swallowing course (rhs …)fac.ksu.edu.sa/sites/default/files/anatomy_and_physiology-.pdf · 2....

SwallowingCourse(RHS…)Dr/Mohamed Farahat Ibrahim, M.D., Ph.D.

Professor, Consultant Phoniatrician

(Communication and Swallowing Disorders)

Chairman, Communication and Swallowing Disorders Unit (CSDU)

King Abdulaziz University Hospital

Supervisor, Swallowing disorders clinic

King Khalid University Hospital

King Saud University, Riyadh, Saudi Arabia.

http://fac.ksu.edu.sa/mfarahat

Coursestructure

1. Anatomy and Physiology of swallowing.

2. Etiology of oropharyngeal dysphagia,

preliminary assessment.

3. FEES & MBS.

4. Management of oropharyngeal dysphagia.

CourseObjectives

• Knowthenormalanatomyofswallowing• Knowthenormalphysiologyofswallowing• Enumeratedifferentetiologiesoforopharyngealdysphagia

• Beabletodobedsideassessment• InterpretMBSandFEESprocedures• WriteMBSandFEESreports• Putashort-termandlong-termtreatmentplan

Generalrules

• Notallinformation,buttheimportant

• Notes

• Questions,anytime

• Moreexplanation

• Reactionsandfeedback

13-Mar-17 SwallowingCourse/AnatomyandPhysiology 4

Recommendedreadings

HistoricalPerspective“Swallowing”

• Swallowing addressed in CP children by“speech specialists” in 1930s


• First article in SLP literature: Larsen, 1972– JSHD “Rehabilitation for dysphagia paralytica”

– Introduced aspects of the clinical exam, radiographic techniques,postural adjustment, dietary changes, electrical stimulation andmaneuvers


LarsenGL.Rehabilitationfordysphagia paralytica.JSpeechHearDisord.1972May;37(2):187-94.


• Between 1968-1970, Logemann began to studyParkinson patients with radiographic techniques– Landmark text, Evaluation and Treatment ofSwallowing Disorders 1983

– Introduced the MBS; provided objective data relativeto maneuvers, diet consistencies and posturaladjustments; extensive influence on educationalstandards and policies

Logemann JA, Blonsky ER, Boshes B. Editorial: Dysphagia in parkinsonism. Br J Radiol. 1970 Jul;43(511):456–457.Logemann JA. Evaluation and Treatment of Swallowing Disorders. 1st ed. Austin, TX, Pro-Ed Publishers; 1983.

HistoricalPerspective“SpeechandLanguage”

• FormativeYears(1900-1925):Firstschool-basedprogram(1910)- ASHA

• ProcessingPeriod(1945-1965):Assessmentandintervention(internalandpsychological)

• LinguisticEra(1965-1975):Separationbetweenspeechandlanguagedeficits

• PragmaticsRevolution:Shapingofprofessionalpractice,ecologicalfactorsDuchan, J.F. (2008). Getting here: A short history of speech pathology in America. Retrieved July 15, 2009, fromhttp://www.acsu.buffalo.edu/~duchan/new_history/overview.html.Smith, Deborah D.; Tyler, Naomi Chodhuri (2009). Introduction to Special Education: Making A Difference (7th Edition). Englewood Cliffs, N.J: PrenticeHall. ISBN 0-205-60056-5. OCLC 268789042

“Beforeyouexaminethebodyofapatient,bepatienttolearnhisstory.Foronceyoulearnhisstory,youwillalsocometoknowhisbody.”

SuzyKassem

I- OralCavity

• Lips,cheeks• Teeth,gingiva• Tongue• Vestibules


I- OralCavity(Cont.)Tongue


I- OralCavity(Cont.)Tonguemuscles


Extrinsic(4) Intrinsic(4)

Position Shape

II- SoftPalate


• Muscles(5)• Functions(5)

II- SoftPalate


III- Pharynx


• Compartments(3)• Walls(3)• Muscles(3)

IV- Larynx

• RHS466• Sphinctericaction• Laryngealsuspension!!


Sternothyroid Muscle

Suprahyoid muscles:DigastricusMylohyoideusStylohyoideus

Infrahyoid muscles:SternohyoideusOmohyoideus

Summary

• Oralcavity(Tongue:4extrinsic,4intrinsic)

• Softpalate(5muscles,5functions)

• Pharynx(3compartments,3walls,3muscles)

• Larynx(Sphincter,laryngealsuspension)


NeuralControlofswallowing

• Receptors(types,sites?)

• Afferent

• Efferent

• Swallowingcenter

• Suprabulbar &Cortical


DysphagiaApplication(iTunes)


OralpreparatoryphaseOral Cavity:Boluscontainmentandpresentation

1. Containment- Lips,Cheeks

ClosureAdequatetension

2. Boluspreparationa. Teeth: masticationb. Tongue:drivingforcetoinitiallypropelthebolusc. Gingivalandbuccalgutters:channelthebolusd. Softpalate(Shutoff!)


• Transferphase?• Reductionphase?

Taste,temperature,viscosityandsizeofbolusaresensed

OraltransportphaseOropharynx: Deliverysystem

1. Oropharyngeal propulsionpumpa. Soft palateb. Lateralpharyngealwallsc. Baseoftongue

2. Velopharyngeal functiona. Softpalate:elevatesastonguepropelsb. Tongueelevation:necessaryforpropulsion


Thetongueistheprimarymanipulatoroffoodduringtheoralphase

Hypopharynx1. Muscular propulsiona. Pharyngealconstrictorsb. Piriformsinusesc. Cricopharyngeal function

2. Laryngeal protectiona. Closure:glottis,ventricularbands,epiglottisb. Pharyngealsqueezec. Hyoidelevation


Pharyngealphase

INVOLUNTARY

Tongue elevation è Velopharyngeal valve closure è forwardmotion of the hyolaryngeal mechanism (increase opening of UES)Laryngeal elevation è relaxation of the cricopharyngeusmusculature

• Size

• Consistency

• swallowingevent“single/

continuous”

Appliedanatomy

Sphincters:

• Velopharyngeal

• Laryngeal

• UES


Appliedphysiology

Temporalmeasures:

• OralTransitTime(OTT)

• PharyngealDelayTime(PDT)

• PharyngealTransitTime(PTT)

• OropharyngealSwallowingEfficiencyScore(OPSE

score)


swallowing course (rhs …)fac.ksu.edu.sa/sites/default/files/anatomy_and_physiology-.pdf · 2....

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