Normal Swallow Cont./ Aging and Dysphagia

When does respiratory pause occur during swallowing? When does it resume?

1. bolus collection at the vallecular level

2. when the bolus passes thru the PES/UES

What are pharyngeal spaces/natural pockets?

What are the roles of the pharynx?

Structures of the pharynx

What cranial nerve(s) are responsible for motor innervation of the pharynx?

What cranial nerve is responsible for motor innervation of the pharynx?

Explain the range of the nasopharynx, oropharynx, and hypopharynx

•Nasopharynx: Nose to soft palate 

•Oropharynx: Portion which is visible via the mouth (Soft palate to vallecula) 

•Hypopharynx: inferior to the tip of the epiglottis

When does the pharyngeal stage of swallowing begin and end?

when the bolus arrives at the level of the vallecula and ends when the PES closes.

peristalsis

a squeezing down motion (e.g. the superior, middle, and inferior constrictor muscles of the pharynx narrow and shorten the pharynx to contribute to bolus propulsion)

How does the PES/UES/CP open?

Relaxes due to signals from CNX

Pulled further open during hyolaryngeal elevation

What is the UES? What is its function?

a muscular ring that separates the pharynx from the esophagus

prevents air from entering the gastrointestinal (GI) tract during respiration

What are the three striated muscles that make up the UES?

lower fibers of the inferior pharyngeal constrictor

the cricopharyngeas (primary muscle)

superior esophageal muscular wall

What are the three distinct zones that coordinate activities during the esophageal stage of swallowing?

the proximal, striated muscle zone

the body

specialized smooth muscle of the distal zone.

Name 4 purposes of the larynx

Organ of communication “voice box”

Important regulator of respiration

Necessary for an effective cough

Prevents aspiration during swallowing

Muscles of the larynx

Cranial nerves of the larynx

structure/anatomy UES

Function/physiology UES

Nerves SNAP stuff

Normal amount of a liquid taken per swallow attempt may range from ___ to ___mL depending on the test instructions, gender, type of cup, and body size

10 to 25

What is viscosity? What is it measured in?

How thick something is

centipose (cP)

Normal ageing symptoms re: swallowing

Peripheral alterations in sensory perception, such as smell and taste, and decreased muscle strength secondary to changes in mass and contractility.

Loss of muscle strength (force) and speed in older persons results in increased, but normal, swallow durations compared with younger cohorts.

What cranial nerves are responsible for sending sensory impulses to the medulla to initiate the pharyngeal swallow?

9 and 10 - pharyngeal plexus

Frailty

a loss of physical strength with an accompanying loss of ability to compensate for the weakness

Presbyphagia

normal age-related changes in the aerodigestive tract

Sarcopenia

a reduction of lean skeletal muscle mass with a marked loss of strength and speed of movement

T/F . There may be as many as 15% in the CDE population who have dysphagia that is undiagnosed (CDE = community dwelling elderly)

true

characteristics of frailty

Hand grip weakness

Slower than normal walking speed

A decrease in normal physical activity

Self-reported exhaustion

Unintentional weight loss

Subtle changes in cognitive status

T/F Sarcopenia is thought to be a consequence seen most often in those who are considered to be frail.

true

Primary vs Secondary Sarcopenia

Primary sarcopenia as a consequence of advancing age; and Secondary sarcopenia as a result of disease or undernutrition.