Adult Swallow Tx 2 Flashcards
What are the goals of dysphagia management?
Pulmonary safety
Getting adequate nutrition
Maximizing quality of life
Make swallowing (close to) normal–not always possible
This is usually done if therapy is unsuccessful. More often than not, this is the last resort. Most procedures are on the larynx or UES.
Surgical treatment
Structure: UES; Surgical Procedure: Cricopharyngeal myotomy. What is the intended effect?
Remove UES outlet obstruction; improve bolus flow
This pharmacological treatment is found in hot peppers, increases release of substance P which improves pharyngeal sensory function.
Capsaicin
This pharmacological treatment is seen in most medication for Alzheimer’s diseases or Myasthenia gravis. This decreases breakdown of acetylcholine which improves muscle function.
Cholinesterase inhibitor drugs
What is enteral feeding or tube feeding?
This is done if there is inability to get proper nutrition by mouth.
Impaired airway protection when swallowing.
Nasogastric tube vs Percutaneous Endoscopic Gastrostomy (PEG)
Other intervention is given to improve tolerance of different food and liquid consistencies, until tube feeding is no longer needed
This is easy, quick. Usually lasts up to 1 months. The invasivenes is high as the patients feel the tube and may feel uncomfortable. Common problems encountered would be mucosa scarring and arytenoid swelling
NGT
This is invasive, and is surgically placed. The tube life is 9 months or more. The replacement is infrequent and the invasiveness is low. Common problems would include the following: infection, tube obstruction, and tube displacement
This is where SLP’s come in. In behavioral approach, this is where the SLP can modify the following:
Diet (bolus modification)
Patient (postural adjustment)
Swallow (compensatory techniques)
Structure (rehabilitative exercises)
With this behavioral technique, this where the SLP changes the consistency, or texture of foods and/or liquids. The SLP can also alter other properties (e.g., size, taste). This also reduced aspiration events (e.g., coughing) but none much else (e.g., improving in fluid intake, decreasing odds of aspiration pneumonia, etc.,) according to current research.
Bolus modification
What are compensatory strategies?
Could be in the form of posture, maneuver, and/or sensory enhancements
Considered “quick fixes” to dysphagia
Does NOT rehabilitate structure or physiology of swallow
Efficacy checked through instrumental evaluation
What compensatory strategy will you use when the patient has poor bolus awareness?
Verbal reminders (e.g., Sir, ready na po ba ka’yo? Or Sir meron po akong bibigay na food na one teaspoon na mashed potato, etc.,), improve taste or aroma
What compensatory strategy will you use when the patient exhibits anterior leakage?
Bolus placement
Use of straw
Syringe delivery
What compensatory strategy will you use when the patient exhibits oral residue?
Finger sweep
Lingual sweep
What compensatory strategy will you use when the patient exhibits nasal regurgitation?
Decrease bolus size
Effortful swallow
Cued swallow
What compensatory strategy will you use when the patient exhibits vallecular residue?
Throat clearing, suctioning, effortful swallow, cued swallow
What compensatory strategy will you use when the patient exhibits pyriform sinus residue? (Note: usually, liquid residues are the one that are found here)
Volitional coughing
Effortful swallow
Cued swallow
What compensatory strategy will you use when the patient exhibits penetration?
Supraglottic swallow
Coughing
Cued swallow
Effortful swallow
What compensatory strategy will you use when the patient exhibits pharyngeal regurgitation?
Decrease bolus size
Cyclic ingestion (solid first, water, solid after–so pa-palit palit)
What is the function of a cued swallow? What does this technique address?
Increases coordination of swallow physiology through increasing awareness of the task
Vallecular residue, pyriform sinus residue, aspiration/penetration
What is the function of the effortful swallow? What does it address?
Increases base of tongue retraction
Addresses: vallecular residue, reduced base of tongue-posterior pharyngeal wall approximation
What is the function of the Mendelsohn maneuver? What does it address?
Increase duration of hyolaryngeal excursion
Impaired UES opening
Impaired hyolaryngeal elevation
This can also be a rehabilitative technique
What is the function of the supraglottic swallow? What does it address?
Increased vocal fold closure
Addresses: penetration and aspiration
What is the function of the super-supraglottic swallow? What does it address?
Increased closure in all laryngeal structures, base of tongue retraction, earlier and prolonger upper esophageal sphincter
It is basically supraglottic swallow + effortful swallow
This addressed penetration, aspiration, and pharyngeal residue
What is the function of thermal-tactile stimulation? What does it address?
Increases oral and pharyngeal perception
Addresses: penetration and aspiration
What is the function of the chin-tuck technique?
This technique pushes the tongue base and epiglottis backward, hyoid and larynx are closer
It addresses pharyngeal residue, penetration, aspiration
What is the function of chin down? What does it address?
It widens vallecula, and increases lingual force, earlier and longer laryngeal closure
Addresses: delayed swallow reflex, and pre-swallow aspiration
When it is head rotation, where do we rotate?
We rotate to the weaker side, because it narrows the hypopharynx on the side of rotation
What does the head rotation address?
Pharyngeal or laryngeal hemiparesis
Reduced laryngeal closure
What is head tilt? What does it address?
Directs the bolus to the side of tilting. So if the weaker side is right, you will tilt your head to the left.
It addresses pharyngeal or laryngeal hemiparesis and reduced laryngeal closure
What is reclining? What does it address?
Uses gravity to aid in bolus transport to pharynx (60 degree angle and 45)
Addresses delayed swallow reflex and impaired pharyngeal wall contraction
What are rehabilitation exercises?
Improve neuromotor control
Can be done with food (direct) or without food (indirect)
Exercise principles should be applied: intensive, specific, structured, feedback
Motivation plays a big part
What are the rehabilitative exercises?
OPM exercises
Effortful swallow
Masako
Mendelsohn
Super-Supraglottic
What is the function of using OPM exercises? What does it address?
Increased strength and range of movement of OPM.
Addresses: poor orolingual control and labial seal (anterior spillage and oral residue)
What is the function of the effortful swallow? What does it address?
Increase base of tongue retraction
Addresses: reduced pharyngeal contraction and reduced base of tongue-posterior pharyngeal wall approximation
What is the function of the Masako? What does it address?
It strengthens posterior pharyngeal wall
This is where you ask the patient to stick out the tongue and then swallow.
Addresses: reduced pharyngeal contraction and reduced base of tongue-posterior pharyngeal wall approximation
What is the function of the Mendelsohn technique?
Strengthen suprahyoid muscles and laryngeal closure
Addresses: Impaired UES opening and hyolaryngeal elevation
What is the function of the super-supraglottic swallow? What does it address?
Increases and prolongs laryngeal closure
It is basically supraglottic swallow + effortful swallow
This addresses impaired laryngeal closure
What is shaker exercise? What does it address?
It strengthen the anterior neck muscles assisting in UES opening
Addresses: Impaired UES opening and hyolaryngeal elevation
What is the neurosensory stimulation?
Increasing cortical activation and pharyngeal swallow response
Addresses: delayed swallow reflex and weak cough
What is the Lee Silverman Voice Treatment (LSVT)?
Strengthens suprahyoid muscles
Addresses: impaired airway protection
Neuromuscular electrical stimulation (NMES) - sends electrical impulses to nerves causing them to contact
Neurostimulation
If in the hospital setting, is the primary of the team; in charge of the patient’s holistic care
Physician
Specializes in diagnosing and treating disorders of the brain
Neurologist
Determines safety and effectiveness of the patient’s breathing
Helps with instrumentation especially during swallow evaluation
Helps with instrumentation especially during swallow evaluation
Otorhinolaryngologist
Provides a meal plan addressing nutritional needs of the patient
Dietician
Works with the patient in improving swallowing function and provides specific food and liquid consistencies
SLP
Helps with independent feeding and improving cognitive functions needed for safe feeding
OT
Helps with facilitating adequate posture that p[romotes successful feeding and swallowing
PT
Helps in ascertaining dosage of pharmacological treatments if applicable to patient
Pharmacist
