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Multimedia List
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Chapter 1
Video 1–1.
Chapter 4
Video 4–1.
Video 4–2. OROPHX
Video 4–3. HYPOPHX
Video 4–4. FEESPT1
Video 4–5. FEESPT2
Chapter 6
Video 6–1.
Video 6–2. AP Aspiration
Chapter 7
Video 7–1.
Video 7–2. AbsInc-PhPeristalsis
Video 7–3. ExcPhPeristalsis
Video 7–4. AbsIncEpigInv
Video 7–5. BolusRedirect
Video 7–6.
ImpairedPharyngeal Shortening
Video 7–7. ASPBefore
Video 7–8. ASPDuring
Video 7–9.
Video 7–10. DiffuseEsophSpasm
Video 7–11. Stasis
Chapter 8
Video 8–1. BTSGTiming
Straw Drinking
VPPORT
ZDtwoviews
NrmPhPeristalsis
ASPAfter
Video 8–2.
Video 8–3. BP1AEcl
Video 8–4.
Video 8–5. HL
Video 8–6. PCR
Video 8–7. PESmax
Video 8–8. BCR
Video 8–9. BulletPharynx
Video 8–10.
Pharyngeal Shortening Measure
Chapter 9
Video 9–1.
Chapter 10
Video 10–1. Strategy 1
Video 10–2. Strategy 2A
Video 10–3. Strategy 2B
Video 10–4.
Video 10–5. Strategy 4
Video 10–6. Strategy 5
Video 10–7.
Chapter 19
Video 19–1.
CSpineBolusConsistManipulation
Video 19–2.
CSpineBolusVolManipulation
Video 19–3. CSpineBolusRedirect
YngEldNormalSwallow
Hmax
GOOSE
Strategy 3
Strategy 6
xi
Acknowledgments
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The authors extend a sincere “thank
you” to the members of the UC Davis
Dysphagia Team, past and present,
as well as to our colleagues at other
institutions, for their generosity and
expertise in the preparation of this text.
Many of our authors have contributed
to previous editions; others, including
James Clark, MD, Assistant Professor at
Johns Hopkins School of Medicine, and
Deirdre Larsen, PhD, Assistant Professor at Eastern Carolina University, are
first-time contributors. Our “team”
experience at UCD has convinced us
that a highly interactive, interdisciplinary group of individuals with unique
backgrounds and skill sets represents
an excellent approach to dysphagia
management, as well as a perpetual
source of continuing education for
individual members. We are hopeful
that the text will inspire other professionals to develop similar resources in
their own settings. We also thank those
patients and volunteer subjects who
have played a role in materials used
in the book, as well as in our collection
of normative and other data. These
individuals have graciously shared
their time and experiences with us,
and we gratefully acknowledge their
contributions.
xii
Contributors
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Jacqui E. Allen, MD, FRACS,
ORL-HNS
Laryngologist
Department of Surgery
University of Auckland
Takapuna, Auckland
New Zealand
Chapters 5, 16
Peter C. Belafsky, MD, MPH, PhD
Professor and Director, Center for
Voice and Swallowing
Department of Otolaryngology
University of California, Davis
Sacramento, California
Chapters 15, 18
Ivy Cheng, PhD
Postdoctoral Research Associate
Division of Diabetes, Endocrinology
and Gastroenterology
University of Manchester
Manchester, United Kingdom
Chapter 10 Addendum
Department of Otolaryngology-Head
& Neck Surgery
Weill Cornell Medical College
New York, New York
Chapter 10 Addendum
Susan J. Goodrich, MS
Ret. Senior Speech-Language
Pathologist
Voice-Speech-Swallowing Center
Department of Otolaryngology
University of California, Davis
Sacramento, California
Chapter 3
Shaheen Hamdy, MB ChB, PhD,
FRCP
Professor and Honorary Consultant
Gastroenterologist/Physician
Department of GI Sciences, School of
Medical Sciences
University of Manchester
Manchester, United Kingdom
Chapter 10 Addendum
James H. Clark, MD
Assistant Professor
Department of Otolaryngology-Head
and Neck Surgery
John Hopkins University, School of
Medicine
Baltimore, Maryland
Chapters 15, 18
James A. Curtis, PhD, CCC-SLP,
BCS-S
Assistant Professor of Speech-
Language Pathology
Maggie-Lee Huckabee, PhD
Director and Distinguished Professor
The Rose Centre for Stroke Recovery
and Research
School of Psychology Speech and
Hearing, College of Science
University of Canterbury
Christchurch, New Zealand
Chapter 10 Addendum
Katherine A. Kendall, MD, FACS
Professor
Division of Otolaryngology
xiii
xiv
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
University of Utah
Salt Lake City, Utah
Chapters 1, 2, 11, 12, 13, 17
Maggie A. Kuhn, MD, MAS
Associate Professor
Department of Otolaryngology-Head
and Neck Surgery
University of California, Davis
Sacramento, California
Chapter 9
Deirdre Larsen, PhD, CCC-SLP
Assistant Professor
Department of Communication
Sciences and Disorders
East Carolina University
Greenville, North Carolina
Chapter 10
Rebecca Leonard, PhD
Professor, Emeritus
Department of Otolaryngology-Head
and Neck Surgery
University of California, Davis
Sacramento, California
Chapters 4, 6, 7, 8, 10
Beverly Lorens, MS, RD
Senior Clinical Dietitian, retired
Food and Nutrition Services
University of California Davis Medical
Center
Sacramento, California
Academy of Nutrition and Dietics
Chapter 13
Georgia A. Malandraki, PhD,
CCC-SLP, BCS-S, ASHA Fellow
Professor
Department of Speech, Language, and
Hearing Sciences
Purdue University
West Lafayette, Indiana
Bonus Online Chapter
Susan McKenzie, MS
Ret. Senior Speech-Language
Pathologist
Voice-Speech-Swallowing Center
Department of Otolaryngology
University of California, Davis
Sacramento, California
Chapters 6, 7
Anna Miles, PhD
Senior Lecturer, Speech Science
The University of Auckland
Auckland, New Zealand
Chapter 14
Madeline Mills, BSLP(Hons)
The Rose Centre for Stroke Recovery
and Research
School of Psychology, Speech and
Hearing, College of Science
University of Canterbury
Christchurch, New Zealand
Chapter 10 Addendum
Derrick R. Randall, MD, MSc,
FRCSC
Clinical Assistant Professor and
Residency Program Director
Section of Otolaryngology-Head and
Neck Surgery
University of Calgary
Calgary, Alberta, Canada
Chapter 19
Catherine J. Rees Lintzenich, MD
Associate Professor Otolaryngology
Head and Neck Surgery
Center for Voice and Swallowing
Disorders
Wake Forest University School of
Medicine
Winston-Salem, North Carolina
Chapters 15, 18
2. HISTORY AND PHYSICAL EXAMINATION IN DYSPHAGIA
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xv
Ann E. F. Sievers, RN, MA, CORLN
ENT Nurse Expert
Department of Patient Care Services
and Otolaryngology
University of California, Davis
Sacramento, California
Chapter 12
Alice I. Walker, MS
Ret. Senior Speech-Language Pathologist
Voice-Speech-Swallowing Center
Department of Otolaryngology
University of California, Davis
Sacramento, California
Chapter 3
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Anatomy and Physiology
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of Deglutition
Katherine A. Kendall
Familiarity with the anatomy and physiology of normal deglutition enables a
focused approach to the evaluation of
patients with disordered swallowing.
An understanding of how head and
neck structures interact to accomplish
swallowing allows the clinician to comprehend how various types of pathology are likely to negatively impact
swallowing function. Once specific
aspects of swallowing dysfunction are
identified, therapy can be tailored to
focus on those dysfunctional aspects
with the goal of achieving safe and
effective swallowing, even in the face
of ongoing pathology. This chapter discusses the anatomy and interaction of
head and neck structures involved in
swallowing and reviews the sequence
of events resulting in a successful
swallow.
PHYSIOLOGY: SERIES OF
CHAMBERS AND VALVES
The oral cavity, oropharynx, and esophagus can be thought of as a series of
expanding and contracting chambers,
divided by muscular sphincters or
valves. Propulsion of a bolus through
this part of the alimentary tract is the
result of forces or positive pressure
developed behind the bolus, as well as
a vacuum or negative pressure developed in front of the bolus. The positive
pressure behind the bolus pushes it
forward through the alimentary tract
while negative pressure in front of the
bolus acts to suck or pull the bolus forward into the next alimentary chamber.
The creation of propulsion pressures
depends on the sequential contraction
and expansion of the chambers of the
1
2
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DYSPHAGIA ASSESSMENT AND TREATMENT PLANNING: A TEAM APPROACH
upper aerodigestive tract and the competency of the sphincters dividing the
chambers. Any disturbance in the functional elements or coordination of this
system is likely to cause a less efficient
transfer of a bolus from the oral cavity
to the stomach, resulting in dysphagia.
Swallowing involves coordination of
the sequence of activation and inhibition for more than 25 pairs of muscles
in the mouth, pharynx, larynx, and
esophagus. An understanding of how
the structures of the head and neck
interact and coordinate to bring about
the propulsion pressures required for
normal swallowing is vital for the clinician involved in the evaluation and
treatment of patients with swallowing
complaints.
For simplicity, the act of deglutition
is traditionally divided into four parts:
the preparatory phase, the oral phase, the
pharyngeal phase, and the esophageal
phase (Dodds et al., 1990; Miller, 1982).
PREPARATORY PHASE
The preparatory phase of swallowing includes mastication of the bolus,
mixing it with saliva, and dividing the
food for transport through the pharynx
and esophagus. The preparatory phase
takes place in the oral cavity, the first
chamber in the swallowing system.
This oral preparatory phase of swallowing is almost entirely voluntary and
can be interrupted at any time.
During bolus preparation, facial
muscles play a role in maintaining the
bolus on the tongue and between the
teeth for chewing. Specifically, the orbicularis oris muscle, the circular muscle
of the lips, maintains oral competence
and can be considered the first sphincter
of the swallowing system (Figure1–1).
Weakness or incompetence of the orbicularis oris muscle results in difficulty
maintaining a bolus inside the oral
cavity during bolus preparation with
spillage of the bolus from the mouth.
Weakness or incompetence of the orbicularis oris muscle will also result in
spillage of saliva, or drooling, between
meals.
The buccinator muscle of the cheek
contracts to keep the bolus from pooling in the pockets formed by the gingival buccal sulci lateral to the mandible.
Buccinator muscle fibers run between
the lateral aspect of the orbicularis oris
muscle and the pterygoid plates of the
skull base (see Figure 1–1).
These facial muscles receive neural input from the facial nerve, also
known as cranial nerve VII (Figure 1–2).
Patients suffering from paralysis of the
facial nerve, such as in Bell’s palsy, will
experience problems during the preparatory phase of swallowing, characterized by difficulty maintaining a bolus
in the oral cavity and lateral pooling of
the bolus between the mandible and the
cheek on the side of the palsy.
Most of the movement and positioning of the bolus during preparation
for swallowing is carried out by the
tongue muscles. In addition to four
intrinsic muscles, the tongue has four
paired extrinsic muscles: the genioglossus, palatoglossus, styloglossus,
and hyoglossus muscles (Figure 1–3).
Along with the genioglossus muscle,
the intrinsic muscles act primarily to
alter the shape and tone of the tongue
while the other three extrinsic muscles
aid in the positioning of the tongue
relative to other oral cavity and pha-
Incisivus labii
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superioris
Zygomatic
major
Risorius
Incisivus
labii inferioris
Zygomatic
Mentalis
minor
1. ANATOMY AND PHYSIOLOGY OF DEGLUTITION
Levator anguli
oris
Levator labii
superioris
Levator labii
superioris
alaeque
nasi
Buccinator
Orbicularis
oris
Depressor
labii inferioris
Depressor anguli
oris
Platysma
3
Figure 1–1. Facial musculature shown in relationship to the oral cavity. Note
the orbicularis oris muscle encircling the mouth and the fibers of the buccinator muscle running anteriorly to insert in the lateral orbicularis oris muscle.
Note the attachment of the buccinator muscles to the lateral pterygoid plate
of the skull base. From Foundations of Speech and Hearing: Anatomy and
Physiology, 2nd ed. (p. 173), by Jeannette D. Hoit, Gary Weismer, and Brad
Story, 2022, Plural Publishing. © 2022 by Plural Publishing.
ryngeal structures. The genioglossus
muscles attach to the interior surface
of the mandible and then fan out into
the tongue so that contraction of the
genioglossus muscles results in movement of the tongue forward in the oral
cavity. The styloglossus muscles run
inferiorly from the medial aspect of the
styloid processes at the skull base to
insert into the side and inferior aspects
of the lateral tongue. Contraction of
these muscles elevates the tongue base.
The hyoglossus muscles arise from the
hyoid bone and insert into the side and
inferior part of the tongue. Contraction
of the hyoglossus muscles results in
depression and posterior movement of
the tongue (see Figure 1–3).
The palatoglossus muscles originate
in the soft palate and insert into the
lateral aspects of the posterior tongue,
along with the styloglossus muscles
(Figure 1–4). Contraction of the palatoglossus muscles elevates the tongue
base and approximates it to the soft
palate. During the bolus preparatory
phase of deglutition, the posterior part
of the tongue elevates against the soft
palate, which simultaneously is pulled
downward against the tongue base.
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