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Ch. 4
*Disorders of Swallowing
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*Oral Preparatory Phase
*Break down food into a bolus
*Mix with saliva
*Bring it together
*Bolus is ready to swallow
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*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
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*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
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*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
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*Oral Phase
*Lingual propulsion of the bolus
*Moves bolus posteriorly through the oral cavity
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*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
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*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
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*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
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*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
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*Disorders in Triggering
Pharyngeal Swallow
*Delayed Pharyngeal Swallow
*Reduced oralpharyngeal sensation of bolus
*Cranial Nerve damage
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*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
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*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
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*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)
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*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
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*Disorders of Pharyngeal Phase
*Increased pharyngeal transit time >1 second
*Decreased pharyngeal constriction
*Decreased pharyngeal coordination
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*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
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*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