*****PRAXIS DYSPHAGIA

a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.

malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death.

-Targeted outcome: Increase muscular activation of the pharyngeal constrictors and base of tongue

-push your tongue to roof of mouth, swallow hard

- Targeted outcome: increased contraction of the superior pharyngeal constrictor muscle

-hold tongue between teeth, swallow your saliva w/ your in this position

-volitional laryngeal vestibule closure

-take a breath & hold it, swallow w effort, cough

- strengthening of hyolaryngeal elevation muscles

- lie flat on back, lift only with head & look at your toes, hold this position for 1 second & then lower your head

-volitional prolonging of hyolaryngeal elevation and upper esophageal sphincter opening

-regular swallow, feel larynx move in upward direction, squeeze your muscles, maintain position for 5 secs, relax & finish swallow

-shortening and constriction of pharynx

-take a deep breath, say "eee" w effort moving from low pitch to high pitch

sucking, chewing, and moving food or liquid into the throat

starting the swallow and squeezing food down the throat. You need to close off your airway to keep food or liquid out. Food going into the airway can cause coughing and choking.

opening and closing the esophagus (the tube that goes from the back of your throat to your stomach). The esophagus squeezes food down to the stomach. Food can get stuck in the esophagus. You may also throw

up a lot if there is a problem with your esophagus or if you have acid reflux

(commonly known as indigestion or heartburn).

lateral or A/P view

limited positioning

in radiology

radiation exposure

visualized

evaluation only

views oral, pharyngeal, and esophageal phases

noninvasive

esophageal transit

superior view

real food

flexible positioning

portable, in clinic/bedside

no radiation

no time limit

inferred after swallow

evaluation or treatment

pre/post pharyngeal phase, real anatomy, secretions

invasive

superior view of UES

can be with flex laryngoscopy

- sucking & swallowing observed

- opens mouth to suck fist

- gag response

- moves tongue in & out, up & down

-show open mouth for food

-can move food from a spoon to the back of the mouth

- gag response decline

-can move food from side to side

eruption of front teeth

can chew softer lumps & keep food in mouth

can close lips to clear the spoon

can bite into harder foods when teeth have erupted

can cope with most textures offered but chewing not fully mature

can cope with most foods offered as part of a family meal

brings hand to mouth & opens mouth in preparation to suck

holds objects

holds objects & puts them in mouth

holds, mouths & shows visual exploration of objects

begins to sit with some support and then unaided

pincer grasp with finger and thumb, sits without support

says first words, context specific, might say word for known food

-recognizes food by sight, smell & taste

-uses words to ask for or name foods they want

visually groups food into categories

starts to hold food and bring food in mouth

begins to try and feed from spoon without spilling from eight months

begins to drink from closed cup

begins to drink from open cup

most infants can feed themselves with a spoon

stroke (the most common cause of dysphagia); traumatic brain injury; cerebral palsy; Parkinson disease and other degenerative neurological disorders such as amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease), multiple sclerosis, progressive supranuclear palsy, Huntington disease, and myasthenia gravis.

V - Trigeminal

XII - Facial

IX - Glossopharyngeal

X - Vagus

XII - Hypoglossal

Motor: Jaw movements, muscles of mastication

Sensory: Oral, lingual (anterior 2⁄3), and facial general sensory

Motor: Muscles of the face, Visceral Motor: submandibular, sublingual,

and mucous glands of mouth, pharynx, and nose.

Special sensory: Anterior 2⁄3 of tongue

Motor: Stylopharyngeus muscle, Visceral motor: Parotid Gland

Sensory: Posterior 1⁄3 of the tongue, tonsils, upper pharynx

Special sensory: Posterior 1⁄3 of tongue

Pharyngeal Branch

Motor: muscles of the pharynx and soft palate, Visceral: pharyngeal mucosa

Sensory: Lower part of pharynx

Superior Laryngeal Branch:

Motor: Cricothyroid muscle

Sensory: Epiglottis, base of tongue, aryepiglottic folds, larynx - to level of VFsRecurrent Laryngeal Branch:

Motor: intrinsic muscles of the larynx (except cricothyroid)

Sensory: the vocal folds, the larynx beneath the vocal folds

Motor: Innervates all intrinsic muscles of tongue and all extrinsic

muscles of the tongue except palatoglossus (X).

Includes - Genioglossus: protrusion

Styloglossus: Elevation and retraction

Hyoglossus: Depression

Also innervates:

One suprahyoid muscle: Geniohyoid

One infrahyoid muscle: Thyrohyoid

The purpose of the Oral Preparatory Phase is to accept, manipulate, break down, and mix the bolus with saliva in the mouth.

The Oral Preparatory Phase of swallowing is almost entirely voluntary.

Putting food/liquid in the mouth

Keeping food/liquid in the mouth

Manipulating the bolus and mixing it with saliva

Chewing food thoroughly

Re-collecting the bolus to form a cohesive mass on the tongue

The purpose of the Oral Transport Phase is to transport the bolus from the anterior to the posterior part of the oral cavity, towards the oropharynx.

The Oral Transport Phase begins with the movement of the tongue.

A pharyngeal swallow response is typically triggered at the end of the Oral Transport Phase.

Bolus propulsion and drive are major contributors to the efficiency of bolus transport during the Oral Transport Phase.

● Anterior faucial arches

● Posterior tongue

● Valleculae

● Pyriform sinuses

● Laryngeal aditus (entrance to the larynx)

Although a swallow response is most commonly triggered by

the time the bolus reaches base of tongue there is

VARIABILITY with this in normal adults and with aging.

The Pharyngeal Phase of swallowing begins with a trigger/response mechanism.

The bolus is moved into the pharynx by the pressure exerted by the tongue.

During the Pharyngeal Phase, the bolus is prevented from entering both the nasal cavity and the larynx/airway.

After passing through the pharynx, the bolus is moved into the esophagus.

The apnea period, characterized by the prefix "a" (meaning no/not) and "Pne(a/o)" (meaning breathing), indicates a temporary cessation of breathing. This apnea period prevents the bolus from entering the airway.

The term "pneumonia" can help you remember the apnea period during the Pharyngeal Phase, as it relates to breathing and the avoidance of aspiration.

After completing the Pharyngeal Phase of swallowing, there is typically little to no residue remaining in the throat.

During the Pharyngeal Swallow phase, the VP port closes.

In the Pharyngeal Swallow phase, both the hyoid and larynx elevate.

During the Pharyngeal Swallow phase, the airway closes to prevent entry of the bolus.

In the Pharyngeal Swallow phase, the pharynx shortens and elevates, contracting behind the bolus.

During the Pharyngeal Swallow phase, the upper esophageal sphincter (UES) relaxes and opens, allowing the bolus to enter the esophagus.

Hyolaryngeal elevation involves the upward and forward movement of the hyoid bone, larynx, and related muscles/ligaments. It contributes to opening the upper esophageal sphincter (UES) and inverting the epiglottis to protect the airway.

The airway closes through the adduction of the true vocal folds and the approximation of the false vocal folds. Additionally, the laryngeal vestibule closes via the anterior movement of arytenoids and the approximation of the base of the epiglottis. Epiglottic inversion also aids in airway closure.

The final line of defense in airway protection is a reflexive cough, which can be triggered to protect the airway if any material attempts to pass beyond the closed airway during swallowing.

SLPs may refer individuals with oropharyngeal and esophageal problems to specialists such as Gastroenterologists (GI), Radiologists, and Otolaryngologists (ENT) for further evaluation and management.

The cricopharyngeal muscle helps to keep the opening to the esophagus closed at rest. It holds the upper esophageal sphincter (UES) closed when not actively swallowing.

The opening of the UES is achieved by the combined effects of movement of the hyolaryngeal complex forward and upward, relaxation of the cricopharyngeal muscle, and the enlargement of the opening as the bolus is pushed into the esophagus (bolus propulsion). Mechanical and pressure forces also play a role in allowing the bolus to be propelled into the esophagus.

The main goal of bolus efficiency in swallowing is to move the bolus from the oral cavity to the esophagus in a timely manner without significant residue, effort, or the need for repeated swallows.

The primary focus of the airway protection aspect of swallowing is to prevent the bolus or any material from entering the larynx and trachea, thereby protecting the airway from aspiration and potential harm.

Residue refers to bolus or material that remains in the oral cavity, pharynx, or esophagus after the swallow has occurred.

Penetration in swallowing refers to the situation where the bolus or material enters the laryngeal vestibule but does not pass below the level of the vocal folds.

Aspiration occurs in swallowing when the bolus or material passes below the level of the vocal folds and enters the trachea, potentially causing harm to the airway.

Dysphagia can result from anything that affects the timing, speed, strength, or coordination of the muscles or structures involved in the oral or pharyngeal phase of swallowing. This can lead to difficulties in the swallowing process.

Lack of sensory input, delayed swallow trigger, incomplete epiglottic inversion, and poor bolus hold (due to coordination or tongue strength issues) can all contribute to a swallowing deficit before the swallow.

The potential consequences include penetration, aspiration, and the presence of bolus or material in the pyriform sinuses prior to the swallow.

During the swallow, potential issues include penetration and aspiration.

Muscle weakness, incomplete epiglottic inversion, lack of sensory input, muscle miscoordination, and structural abnormalities can all contribute to the occurrence of penetration and aspiration during the swallow.