Oral Stage 1. The bolus is ready to be ___ 2. Tongue ___ and pulls ___ 3. ___ stops 4. Anterior tongue elevates to the __ ___, squeezing the bolus toward the __ ___ 5. Contact with the ___, soft palate, or posterior tongue triggers the ____ stage reflex

1. The bolus is ready to be swallowed 2. Tongue drops down and pulls posteriorly 3. Mastication stops 4. Anterior tongue elevates to the hard palate, squeezing the bolus toward the faucial pillars 5. Contact with the fauces, soft palate, or posterior tongue triggers the pharyngeal stage reflex

Pharyngeal Stage 1. Bolus reaches ___ ____ 2. Elevation of __ ___ (separation of oropharynx from nasopharynx) 3. Cease of _____ - lip ___ - tight ___ of larynx - constriction of __ __ __ - depression of ___ - ____ of larynx

1. Bolus reaches faucial pillars 2. Elevation of soft palate (separation of oropharynx from nasopharynx) 3. Cease of respiration - lip sealed - tight adduction of larynx - constriction of false vocal folds - depression of epiglottis - elevation of larynx

Pharyngeal Stage - -Relaxed _____ (upper esophageal sphincter) - -Sequential constriction of ________________ - -Reaching esophageal entrance through __ ___

- -Relaxed cricopharyngeus (upper esophageal sphincter) - -Sequential constriction of superior, middle, and inferior pharyngeal constrictors - -Reaching esophageal entrance through pyriform sinuses.

Esophageal Stage - -Purely ____ - -Bolus reaches the orifice of the ____ - -Transported to the LES by ___ contraction and ___ - -_____ contracts again, when the bolus enters the ___ - -Depressed ___ & ____ - _____ re-begins

- -Purely reflexive - -Bolus reaches the orifice of the esophagus - -Transported to the LES by peristaltic contraction and gravity - -Cricopharyngeus contracts again, when the bolus enters the UES - -Depressed larynx and soft palate - -Respiration re-begins

Neurological Control: - -“Swallowing is mediated by a distributed neural network that includes ___ & ____ structures with descending input to the brainstem.” –Daniels,(2010) - -Theories of neural control: - ---Chain of linked ___ - ---___ ___ ___ hypothesis

- --“Swallowing is mediated by a distributed neural network that includes cortical and Subcortical structures with descending input to the brainstem.” –Daniels,(2010) - --Theories of neural control: - Chain of linked Reflexes - Central pattern generator hypothesis

~Cerebral control - ____ cortex - ___ ___ cortex- face area - Primary ____ Cortex - Insula - _____ White matter

~Cerebral control - Pre-Motor cortex - Primary motor cortex- face area - Primary somatosensory Cortex - Insula - Periventricular White matter

Cortical and Sub-cortical Lesion Location: - Anterior to the __ ___ - ___ vessels more than ___ - Specific Areas: - Brainstem - __ ___ cortex - __ ___ cortex - Primary _____ Cortex - Insula - _____ White matter

- Anterior to the central sulcus - Large vessels more than small - Specific Areas: - Brainstem - Pre-Motor cortex - Primary motor cortex - Primary somatosensory Cortex - Insula - Periventricular White matter

Class 2 Flashcards by Haley Thompson

Innervation of the Swallow

Normal swallowing includes an integrated, interdependent group of complex ___ ___ emerging from interacting cranial nerves of the ____ and governed by neural regulatory mechanisms in the _____, as well as in the ____ and ___ cortical system.

Normal swallowing includes an integrated, interdependent group of complex feeding behaviors emerging from interacting cranial nerves of the brainstem and governed by neural regulatory mechanisms in the medulla, as well as in the sensorimotor and limbic cortical system.

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Oral Preparatory Stage

After food is introduced into the mouth:
1. Closure of \_\_\_
2. Tongue bunches up in the \_\_ with pulled down \_\_ \_\_\_
3. \_\_\_ is in charge of keeping the food in oral cavity
     - sealing along the \_\_\_ \_\_\_
     - compressing food against  
        the \_\_ \_\_\_
     - moving the food onto \_\_
     - pulling back of food to mix  
        it with \_\_
4. \_\_\_ (parotid, submandibular, sublingual)
5. \_\_ and \_\_wall contraction

After food is introduced into the mouth
Closure of mouth
Tongue bunches up in the back with pulled down soft palate
 Tongue is in charge of keeping the food in oral cavity
     - sealing along the alveolar 
       ridge
     - compressing food against    
       the hard palate
     - moving the food onto teeth
     - pulling back of food to mix it 
       with saliva
Salivary glands (parotid, submandibular, sublingual)
Facial and buccal wall contraction

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Oral Stage

The bolus is ready to be ___
Tongue ___ and pulls ___
___ stops
Anterior tongue elevates to the __ ___, squeezing the bolus toward the __ ___
Contact with the ___, soft palate, or posterior tongue triggers the ____ stage reflex

The bolus is ready to be swallowed
Tongue drops down and pulls posteriorly
Mastication stops
Anterior tongue elevates to the hard palate, squeezing the bolus toward the faucial pillars
Contact with the fauces, soft palate, or posterior tongue triggers the pharyngeal stage reflex

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Pharyngeal Stage

Bolus reaches ___ ____
Elevation of __ ___ (separation of oropharynx from nasopharynx)
Cease of _____
- lip ___
- tight ___ of larynx
- constriction of __ __ __
- depression of ___
- ____ of larynx

Bolus reaches faucial pillars
Elevation of soft palate (separation of oropharynx from nasopharynx)
Cease of respiration
- lip sealed
- tight adduction of larynx
- constriction of false vocal folds
- depression of epiglottis
- elevation of larynx

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Pharyngeal Stage

-Relaxed _____ (upper esophageal sphincter)
-Sequential constriction of ________________
-Reaching esophageal entrance through __ ___

-Relaxed cricopharyngeus (upper esophageal sphincter)
-Sequential constriction of superior, middle, and inferior pharyngeal constrictors
-Reaching esophageal entrance through pyriform sinuses.

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Esophageal Stage

-Purely ____
-Bolus reaches the orifice of the ____
-Transported to the LES by ___ contraction and ___
-_____ contracts again, when the bolus enters the ___
-Depressed ___ & ____
_____ re-begins

-Purely reflexive
-Bolus reaches the orifice of the esophagus
-Transported to the LES by peristaltic contraction and gravity
-Cricopharyngeus contracts again, when the bolus enters the UES
-Depressed larynx and soft palate
-Respiration re-begins

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Cavities

1.
2.
3.

Nasopharynx
Oropharynx
Hypopharynx

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Neurological Control:

-“Swallowing is mediated by a distributed neural network that includes ___ & ____ structures with descending input to the brainstem.” –Daniels,(2010)
-Theories of neural control:
—Chain of linked ___
—___ ___ ___ hypothesis

–“Swallowing is mediated by a distributed neural network that includes cortical and Subcortical structures with descending input to the brainstem.” –Daniels,(2010)
–Theories of neural control:
Chain of linked Reflexes
Central pattern generator hypothesis

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~Efferent Motor fibers: 
~Afferent sensory fibers:
~Cerebral and \_\_\_ fibers
~\_\_\_\_ swallowing centers 
-Dorsal Nucleus Tractus \_\_
   --Nucleus \_\_\_
   --Primary \_\_\_\_ Nucleus
   --Ventral Medial \_\_\_ \_\_\_\_

~Efferent Motor fibers: (away from organ)
~Afferent sensory fibers (toward organ)
~Cerebral and Midbrain fibers
~Brainstem swallowing centers -
-Dorsal Nucleus Tractus Solitarius
   --Nucleus Ambiguous
  -- Primary Trigeminal Nucleus
   --Ventral Medial reticular     
      formation

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~Cerebral control

____ cortex
___ ___ cortex- face area
Primary ____ Cortex
Insula
_____ White matter

~Cerebral control

Pre-Motor cortex
Primary motor cortex- face area
Primary somatosensory Cortex
Insula
Periventricular White matter

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Cortical and Sub-cortical Lesion Location:

Anterior to the __ ___
___ vessels more than ___
Specific Areas:
Brainstem
__ ___ cortex
__ ___ cortex
Primary _____ Cortex
Insula
_____ White matter

Anterior to the central sulcus
Large vessels more than small
Specific Areas:
Brainstem
Pre-Motor cortex
Primary motor cortex
Primary somatosensory Cortex
Insula
Periventricular White matter

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Brainstem Made up of:

1.
2.
3.

Made up of:
midbrain
pons
medulla oblongata

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Cranial nerves and their nuclei arise from the ____

___ ___ ___ for life are maintained here

Cranial nerves and their nuclei arise from the brainstem

Basic bodily functions for life are maintained here

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V Trigeminal Nerve

3 branches :
__ to the muscles of mastication
_____ : ___ 2/3 on tongue, floor of mouth, gums, teeth, inner lining of cheek, pinna, auditory meatus, TMJ, nasal cavity, eyelids, etc.

V Trigeminal Nerve
- 3 branches
opthalmic (GSA),
maxillary (GSA),
mandibular (GSA, SVE)
- motor supply (efferent) to the muscles of mastication
- sensory info (afferent) : anterior 2/3 on tongue, floor of mouth, gums, teeth, inner lining of cheek, pinna, auditory meatus, TMJ, nasal cavity, eyelids, etc.

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VII Facial Nerve

__ __ : bilateral innervation for the __ facial muscles, contralateral innervation for the ____ facial muscles
___ (lacrimal gland) and ___ (sublingual , submandibular gland)
taste for ____ of tongue

VII Facial Nerve

 - facial expression : bilateral innervation for the upper facial muscles, contralateral innervation for the lower facial muscles 
 - tears (lacrimal gland)and salivation (sublingual , submandibular gland)
 - taste for anterior two-thirds of tongue

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Facial VII: Oral & Pharyngeal

Distorted ___ ___
Loss of taste in _____ of the tongue

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Facial VII: Oral & Pharyngeal

Distorted facial appearance

Loss of taste in front 2/3 of the tongue

IX Glossopharyngeal Nerve ~~taste for ____ of tongue and soft palate

touch, pain, and temperature for __ ___, faucial pillars, upper ____, and ET
muscle activation for ____ and superior constrictor muscles
___ portion for parotid gland

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IX Glossopharyngeal Nerve
~~taste for posterior 1/3 of tongue and soft palate
- touch, pain, and temperature for posterior tongue, faucial pillars, upper pharynx, and ET
- muscle activation for stylopharyngeus and superior constrictor muscles
- efferent portion for parotid gland

X Vagus Nerve
- motor innervation of most ___,___, & ____ muscles as well as intestines, stomach, esophagus, kidney, heart, trachea, and bronchi

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X Vagus Nerve
- motor innervation of most laryngeal, palatal, and pharyngeal muscles as well as intestines, stomach, esophagus, kidney, heart, trachea, and bronchi

X Vagus Nerve

afferent: pain, touch, temperature to skin surrounding ear drum, posterior pinna, EAM as well as pain from lower ___, ___, ___, palatopharyngeus, palatoglossus, levator veli palatini, uvula (tensor veli palatini is not innervated by Facial nerve) taste to epiglottis and ____.

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afferent: pain, touch, temperature to skin surrounding ear drum, posterior pinna, EAM as well as pain from lower pharynx, larynx, esophagus, palatopharyngeus, palatoglossus, levator veli palatini, uvula (tensor veli palatini is not innervated by Facial nerve) taste to epiglottis and valleculae.

X Vagus Nerve

lesions of Vagus nerve: difficulty ____, hypernasality and nasal regurgitation due to paralysis of ___ ___. flaccidity of VF on side of lesion (bilateral lesion would cause paralysis of both VFs in adducted position or medial position), laryngeal stridor, ___, decreased ___ range.

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lesions of Vagus nerve: difficulty swallowing, hypernasality and nasal regurgitation due to paralysis of levator veli. flaccidity of VF on side of lesion (bilateral lesion would cause paralysis of both VFs in adducted position or medial position), laryngeal stridor, aspiration, decreased pitch range.

X Vagus nerve

~Pharyngeal &amp; \_\_\_\_  (Note: often damaged in endarterectomy surgery)  
~Sensation and motor  to 
\_\_\_ &amp; \_\_\_\_
~\_\_\_ effected
~X only = hoarseness,  swallow,  
soft palate on one side

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~Pharyngeal &amp; Esophogeal 
(Note: often damaged in 
endarterectomy                                                     surgery)
~Sensation and motor  to 
pharynx &amp; larynx
~Paristalsis effected
~X only = hoarseness,  swallow,  
soft palate on one side

XI Accessory Nerve

efferent innervation of ____ & ____muscles
also works with ___ to innervate laryngeal, pharyngeal, and __ __ muscles

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XI Accessory Nerve

efferent innervation of sternocleidomastoid and trapezius muscles
also works with Vagus to innervate laryngeal, pharyngeal, and soft palate muscles

XII Hypoglossal Nerve

__ & ___ muscles of tongue
- Upper motor neurons serve ___ side, therefore left damage will cause __ ___ tongue paralysis
- Lower motor neurons will result in __ ___
—- ____ of tongue to side of lesion,
—- ____ (twitching movements of tongue)

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Extrinsic & instrinsic muscles of tongue
- Upper motor neurons serve contralateral side, therefore left damage will cause right sided tongue paralysis
- Lower motor neurons will result in ipsilateral paralysis
—– deviation of tongue to side of lesion,
—– fasciculations (twitching movements of tongue)

Hypoglossal XII: Oral, Oral prep., pharyngeal
___ to the oral functions
Some ____
Can’t ____ tongue

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Hypoglossal XII: Oral, Oral prep., pharyngeal
     Motor to the oral   
     functions
     Some pharyngeal 
     Can’t protrude tongue

Testing for Cranial Nerve Function

Barbara Sonies Cranial Nerve Assessment

Related to Taste VII facial nerve - ___ ___ of the tongue and palate - __, ___, & ___ sensation

VII facial nerve - anterior two-thirds of the tongue and palate - sweet, salty, and sour sensation

Related to Taste IX Glossopharyngeal - __ ____ of the tongue - ___ sensation

IX Glossopharyngeal - posterior one-third of the tongue - bitterness

Related to Taste X Vagus -___ & ___

X Vagus | - epiglottis and esophagus

Motor Responses to Tastes ~The nucleus of the solitary tract projects to the __ ___ serving the __ ~Our bodies will crave tastes like __ as this is a necessary nutrient ~The tastes we crave will elicit __ as well as ___ responses such as tongue ___, mastication, and ___ ~Bitter and sour tastes will elicit opposite responses like ___, coughing, and ___ to protect the oral cavity

~The nucleus of the solitary tract projects to the motor cortex serving the tongue ~Our bodies will crave tastes like salt as this is a necessary nutrient ~The tastes we crave will elicit salivation as well as ingestive responses such as tongue protrusion, mastication, and swallowing ~Bitter and sour tastes will elicit opposite responses like gagging, coughing, and saliva to protect the oral cavity

Motor Responses to Taste ~Gag response involves elevation of ___ & ___, clamping of VFs, compressing ___ & thorax, and protrusion of ___ (Not volitional) ~Coughing entails tightly closing VFs, compressing abdomen & thorax, and then blowing __ __.

~Gag response involves elevation of larynx and velum, clamping of VFs, compressing abdomen & thorax, and protrusion of tongue (Not volitional) ~Coughing entails tightly closing VFs, compressing abdomen & thorax, and then blowing VFs apart.

Olfaction ~Increase magnitude of the ___ perception ~Arise from __ ___ ~___ lining of the upper posterior nasal cavity ~Olfactory sensors are replaced every __ days and have cilia that are specialized for over __ different smells

~Increase magnitude of the taste perception ~Arise from olfactory bulb ~Epithelia lining of the upper posterior nasal cavity ~Olfactory sensors are replaced every 60 days and have cilia that are specialized for over 1000 different smells

Tactile Sense ~____ ~____ skin (hairless) vs. hairy skin

``` Mechanoreceptors Glabrous skin (hairless) vs. hairy skin ```

Muscle Stretch Sense ~Muscle ____ ~Nuclear ___ fibers and nuclear ___ fibers ~Found in ___ muscles as well as __ muscles (e.g., mandibular elevators and tongue muscles) ~Return a muscle to its original position following passive stretching ~Normally ____ during active contraction

~Muscle spindle ~Nuclear chain fibers and nuclear bag fibers ~Found in larger muscles as well as oral muscles (e.g., mandibular elevators and tongue muscles) ~Return a muscle to its original position following passive stretching ~Normally inhibited during active contraction

Respiration and Swallowing ``` ~Linked by anatomy ~Control centers in ___ ~___ disorders effect swallowing ~Airflow inhibition-onset of ___ stage ~Protection of airway achieved by: --__________ --Laryngeal ____ --Tongue ___ retraction --____ tilt ```

``` ~Linked by anatomy ~Control centers in medulla ~Respiratory disorders effect swallowing ~Airflow inhibition-onset of oral stage ~Protection of airway achieved by: --True and false vocal folds --Laryngeal elevation --Tongue base retraction --Epiglottic tilt ```

Normal Aging Issues – McCullough article - Swallowing and the Frail/Aged Patient: McCullough - ___ Changes: McCullough article - ___ Changes: McCullough article

– McCullough article - Swallowing and the Frail/Aged Patient: McCullough - Sensory Changes: McCullough article - Motor Changes: McCullough article

Changes related to stages (Text) Oral stage: - ___ of tongue - Dentition - ____ flow

Oral stage: Hypertrophy of tongue Dentition Salivary flow

Pharyngeal Stage/Aging ~Reduced ___ ____ movement ~Less distention of PES ~More ___ penetration in ___ over 50 ~Aviv, et al.: reduced sensory response leads to ___ ___ ___ ___

~Reduced anterior hyoid movement ~Less distention of PES ~More laryngeal penetration in males over 50 ~Aviv, et al.: reduced sensory response leads to upper airway protection problems

Esophogeal Aging Reduced ___ activity __ ____ thickening Delay in ___

Reduced motor activity Smooth muscle thickening Delay in emptying

Class 2 Flashcards

(38 cards)