Swallowing disorders disorders in oral prep and oral phase

Normal Swallow

○ Bolus preparation (oral)
○ Airway protection (pharyngeal)
○ Bolus movement (esophageal)

a normal swallow entails the actions of which cranial nerves?

trigeminal, glossopharyngeal, vagus

a normal swallow entails the timely interaction of which muscles?

muscles of mastication, pharyngeal and laryngeal muscles

actions carried out by the brainstem:

sending motor commands to the cranial and spinal nerves

Penetration:

entry of bolus contents into the larynx to a level that does NOT
extend below true vocal folds

Aspiration

entry of material into the airway below the level of true vocal folds

Silent Aspiration:

material passes true vocal folds WITHOUT RESPONSE

Aspiration Pneumonia

results from entrance of foreign materials (usually food,
liquids or vomit) into the lungs with resulting infection

Disorders in ORAL PREP Stage

Reduced lip closure

Reduced labial tension/tone

Reduced buccal tension/tone

Reduced ROM and/or coordination in tongue, lips, jaw:

Reduced tongue shaping/coordination:

Reduced tongue control/tongue thrust:

Oral prep stage- 1) reduced lip closure

May result in anterior oral spillage

oral prep stage- 2)Reduced labial tension/tone:

Material falls into anterior sulcus (pocketing)
■ Anterior oral spillage

oral prep stage- 3- Reduced buccal tension/tone

Material falls into lateral sulcus (pocketing)

oral prep stage 4- Reduced ROM and/or coordination in tongue, lips, jaw:

Cannot form bolus; food spreads in oral cavity
■ Reduced bolus cohesion results can result in
premature spillage and oral residue

oral prep stage 5- Reduced tongue shaping/coordination:

Cannot hold bolus with tongue and material spreads all over oral cavity.
■ If soft palate does not make contact with base
of tongue, food lost into pharynx prematurely
which can result in aspiration before the swallow
(“Premature spillage”)

oral prep 6- Reduced tongue control/tongue thrust:

If bolus held against front teeth, swallow will likely
be accomplished by tongue thrusting behavior,
thereby pushing bolus forward and may push out
oral cavity

Disorders in oral stage (function)

Lingual propulsion of bolus through oral cavity.
Plays a role in initiation of triggering pharyngeal swallow.

oral stage 1-Delayed oral onset of swallow

Symptom may indicate severe swallow apraxia,
reduced oral sensation or lack of recognition of bolus
as something to be swallowed

ORAL Stage 2 Apraxia of swallow/searching tongue movements

Good ROM but inability to organize front/back lingual
movements
■ May hold bolus without initiating oral swallow
■ Self-feeding may facilitate oral activity
■ Refrain from giving commands to swallow

Oral Stage 3 Reduced labial tension/tone

Reduced intraoral pressure
■ Anterior oral spillage

Oral Stage 4 Reduced buccal tension/tone

Buccal tension plays a role in movement of bolus by
providing pressure in lateral walls of oral cavity

oral stage 5 Residue on floor of mouth:

Reduced ability to shape and coordinate tongue around
bolus and/or maintain contact of tongue tip and side of
tongue to hard palate as bolus moves posteriorly

oral stage 6

Residue mid tongue

oral stage 7- Residue of food on tongue/hard palate

Indicates reduced range of movement or
strength of tongue

oral stage 8- Incomplete tongue-palate contact:

Indicative of reduced tongue
elevation

oral stage 9- Lingual discoordination-video

Tongue moves in random, nonproductive
motions (disorganized A-P movement)

oral stage 10- Uncontrolled bolus/premature spillage:

May be indicative of reduced tongue
control and/or reduced lingual-alveolar seal

oral stage 11- piecemeal deglutition

Bolus not swallowed in a cohesive mass; rather
patient swallows only a portion or piece of the
bolus at a time.

Usually happens with larger boluses/bites

May indicate fear of swallowing and risk for
aspiration