Ch. 4

*Disorders of Swallowing

*Oral Preparatory Phase

*Break down food into a bolus

*Mix with saliva

*Bring it together

*Bolus is ready to swallow

*Disorders in the Oral Preparatory

Phase

*Cannot Hold Food in Mouth Anteriorly

*Reduced Lip Closure

*?Mouth breather

*Cannot Hold a Bolus

*Reduced Tongue Shaping/Coordination

*Reduced soft palate movement down/forward against back of tongue

*Possible aspiration if bolus goes over back of tongue before ready

*Disorders of the Oral Preparatory

Phase

*Cannot Form a Bolus

*Reduced range of Tongue Motion or Coordination

*Unable to pull all the pieces together

*Material Falls into the Anterior Sulcus

*Reduced Labial Tension/Tone

*Inadequate closure of the anterior sulcus

*Material Falls into the Lateral Sulcus

*Reduced Buccal Tension/Tone

*Disorders of the Oral Preparatory

Phase

*Abnormal Hold Position

*Reduced Tongue Control

*Tongue Thrust

*Held against the front teeth

*Can push the food out of the oral cavity

*Oral Phase

*Lingual propulsion of the bolus

*Moves bolus posteriorly through the oral cavity

*Disorders of the Oral Phase

*Delayed Oral onset of swallow

*Reduced oral sensation

* Lack of recognition of bolus to be swallowed

*Tongue moves forward to start swallow

* Tongue Thrust

*Can be preceded by an abnormal hold position of the bolus

*Residue in Anterior Sulcus

*Reduced Labial Tension/Tone

*Residue in Lateral Sulcus

*Reduced Buccal Tension/Tone

*Disorders of the Oral Phase

*Residue on the Floor of the mouth

*Reduced tongue shaping

*Poor seal of tongue to anterior and lateral alveolus

*Residue of Food on the Tongue

*Reduced tongue range of motion

*Reduced tongue strength

*Disorders of Oral Phase

*Incomplete Tongue-Palate contact

*Reduced Tongue Elevation

*Reduced range of vertical tongue motion

*Residue of food on Hard Palate

*Reduced Tongue Elevation

*Reduced Tongue strength

*Disorders of Oral Phase

*Reduced Anterior-Posterior Tongue Movement

*Reduced Lingual Coordination

*Uncontrolled Bolus/Premature Spillage

*Reduced Tongue control

*Reduced Linguavelar seal

*Piecemeal Deglutition

*Poor bolus formation

*Poor tongue coordination

*Disorders in Triggering

Pharyngeal Swallow

*Delayed Pharyngeal Swallow

*Reduced oralpharyngeal sensation of bolus

*Cranial Nerve damage

*Disorders of Pharyngeal Phase

*Nasal Penetration during swallow

*Reduced velopharyngeal closure

*Bony Outgrowth from Cervical Vertebrae

*Narrow the pharynx

*May have the sense that “something is there” when they swallow

*Residue on one side of Pharynx

*Unilateral Pharyngeal wall weakness- constrictors

*Disorders of Pharyngeal Phase

*Coating on Pharyngeal Walls after the study

*Reduced pharyngeal contraction bilaterally

*Valleculae residue after the swallow

*Reduced tongue base posterior movement

*Reduced bulging posterior pharyngeal wall contacting tongue base

*Residue at Top of airway

*Reduced laryngeal elevation

*Disorders of Pharyngeal Phase

*Laryngeal Penetration and Aspiration after the swallow

*Reduced vocal fold closure

*Residue in pharynx, valleculae or pyriform sinuses

*Aspiration During the Swallow

*Reduced vocal fold closure

*Reduced epiglottic inversion

*Reduced false vocal fold closure (aryepiglottic fold)

*Disorders of Pharyngeal Phase

*Residue in pyriform sinuses

*Reduced anterior laryngeal movement

*Upper Esophagus Sphincter dysfunction

*Esophageal stricture

*Residue throughout the pharynx

*Decreased pharyngeal pressure

*Decreased pharyngeal constriction

*Disorders of Pharyngeal Phase

*Increased pharyngeal transit time >1 second

*Decreased pharyngeal constriction

*Decreased pharyngeal coordination

*Disorders of Cervical

Esophageal Phase

*Esophageal-to-Pharyngeal Backflow

*Upper Esophageal Sphincter dysfunction

* Frequent gagging/coughing

* Potential for aspiration

*Burning sensation in the pharynx

*Tracheoesophageal Fistula

*Hole that develops in the soft tissue common wall between the trachea and the esophagus

*Between the 1st to 3rd thoracic vertebrae

*Backflow into the trachea from the esophagus

*Coughing after the swallow

*Disorders of Cervical

Esophageal Phase

*Zenker’s Diverticulum

*Side pocket that forms when the pharyngeal or esophageal muscle herniates

*Forms in the area of the Upper esophageal sphincter

*Material collects in this pocket and usually empties after the swallow

*Reflux

*Backflow of food and stomach acid from the stomach to the esophagus

*Failure of the Lower Esophageal Sphincter