Swallowing and feeding- rehab sci

Bolus

• oral prepatroy phase

• ingested material is broken down mechnaically forming bolus

number of steps in swallowing phases

4

what is swallowing

patterned motor response

moves material from the mouth to the esophagus

Step 1

oral preperatory phase

• material is contained manipulated and made into bolus

• voluntary phase and varies based on material

step 2

oral transport

• tongue propels the bolus posteriorly until the pharyngea phase is triggered

Step 3

Pharyngeal

• reflexive swallow carries the bolus through the pharynx

• invlountary: patterned motor response

• Airway protection: closure of the true vocal folds first then closure of the laryngeal vestibule

• bolus pathway is lateral to the larynx through the pyriform sinus

Step 4

Esophageal

• the bolus is transported to the stomach

Dysphagia

• difficulty moving food/liquid from the mouth to the stomach

• can occur in more than one swallowing phase

• Increase morbidities and mortality

• common causes: neurogenic, mechanical

• signs: throat clearing, coughing, choking ect.

Laryngeal penetration

foreign material enters the larynx ABOVE the true vocal folds

Tracheal aspiration

foreign material passes BELOW the true vocal folds

swallowing assessments (3)

screening, clinical swallowing assessment (bedside swallowing assessment), Instrumental assessment

Videoflouroscopic swallow study

VFSS/ Modified Barium Swallow study:

• dynamic x-ray procedure where the patient swallows barium of varying volumes/consistancies

• images the mouth, pharynx, larynx and cervial esophagus

fiberoptic endoscope evaluation of swallowing

FEES:

• Dynamic procedure where the pharynx and larynx are visualized while the patient swallows varying volumes/consistancies