7026915
Descripción
Mapa Mental por Heather Snaith, actualizado hace más de 1 año
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Creado por Heather Snaith
hace alrededor de 8 años
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Dysphagia: Normal Swallow
- Many studies which
look at swallow
breakdown haven't
included controls w
no dysphagia
(Huckabee 2012)
- Two types of
swallow
- Controlled
by
cortex
- Voluntary
swallow
- Voluntary
swallow
- Controlled
by
brainstem
- Reflex
phases of
swallow
- Reflex
phases of
swallow
- Controlled
by
cortex
- Dynamic process
requiring intact
anatomy and
neurology (25
pairs muscles)
- Also
affected by
- Appetite
- Food on offer
- Sight
- Smell
- Saliva
- Appetite
- Also
affected by
- Has to be co-ordianted with respiration
- Has three, or some say
four stages (if you
include pre-oral phase)
(Huckabee 2008)
- 1. Oral preparatory
- Under
volutary
control.
- Respiration
continues
- Lips sealed
(CNVII):
Orbicularis
Oris
- Food held
between
tongue and
hard palate
- Bolus
pulled
into
cohesive
formation
- Bolus
pulled
into
cohesive
formation
- LATERAL ROTARY
MOVEMENT of
mandible (jaw) and
tongue muscles of
mastication
- Velum down
approximates
with post tongue
(Palatoglossus
CNX)
- Velum down
approximates
with post tongue
(Palatoglossus
CNX)
- Buccal muscles
tense,
buccinator
(CNVII)
- MUSC.
MASTICATION (CNV)
- Masseter
- Temporalis
- Medial and
lat.
pterygoids
- TONGUE
MUSCLES (CNXII)
except p'glossus.
- Intrinsic -
shape and tone
- Extrinsic -
tongue
position
- Intrinsic -
shape and tone
- Masseter
- MUSC.
MASTICATION (CNV)
- SENSORY FEEDBACK
- Anterior
Tongue (CNV)
- TASTE CNVII ant. 2/3
- TASTE CNVII ant. 2/3
- Posterior
Tongue (CNVII)
- Part post*
(CNIX)
- Anterior
Tongue (CNV)
- Under
volutary
control.
- 2. Oral phase
(Oral cavity to
pharynx)
- Tongue makes a
central groove
- Initiates a
'Stripping' action
along hard palate
- Intra oral
pressure increases
- Orbicularis Oris &
Buccinator remain
contracteu
- Orbicularis Oris &
Buccinator remain
contracteu
- Velum (sof palate)
elevates opening
pharynx (CNX -
levator palatini)
- Posterior tongue
lowers (CNXII)
- Contraction of
posterior
pharyngeal wall
(PPW) (CNX)
- Contraction of
posterior
pharyngeal wall
(PPW) (CNX)
- Posterior tongue
lowers (CNXII)
- Finally, hyoid
begins to elevate
(Mylohyoid CNV)
- Tongue makes a
central groove
- 3. Pharyngeal
stage
(Involuntary)
- Lasts 1 second -
apnoeic period
while resp
ceases
- Swallow
OCCURS ON
EXPIRATION
(mostly)
- Respiratory
disease may
occur on insp.
- Respiratory
disease may
occur on insp.
- Swallow
OCCURS ON
EXPIRATION
(mostly)
- ELEVATION &
RETRACTION of
Velum - closes VP
port
- Tongue BASE
RETRACTION to
contact PPW
- Oropharynx =
closed
creating
pressure to
drive bolus
- Oropharynx =
closed
creating
pressure to
drive bolus
- LARYNX RAISES with hyoid
bone as attached by
THYROHYOID membrane
and muslces
- ANTERIOR MOVEMENT (see below)
- CNXII
- CNV
- Anterior belly of... (CNV)
- ELEVATION
- CNVII
- Posterior
belly of
diagastirc
(CNVII)
- CNVII
- CNXII
- Larynx closes on 3 levels:
- 1. True
VF's (Lat.
cricoaryteniod
CNX)
- 2. False VF's
- 3. Epiglottis
- Tongue stabilised
by mandibular
musc. Mandible
CLOSED
- 1. True
VF's (Lat.
cricoaryteniod
CNX)
- Crycoid lamina away
ph. wall - opens UES
- Spincter most
relaxed at
point of
highest laryn.
elevation
- Bolus into
PE
segment
- Pharyngeal
contractions
move bolus from
height of glottic
opening
- Pharyngeal
contractions
move bolus from
height of glottic
opening
- Bolus into
PE
segment
- Spincter most
relaxed at
point of
highest laryn.
elevation
- ANTERIOR MOVEMENT (see below)
- Lasts 1 second -
apnoeic period
while resp
ceases
- 4. Oesophageal
(8-20 secs)
- Gravity &
sequential
peristaltic wave
- Blous down oes.
canal to LOWER
oes. sphincter
- Upper 1/3
Striated, lower
1/3 smooth
- Gravity &
sequential
peristaltic wave
- 1. Oral preparatory
- We swallow
1-1.5L SALIVA/
day
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