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
