Competency 1: Reading

Logemans chapter 2 and Love and web Chapter 7: The normal swallow and the cranial nerves.

Summary	·         4 stages in the swallow: Oral preparatory, Oral stage, Pharyngeal stage and the Oesophageal stage. ·         Originate from the brainstem and are part of the PNS – provide sensory and motor information to the facial, oral, pharyngeal and laryngeal musculature.
Key information	Oral Preparatory Stage l  Anticipation and Sensory recognition of food. l  Lip seal. l  Nasal breathing l  Mastication (to form a bolus). l  Lip, jaw, tongue & palate sensory & motor function needed [& dentition]. Oral Stage l  CN V (Trigeminal) – responsible for the chewing muscles (Masseter (closes jaw), Temporalis (moves jaw up), Pterygoids (jaw side to side). l  CN VII (Facial) – Lower facial muscles/ lip seal + pressure build up. l  CN XII (Hypoglossal) – tongue l  Tongue moves bolus posteriorly (striping action). l  Open airway l  1-1.5 seconds to complete. l  Nasal breathing l  Need intact labial, tongue, palate and jaw musculature. Pharyngeal stage l  CN XII (Hypoglossal) – tongue/ geniohyoid l  CN V (Trigeminal) – elevates/retracts the hyoid. l  CN VII (Facial) – Stylohyoid elevates the hypoid. l  CN X (Vagus) and Spinal accessory N – innervate the pharyngeal muscles + Cricopharyngeous. Triggered by sensory receptors in the tongue/ oro-pharynx – info to the brainstem/cortex. Elevation of the velum Elevation + anterior hyoid/larynx movement. Closure of the larynx (epiglottis) Opening of the cricopharyngeal sphincter Tongue base retraction to contact the posterior pharyngeal wall. Pharyngeal constriction. Normally the duration of airway closure increases as bolus volume increases. Swallow normally followed by exhalation. Cup Drinking ·         Sequential swallows Older Adults ·         Can still chew with poor dentition. ·         Often have decreased strength of pharyngeal contraction – therefore may have second residue clearing swallows. ·         Increased delayed triggering of the pharyngeal swallow.
Clinical application	l  Oral preparation –        spilling food/drink/saliva from mouth; food pocketing in cheeks; long time chewing, trying to swallow big bits, food/drink goes back too quick/ before the oral/pharyngeal swallow is initiated. l  Oral phase –        holding food in mouth, several attempts to swallow, food left in mouth l  Pharyngeal phase –        food/drink enters airway (penetration / aspiration), coughing / no coughing, food/drink remains in pharynx l  Oesophageal phase –        food/drink remains in pharynx, reflux
What I will do to investigate the articles findings	·         Observe swallowing in 5 patients who do not have dysphagia. Observations: ·         Double swallows ·         Eat and talk ·         Variable hyoid elevation and anterior movement of the larynx.
Literature review	·         Normal swallow is variable i.e. timing, strength…