Card Set Information
muscle that helps squeeze bolus down
superior, middle constrictor
muscle that included TP and CP
Which muscle is tonically active; relaxes during the swallow to open so bolus can pass
These muscles elevate the pharynx
stylopharyngeous and palatopharyngeous
This muscle includes the vocalis and can be an adductor, tensor or relaxor
This muscle lengthens and tenses the VF
This muscle abducts and externally rotates the arytenoids
Adducts and internally rotates the arytenoids
Adducts the arytenoids
transverse and oblique arytenoids
- mucous membrane of mouth, palate, nasopharynx, teeth, face
jaw movement, chewing, bite, tongue movement to propel bolus
Trigeminal (V) Damage
Unilateral- no major effects on speech/swallow
Bilateral- jaw hangs open, slow chewing, poor artic and ROM
Motor nucleus in Pons
muscles for facial expression, sublingual glands, taste, nasopharynx (swallowing)
Facial (VII) Damage
Affects voluntary, emotional and reflex movement
Nucleus in Medulla
elevates pharynx, sublingual glans, pharynx, taste, gag reflex (primarily swallowing)
Glossopharyngeal (IX) Damage
-Reduced pharyngeal sensation
-impaired gag reflex
-reduced pharyngeal elevation
-Excessive oral secretions
Nucleus in Medulla
-Soft palatte, pharynx (contraction & elevation of soft palate)
-Soft palate, base of tongue, supraglottic area, larynx, esophagus, trachea
Vagus (X) Damage
Unilateral LMN- resonance, voice, swallowing
Bilateral LMN- Resonance, voice, swallowing, prosody, artic
Swallowing- reduced airway closure and sensation
pharyngeal and superior RLN
-Uvula, levator palatini, intrinsic laryngeal muscle
Spinal/Accessory (XI) Damage
Head rotation on contralateral side
Shrug shoulder on ipsilateral side
All muscles of tongue except palatoglossus
Hypoglossal (XII) Damage
-Tongue atrophy, weakness, and fasiculations of the tongue (ipsilateral)
-Tongue deviation TOWARD side of lesion
Oral Prep Phase
-Voluntary & Can be bypassed
-Bolus formed (food broken down and moistened with saliva)
-Lingual velar closure prevents premature spillage
-Airway open, nasal breathing, labial seal,
-Duration is variable
Oral (Transport) Phase
-Food moved to back of mouth by tongue (AP rolling)
-Tongue propels bolus into pharynx
: 1-1.5 seconds
-Respiration put on hold
-Velum is raised to prevent food entering nasopharynx
-Bolus driven through the pharynx
-Tongue is retracted to prevent food from re-entering mouth and drive bolus into pharynx
: 1-2 seconds
What is the most important phase of the swallow?
3 actions that occur to protect the airway
1. Larynx & hyoid pulled up & forward
-creates vacuum in pharynx pulls bolus down
-relaxes CP to open esophagus
2. Epiglottis flaps over larynx
3. Larynx closes at:
-Base of epiglottis to aryepiglottic folds
Esophageal phase of swallow
-CP/UES relaxes and is pulled open
-Bolus is pulled down esophagus
-larynx lowers and returns to original position
-CP contracts to prevent reflux
: 8-20 seconds (longer in elderly)
When food or bolus enters vestibule/airway to any level but not below the superior surface of the true VF
Entry of food into the airway below the level of the true vocal folds
What is the technical term for bedside eval?
What does a bedside evaluation include?
-Physical inspection of swallowing musculature
-Observation of swallow (test swallow)
What is the order of solids from "Least restrictive" to "most restrictive"?
What is the order of liquids from "least" to "Most" restrictive?
Order of po trials
(spoon cup and straw)
Where do you put fingers for laryngeal palpatation?
Base of tongue
What are you feeling for during laryngeal palpation?
-Timing of swallow
-Up and forward movement
How would you interpret immediate coughing/choking?
How would you interpret delayed coughing/choking?
-P/A of residual
-aspiration with delayed sensation
How would you interpret nasal regurgitation?
How would you interpret food stuck in throat, especially solids?
Weak laryngeal constrictors
poor hyolaryngeal movement
poor base of tongue retraction
How would you interpret burning during/after swallow?
How would you interpret multiple swallows?
Reduced hyolaryngeal movement
Reduced base of tongue retraction
Reduced pharyngeal contraction
How would you interpret food residual throughout mouth?
Poor oral bolus formulation
How would you interpret food falling out of mouth?
Poor lip seal
Medical Treatment options
Secretion management medication
Surgical Treatment Options
Improve glottic closure (injection, thyroplasty)
Improve PES opening (dialation, botox)
Protect airway (trach, feeding tube)
Behavioral Treatment Options
Active Therapy Techniques
What is an example of diet modification?
Thickened Liquids (Compensatory)
What is an example of postural changes?
Active therapy techniques (rehabilitative)
Oral Motor Exercises
Thermal Tactile Stimulation
Tongue hold maneuver
Head lift exercise
Active Therapy Techniques (Rehabilitative and compensation)
Super supraglottic swallow