervation: CN XII, CN X, CN V, CN VII
action: intrinsic muscles press the tongue against the palate to move the bolus posteriorly and maintains cohesive shape of bolus between the tongue and palate, extrinsic muscles position the tongue agains the palate to move the bolus posteriorly, suprahyoid muscles stabilize the floor of mouth to maximize efficiency of tongue movement
Component 5
Oral Residue
-Judge after first swallow or after the last swallow of the sequential swallow tasks-
0=complete oral clearance
1=trace residue lining oral structures (normal variant)
2= residue collection on oral structures
3= majority of bolus remaining
4= minimal to no clearance
Oral Residue Muscles, Innervation, Action
muscles: intrinsic muscles of the tongue, muscles of mastication, extrinsic muscles of the tongue, suprahyoid muscles
innervation: CN XII, CN V, CN VII, CN X
action: collects and shapes bolus and transports bolus posteriorly, stabilizes the floor of mouth to maximize efficiency of tongue movement, compresses the cheeks against the teeth, positions the tongue against the palate to move bolus posterioly, stabilizes the floor of mouth to maximize efficiency of tongue movement
Component 6
Initiation of Pharyngeal Swallow
-judge at first movement of the brisk superior-anterior hyoid trajectory-
*sensory inputs including bolus characteristics and movement of the tongue*
0=Bolus head at posterior angle of ramus (first hyoid excursion)
1= Bolus head in valleculae
2= bolus head at posterior laryngeal surface of epiglottis
3= bolus head in pyriforms
4= no visible initiation at any location
Initiation of Pharyngeal Swallow Muscles, Innervation, Action
muscles: N/A
innervations: CN IX (pharyngeal branch), CN X (superior laryngeal nerve, internal branch
action: initiation of pharyngeal swallow
Component 7
Soft Palate Elevation (and retraction)
-judge during maximum displacement of soft palate-
0= no bolus between soft palate (SP)/pharyngeal wall (PW)
1= trace column of contrast or air between SP or SW
2= escape to nasopharynx
3= escape to nasal cavity
4= escape to nostril with/without emission
Soft Palate Elevation Muscles, Innervation, Action
muscles: muscles of the soft palate (levator veli palatini, tensor veli palatini, musculus uvulae)
innervation: CN X, CN V, CN X
action: elevates, tenses, and retracts the soft palate against the posterior pharyngeal wall
Component 8
Laryngeal Elevation
-judge when epiglottis is in its most horizontal position-
0= complete superior movement of thyroid cartilage with complete approximation of arytenoids to epiglottic petiole
1= partial superior movement of thyroid cartilage/ partial approximation or arytenoids to epiglottic petiole
2= minimal superior movement of thryoid cartilage with minimal approximation of arytenoids to epiglottic petiole
3= no superior movement of thyroid cartilage
Laryngeal Elevation Muscles, Innervation, Action
muscles: long pharyngeal muscles, infra hyoid muscle (thyrohyoid), intrinsic muscles of the larynx
innervation: CN IX, CN X, CN X
action: shortens and widens pharynx and elevates the larynx, elevates the thyroid cartilage to the hyoid, rotation of arytenoid cartilages to meet bulging epiglottic petiole, adducts the true vocal folds and approximation of the ventricular folds
Component 9
Anterior Hyoid Extension
-judge at height of swallow/maximal anterior hyoid displacement-
0= complete anterior movement
1= partial anterior movement
2=no anterior movement
Anterior Hyoid Extension Muscles, Innervation, Action
muscles: suprahyoid muscles (geniohyoid, mylohyoid, digastricus
innervation: CN 1, CN V, Anterior belly: CN V
action: anterior movement of the hyoid
Component 10
Epiglottic Movement
-judge at the height of the swallow/maximal anterior hyoid displacement-
0=complete inversion
1= partial inversion
2= no inversion
Epiglottic Movement Muscles, Innervation, Action
muscles: suprahyoid muscles, muscles of the base of tongue, long pharyngeal muscles, infrahyoid muscle
innervation: CN V, CN XII, CN X, CN IX
Component 11
Laryngeal Vestibular Closure
-judge at the height of swallow/maximal anterior hyoid displacement
0= complete: no air/contrast in laryngeal vestibule
1= incomplete; narrow column air/contrast in laryngeal vestibule
2= none; wide column air/contrast in laryngeal vestibule
Laryngeal Vestibular Closure Muscles, Innervation, Action
muscles: intrinsic muscles of the larynx, muscles of the tongue base (styloglossus, palatoglossus)
Innervation: CN X, CN XII
action: rotation and approximation of the arytenoid cartilages to meet bulging epiglottic petiole associated with larygeanl elevation
adducts (closes) the true vocal folds and approximation of ventricular folds, retracts the base of the tongue and assists in shielding laryngeal inlet
Component 12
Pharyngeal Stripping Wave
-judge during the full duration of the swallow-
0= present-complete
1= present-diminished
2=absent
Pharyngeal Stripping Wave Muscles, Innervation, Action
muscles: pharyngeal constrictor muscles
innervation: CN X
action: applies positive pressure generation to the bolus tail through sequential contractions superiorly and inferiorly​
Component 13
Pharyngeal Contraction
-judge in AP view at rest and through maximum movement of structures-
0=complete
1=incomplete (psuedodiverticulae)
2= unilateral bulging
3=bilateral bulging
Pharyngeal Contraction Muscles, Innervation, Action
muscles: pharyngeal constrictor muscles, long pharyngeal muscles
innervation: CN X, CN IX
action: applies positive pressure generation to the bolus tail through sequential contractions superiorly to inferiorly, shortens and widens the pharynx, elevates the layrn
Component 14
Pharyngoesophageal Segment Opening
-judge during maximum distension of PES and throughout opening and closure-
0= complete distension and complete duration; no obstruction of flow
1= partial distention/ partial duration; partial obstruction of flow
2= minimal distension/minimal duration; marked obstruction of flow
3=no distention with total obstruction of flow
Pharyngoesophageal Segment Opening Muscles, Innervation, Action
muscles: pharyngoesophageal segment (PES), suprahyoid muscles, long pharyngeal muscles, infrahyoid muscles
innervation: CN X, anterior belly: CN V, CN VII, CN IX
action: PES relaxes during swallowing to facilitate bolus passage, functional component of the PES region`
Component 15
Tongue Base (TB) Retraction
-judge during maximum retraction of the tongue base-
0= no contrast between TB and posterior wall (PW)
1= trace column of contrast or air between TB and PW
2= narrow column of contrast or air between TB and PW
3= wide column of contrast or air between TB and PW
4= no visible posterior motion of TB
Tongue Base Retraction Muscles, Innervation, Action
muscles: extrinsic tongue muscles, pharyngeal constrictor
innervation: CN XII, CN X
action: retracts the base of tongue, constricts the middle pharynx apposing the base of tongue
Component 16
Pharyngeal Residue
-judge after first swallow or after the last swallow of the sequential swallow task-
0= complete pharyngeal clearance
1= trace residue within or on pharyngeal sturctures
2= collection of residue within or on pharyngeal structures
3= majority of contrast within or on pharygeanl structures
4= minimal to no pharyngeal clearance
Pharyngeal Residue Muscles, Innervation, Action
muscles: pharyngoesophageal segment, pharyngeal constrictor muscles, muscles of the base of the tongue, long pharyngeal muscles, suprahyoid muscles, infrayhoid muscle
innervation: CN X, CN XII, CN IX, CN V, CN VII
Component 17
Esophageal Clearance Upright Position
-Judge in AP view during bolus transit though the oral cavity to the LES-
0= complete clearance; esophageal coating
1= esophageal retention
2= esophageal retention with retrograde flow below PES
3= esophageal rentention with retrograde flow through PES
4= minimal to no esophageal clearance
Esophageal Clearance Muscles, Innervation, Action
muscle: longitudinal and circular muscles of the esophagus
innervation: CN X, myenteric plexus
action: primary and secondary peristaltic contraction
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