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2nd Repetition > Adult Swallow Tx 2 > Flashcards

Adult Swallow Tx 2 Flashcards

1
Q

What are the goals of dysphagia management?

A

Pulmonary safety
Getting adequate nutrition
Maximizing quality of life
Make swallowing (close to) normal–not always possible

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2
Q

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.

A

Surgical treatment

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3
Q

Structure: UES; Surgical Procedure: Cricopharyngeal myotomy. What is the intended effect?

A

Remove UES outlet obstruction; improve bolus flow

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4
Q

This pharmacological treatment is found in hot peppers, increases release of substance P which improves pharyngeal sensory function.

A

Capsaicin

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5
Q

This pharmacological treatment is seen in most medication for Alzheimer’s diseases or Myasthenia gravis. This decreases breakdown of acetylcholine which improves muscle function.

A

Cholinesterase inhibitor drugs

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6
Q

What is enteral feeding or tube feeding?

A

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

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7
Q

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

A

NGT

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8
Q

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

A
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9
Q

This is where SLP’s come in. In behavioral approach, this is where the SLP can modify the following:

A

Diet (bolus modification)
Patient (postural adjustment)
Swallow (compensatory techniques)
Structure (rehabilitative exercises)

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10
Q

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.

A

Bolus modification

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11
Q

What are compensatory strategies?

A

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

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12
Q

What compensatory strategy will you use when the patient has poor bolus awareness?

A

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

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13
Q

What compensatory strategy will you use when the patient exhibits anterior leakage?

A

Bolus placement
Use of straw
Syringe delivery

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14
Q

What compensatory strategy will you use when the patient exhibits oral residue?

A

Finger sweep
Lingual sweep

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15
Q

What compensatory strategy will you use when the patient exhibits nasal regurgitation?

A

Decrease bolus size
Effortful swallow
Cued swallow

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16
Q

What compensatory strategy will you use when the patient exhibits vallecular residue?

A

Throat clearing, suctioning, effortful swallow, cued swallow

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17
Q

What compensatory strategy will you use when the patient exhibits pyriform sinus residue? (Note: usually, liquid residues are the one that are found here)

A

Volitional coughing
Effortful swallow
Cued swallow

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18
Q

What compensatory strategy will you use when the patient exhibits penetration?

A

Supraglottic swallow
Coughing
Cued swallow
Effortful swallow

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19
Q

What compensatory strategy will you use when the patient exhibits pharyngeal regurgitation?

A

Decrease bolus size
Cyclic ingestion (solid first, water, solid after–so pa-palit palit)

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20
Q

What is the function of a cued swallow? What does this technique address?

A

Increases coordination of swallow physiology through increasing awareness of the task
Vallecular residue, pyriform sinus residue, aspiration/penetration

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21
Q

What is the function of the effortful swallow? What does it address?

A

Increases base of tongue retraction
Addresses: vallecular residue, reduced base of tongue-posterior pharyngeal wall approximation

22
Q

What is the function of the Mendelsohn maneuver? What does it address?

A

Increase duration of hyolaryngeal excursion
Impaired UES opening
Impaired hyolaryngeal elevation
This can also be a rehabilitative technique

23
Q

What is the function of the supraglottic swallow? What does it address?

A

Increased vocal fold closure
Addresses: penetration and aspiration

24
Q

What is the function of the super-supraglottic swallow? What does it address?

A

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

25
Q

What is the function of thermal-tactile stimulation? What does it address?

A

Increases oral and pharyngeal perception
Addresses: penetration and aspiration

26
Q

What is the function of the chin-tuck technique?

A

This technique pushes the tongue base and epiglottis backward, hyoid and larynx are closer
It addresses pharyngeal residue, penetration, aspiration

27
Q

What is the function of chin down? What does it address?

A

It widens vallecula, and increases lingual force, earlier and longer laryngeal closure
Addresses: delayed swallow reflex, and pre-swallow aspiration

28
Q

When it is head rotation, where do we rotate?

A

We rotate to the weaker side, because it narrows the hypopharynx on the side of rotation

29
Q

What does the head rotation address?

A

Pharyngeal or laryngeal hemiparesis
Reduced laryngeal closure

30
Q

What is head tilt? What does it address?

A

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

31
Q

What is reclining? What does it address?

A

Uses gravity to aid in bolus transport to pharynx (60 degree angle and 45)
Addresses delayed swallow reflex and impaired pharyngeal wall contraction

32
Q

What are rehabilitation exercises?

A

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

33
Q

What are the rehabilitative exercises?

A

OPM exercises
Effortful swallow
Masako
Mendelsohn
Super-Supraglottic

34
Q

What is the function of using OPM exercises? What does it address?

A

Increased strength and range of movement of OPM.
Addresses: poor orolingual control and labial seal (anterior spillage and oral residue)

35
Q

What is the function of the effortful swallow? What does it address?

A

Increase base of tongue retraction
Addresses: reduced pharyngeal contraction and reduced base of tongue-posterior pharyngeal wall approximation

36
Q

What is the function of the Masako? What does it address?

A

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

37
Q

What is the function of the Mendelsohn technique?

A

Strengthen suprahyoid muscles and laryngeal closure
Addresses: Impaired UES opening and hyolaryngeal elevation

38
Q

What is the function of the super-supraglottic swallow? What does it address?

A

Increases and prolongs laryngeal closure
It is basically supraglottic swallow + effortful swallow
This addresses impaired laryngeal closure

39
Q

What is shaker exercise? What does it address?

A

It strengthen the anterior neck muscles assisting in UES opening
Addresses: Impaired UES opening and hyolaryngeal elevation

40
Q

What is the neurosensory stimulation?

A

Increasing cortical activation and pharyngeal swallow response
Addresses: delayed swallow reflex and weak cough

41
Q

What is the Lee Silverman Voice Treatment (LSVT)?

A

Strengthens suprahyoid muscles
Addresses: impaired airway protection

42
Q

Neuromuscular electrical stimulation (NMES) - sends electrical impulses to nerves causing them to contact

A

Neurostimulation

43
Q

If in the hospital setting, is the primary of the team; in charge of the patient’s holistic care

A

Physician

44
Q

Specializes in diagnosing and treating disorders of the brain

A

Neurologist

45
Q

Determines safety and effectiveness of the patient’s breathing

A

Helps with instrumentation especially during swallow evaluation

46
Q

Helps with instrumentation especially during swallow evaluation

A

Otorhinolaryngologist

47
Q

Provides a meal plan addressing nutritional needs of the patient

A

Dietician

48
Q

Works with the patient in improving swallowing function and provides specific food and liquid consistencies

A

SLP

49
Q

Helps with independent feeding and improving cognitive functions needed for safe feeding

A

OT

50
Q

Helps with facilitating adequate posture that p[romotes successful feeding and swallowing

A

PT

51
Q

Helps in ascertaining dosage of pharmacological treatments if applicable to patient

A

Pharmacist

2nd Repetition (13 decks)

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