respiratory swallowing coordination

multifunctionality

respiration and swallowing are centrally controlled acts (controlled by CPGs) that share the upper aerodigestive tract

causes of dysphagia impact the functionality of swallowing muscles that result in

impaired bolus flow and airway invasion

behavioral therapy approaches can result in modifications of

respiratory behavior

behavior modifications: defects

some approaches can have damaging effects of swallowing func.

mendelsohn maneuver

holding the larynx up while swallowing to allow bolus to move more easily

normal breathing and swallowing coordination

expiration → apnea → expiration at mid-to-low lung volumes

how long does apnea last?

1-1.5 seconds during liquid swallows in most healthy adults

* varies based on viscosity

apnea

protective, momentary medialization of the true vocal folds

when do we expel in a swallow and why

at the end for protection

when does respiration resume in a swallow

during the descent of the larynx

disordered respiratory/swallowing coordination

inspiration → apnea → inspiration

• disadvantage for airway protection especially with thin liquids

what are the physiological conditions that are disrupted from disordered respiratory/swallowing coordination?

• aging

• neurological disease (75%) of caseload

• Head and neck cancer

• compensatory posturing

development and age

fragile patients on the extreme ends of age fall victim to swallowing disorders, aspiration, and PNA with more regularity

development and age: pediatrics

struggle to maintain breathing/swallowing rate → elevates temperature and HR, fatigue and agitation present

leading cause of SIDS

inspiration near swallow

at what age do babies self correct their respiratory/swallow coordination

12 months

older adults

greater occurrence of liquid swallows initiated and followed by inspiration

• aspiration

• poor bolus control

when is apnea shown to double

liquid swallowing; can be normal but can be negative if exceeding normal limit

older adults: reduced access to vital capacity

• calcification

• sarcopenia

*these changes are exacerbated by disease

calcification

he buildup of excess calcium salts in body tissues, organs, or blood vessels, which causes the tissue to harden

sarcopenia

age-related, progressive loss of skeletal muscle mass, strength, and function

what % of patients with chronic respiratory failure and neuromuscular disease exhibited normal swallowing/breathing coordination

only 50%

tracheostomy

significantly affected the number of swallows per bolus/duration of swallowing

• supports withholding oral intake while weaning

compensatory strategies

60 degree recline and chin tuck resulted in increased duration of apnea during swallowing and increased total swallowing duration compared to swallowing upright

future therapy: biofeedback techniques

targeted swallowing initiation lung volumes

improved coordination and airway protective outcomes

• COPD, H&N cancer, and CVA

respiratory retraining found viable and effective in PD

• paired w/ voluntary cough training

• significantly reduced penetration/aspiration, residue, and voluntary cough effectiveness

• demonstrates the feasibility of this tx for PD