In a hospital patient with brainstem stroke who shows anterior tongue movements and residue in the anterior and lateral sulci, premature swallow, and reduced range of tongue elevation, which swallow phase is most likely affected?

• A. Oral Phase
• B. Pharyngeal Phase
• C. Esophageal Phase
• D. None of the Above

Answer: (A)

The key idea is that the oral phase depends on the tongue to gather, hold, and propel the bolus toward the back of the mouth. Anterior tongue movements with residue in the anterior and lateral sulci show the bolus isn’t being formed or moved effectively within the oral cavity. A reduced range of tongue elevation further limits the ability to elevate and press the bolus posteriorly, impairing oral propulsion and containment. Premature swallow reflects poor oral control, where the swallow is triggered before the bolus is properly prepared, which again points to the oral stage rather than a failure of the pharyngeal swallow. In contrast, problems with the pharyngeal phase would present with airway protection issues or residues in the pharyngeal recesses, and esophageal problems would show signs downstream, not described here. So the findings best indicate an impairment of the oral phase.