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Dysphagia Test 1 > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

A screening is a

A

quick, non-invasive, low risk and low cost

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2
Q

How long does a dysphagia screening last?

A

10-30 minutes

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3
Q

What is a false positive?

A

ID’d as aspirating but aren’t

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4
Q

What is a false negative?

A

ID’d as not aspirating but are

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5
Q

Is a screening always 100% accurate?

A

no

further diagnostic assessment needed

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6
Q

Symtomatology of Dysphagia

A

Valleculae hesitation/pooling
Pyriform pooling
UES dysfunction
Aspiration

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7
Q

How does a patient describe valleculae hesitation/pooling

A

Patient says they have something “stuck” high in throat

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8
Q

How does a patient describe pyriform pooling

A

patient says they have something “stuck” in middle of throat

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9
Q

Hoe does a patient describe UES dysfunction

A
  • pain in upper chest or inches below larynx

- patient says they have something “stuck” lower in throat or high in chest

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10
Q

Describe aspiraiton

A

coughing, choking, 50%+ aspirate without cough (silent)

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11
Q

The bedside clinical swallowing exam provides

A
  • medical diagnostic, history, patient’s perception
  • patient’s medical status: nutritional (tube?), respiratory (trach tube? ventilator?)
  • Patient’s oral anatomy (coordination and strength)
  • Patient’s respiratory function
  • Control/function: labial, lingual, palatal, pharyngeal, laryngeal
  • Cognitive status: comprehension, awareness
  • Sensory: taste, temperature and texture
  • Signs and symptoms during swallow attempts
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12
Q

What materials do you need for a bedside clinical exam for swallowing?

A

laryngeal mirror, tongue blades, cup, spoon, straw, syringe, towel/drape cloth, gloves, gown, eyewear/mask, stethoscope

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13
Q

Why do you need to bring a cup, syringe, spoon and a straw to a bedside evaluation?

A

to accommodate to whatever method the patient will be able to swallow

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14
Q

What is below sternal notch?

A

esophagus

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15
Q

What is above the sternal notch?

A

larynx

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16
Q

Where are the valleculae?

A

the base of tongue/epiglottic area, these are the swimming pools right below chin

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17
Q

Where are the pyriforms?

A

Its just below the larynx, by the thyroid cartilage area

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18
Q

Where is the UES?

A

its by C-6, right at the sternal notch

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19
Q

What do you need to prepare for a bedside exam?

A

chart review

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20
Q

What is included in the chart review?

A
  • respiratory status
  • dysphagia history
  • history of pneumonia
  • nutritional status
  • medications
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21
Q

What does a fever indicate?

A

infection

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22
Q

When you are doing a chart review for a patient, what must you explore about their respiratory status?

A
  • Do they have a trach, vent or are they intubated?
  • What is their respiratory rate at rest?
  • Time their saliva swallows and phase of respiration
  • Time/gauge strength of cough (volitional and reflexive)
  • Time of apneic period
  • Do they breathe through their mouth or nose?
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23
Q

What is a normal respiration rate?

A

6-12 cycles per minute

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24
Q

Pneumonia, COPD and other respiratory diseases cause __ respiration

A

higher

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25
Q

What is a normal time for saliva swallows and phase of respiration?

A

2 min/swallow

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26
Q

When you are doing a chart review for a patient, what must you explore about their dysphagia history?

A

onset, symptoms, patient awareness and localization

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27
Q

When you are doing a chart review for a patient, what must you explore about their history of pneumonia?

A

check if they have a fever

*get their most recent vitals

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28
Q

When you are doing a chart review for a patient, what must you explore about their nutritional status?

A

diet type, its duration and adequacy
Were they ever tubed?
complications from food

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29
Q

When you are doing a chart review for a patient, why must you explore the medications they are on?

A

A lot of medications can cause xerostomia, decreased alertness or delayed reaction time

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30
Q

What does a bedside exam entail?

A

prep, physical exam and trial swallows

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31
Q

What needs to be explored during the physical part of bedside exam?

A

Posture, oral exam, laryngeal function, pulmonary function testing and pneumotachometry

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32
Q

When doing the physical exam portion of a bedside, what do you look for in the oral exam?

A

Anatomy and physiology

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33
Q

Bedside swallow
Physical exam
What do you look for in patient’s anatomy?

A
  • observe patient’s lips, hard palate, soft palate, uvula, faucial arches, tongue, sulci, teeth, secretions
  • look for scarring or asymmetry
  • observe if there is any leftover food or if the mouth is dry
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34
Q

Bedside swallow
Physical exam
What do you do to examine patient’s oral physiology?

A

open mouth, stimuli (texture/taste/temperature)
examine chewing and sensitivity
look at labial, lingual, soft palate functions

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35
Q

Bedside swallow
Physical exam
Physiology/labial function

A

/i/, /u/, ddk, /pa/, bilabilal stops and check labial closure by having lips around object

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36
Q

Bedside swallow
Physical exam
Physiology/ anterior lingual function

A
  • extension/retraction
  • corners of mouth
  • clear sulcus
  • tip to alveolar ridge and behind bottom teeth with open mouth
  • ddk, /ta/, alveolar stops
  • rub along palate
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37
Q

Bedside swallow
Physical exam
Physiology/ posterior lingual function

A
  • back elevated

- /k/, ddk, /ka/, velar stops

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38
Q

Bedside swallow
Physical exam
Physiology/ soft palate

A

sustain /a/, palatal reflex, gag reflex

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39
Q

Bedside swallow
Physical exam
Physiology/ apraxia

A

look for groping

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40
Q

Bedside swallow
Physical exam
Physiology/ abnormal oral reflexes

A

increased gag reflex, tongue thrust, tonic bite

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41
Q

Bedside swallow
Physical exam
How do you asses laryngeal function?

A
  • listen to gurgly voice
  • listen for hoarseness/breathiness
  • DDKs, /ha/ for neurological impairments
  • Strong cough and throat clear (reflexive/volitional)
  • Vocal scaling
  • phonation time with /s/ or /z/
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42
Q

Bedside swallow
Physical exam
Laryngeal function
What does a wet, grugly voice indicate?

A

definite penetration and possible aspiration because there is something sitting on the vocal folds

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43
Q

Bedside swallow
Physical exam
Laryngeal function
What does a hoarse or breathy voice indicate?

A

incomplete glottic closure

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44
Q

Bedside swallow
Physical exam
Laryngeal function
What does can vocal scaling indicate?

A

problems with CT muscle or SLN, intrinsics
decreased laryngeal sensitivity?
Apparent in PD and other neurological impairments

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45
Q

Most patients with neurological impairments won’t

A

cough volitionally but will throat clear instead

46
Q

Bedside swallow
Physical exam
Laryngeal function
What does phonation time with /s/ or /z/ indicate?

A

decreased laryngeal control or decreased respiratory function

47
Q

What is the longest part of a bedside?

A

pulmonary function testing

48
Q

What parts of a bedside are used only if warranted?

A

Pulmonary function testing and pneumotachometry

49
Q

How do you test pulmonary function as part the physical exam of the bedside?

A

Spirometry and manometry

50
Q

What does spirometry measure?

A

capacities

FVC, FEV1

51
Q

What does manometry measure?

A

strength

MIP, MEP

52
Q

What does pneumotachometry assess?

A

inspiration, LCT, peak

53
Q

What is the last part of a bedside?

A

trial swallows

54
Q

You should not attempt trial swallows if

A

patient is acutely ill, has weak pulmonary functions, very weak cough, 90+ years old, decreased cognition or is suspected of silent aspiration

55
Q

With trial swallows, use material that is

A

easiest for the patient to swallow

56
Q

What quantity is recommended for a bedside trial swallow?

A

3 cc/ml

57
Q

If you cannot attempt trial swallows, then send patient directly to

A

MBS or FEES to avoid risk

58
Q

What quantity is recommended for a bedside trial swallow if patient has CVA?

A

9 OZ of water because they do better with bigger gulps

59
Q

Why do CVA patients do better with larger quantity of water?

A

because it increases pharyngeal pressure and requires more muscle activity

60
Q

What is another part of the trial swallow in a bedside?

A

cervical auscultation with 3-finger position on neck

61
Q

What are you listening for with the cervical auscultation?

A

a hard gulp or clunk

If you hear dripping or shower sound, not good

62
Q

Where do you place your fingers in the 3-finger position on neck?

A

index finger- suprahyoid, under chin to feel for pressure
middle finger- hyoid bone/thyroid cartilage to feel laryngeal movement
ring finger- cricoid

63
Q

Where do you place the stethoscope for cervical ausculation?

A

on the side of the neck

64
Q

What are some things to note when doing the trial swallow part of a bedside eval?

A
  • Patient’s reaction to food
  • Oral movements (chewing, manipulation, propulsion)
  • Coughing, throat clearing before/after/during
  • Secretion levels
  • Meal duration (if observed) and what percentage was eaten
  • Respiration/swallow coordination
  • Hypolaryngeal excursion
  • Sound of swallow
65
Q

How do you assess hypolaryngeal excursion?

A

3 finger test

66
Q

How do you assess sound of swallow?

A

cervical ausculation

67
Q

What recommendation can an SLP give after a bedside or clinical exam?

A 
posture resulting in best/safest swallow
best positioning for food in mouth
best food consistency
hypothesis as to nature or swallowing disorder
recommendations for treatment
68
Q

What is the best posture resulting in safest/best swallow?

A

90 degree hip flexion

69
Q

If best positioning for food in mouth applies, what is the best position?

A

depends on their problem

70
Q

Can you do a diet modification (food consistency) with only a bedside eval?

A

no, you need a diagnostic

71
Q

What is the proper way to hypothesize a patient’s problem in an official report?

A

“Patient showed symptoms __ which is indicative of __

72
Q

Where can you order a FEES or MBS?

A

in recommendations

73
Q

What are some imaging diagnostic instrumentations?

A

Videofluoroscopy (xray), VFSS, MBS, MBSS
FEES/FEESST/Videoendoscopy (raw view)
Ultrasound/fMRI/PET
Scintigraphy

74
Q

What two imaging diagnostic instruments are not widely used for swallowing?

A

ultrasound and scintigraphy

75
Q

Why isn’t scintigraphy used?

A

because of the large amounts of radiation

76
Q

Why isn’t ultrasound used?

A

because the machine has a hard time picking up all the different muscles and bones in that area

77
Q

What are some non-imaging diagnostic instrumentations?

A

EMG
EGG
Acoustics
Manometry

78
Q

What does the EMG do?

A

measures muscle activity

79
Q

What does EGG do?

A

measures vf vibration at the thyrohyoid level

80
Q

How do you go about listening to acoustics?

A

accelerometer or stethoscope to listen

81
Q

What does manometry measure?

A

pressure

82
Q

Videofluoroscopy/MBS

Indications

A
  • To identify normal and abnormal A&P of the swallow
  • To evaluate airway protection before/during/after swallowing
  • To evaluate the effectiveness of postures, maneuvers, bolus modifications and sensory enhancements in improving swallowing safety and efficiency
  • To provide recommendations regarding the optimum delivery of nutrition and hydration
  • To determine appropriate therapeutic techniques
  • To obtain information in order to collaborate with and educate other team members, referral sources, caregivers, and patients regarding recommendations for optimum swallow safety and efficiency
83
Q

Videofluoroscopy/MBS

Contraindications

A
  • Medically unstable, lethargic, un-oriented, agitated, uncooperative, cognitive deficits
  • When the information obtained from the study is unlikely to change the patient’s management (advanced care prefernces, chronic disease or end-of-life situations)
  • Patient is unable to be adequately positioned
  • Size of patient prevent adequate imaging or exceeds limit of positioning devices
  • Allergy to barium (rare)
84
Q

Videofluoroscopy/MBS

Limitations

A
  • Time constraints due to radiation exposure
  • As the procedure only samples swallow function, it does not fully represent mealtime function
  • Contrast materials such as barium slightly increase viscosity and alter liquid and solid food composition and are not natural foods-may result in discordance between the results of VFSS and real meals
  • Limited ability to evaluate a fatigue effect on swallowing, unless specifically evaluated
  • Barium in an unnatural food bolus with potential for refusal
85
Q

What does the FEES examine?

A

A&P before and after the swallow

86
Q

What’s an advantage of FEES?

A

no barium and no radiation exposure

87
Q

The FEES gives an excellent view of

A

vocal folds and larynx

88
Q

What stage is visible?

A

pharyngeal only

89
Q

What’s a disadvantage of the FEES?

A

The “white out” period

90
Q

The Ultrasound displays what stage of the swallow?

A

oral stage only

91
Q

What does the Ultrasound display?

A

tongue function, oral transit time and hyoid motion

92
Q

What two diagnostic instrumentations are mostly used in studies?

A

fMRI (Functional Magnetic Resonance Imaging)

PET (Positron Emission Tomography)

93
Q

What does fMRI (Functional Magnetic Resonance Imaging) display?

A

neural basis/mechanisms

neural mapping-cortical control

94
Q

What does PET (Positron Emission Tomography) display?

A

neural activity associated with motion

95
Q

What is a huge disadvantage of PET?

A

larger radiation exposure than MBS

96
Q

What can the scintigraphy diagnose?

A

esophageal issues

97
Q

What does scintigraphy display?

A

amount of aspiration and residue

98
Q

What does scintigraphy use?

A

its radioactive and uses a gamma camera

99
Q

The __ and __ are not well visualized in scintigraphy

A

mouth, pharynx

100
Q

Can scintigraphy identify dysfunction?

A

No

101
Q

What is thin puree?

Food consistency

A

applesauce

102
Q

What is thick puree?

Food consistency

A

pudding

103
Q

What is mechanical soft?

Food consistency

A

scrambled eggs

104
Q

What is chopped?

Food consistency

A

corn beef hash

105
Q

What is regular?

Food consistency

A

cookie, cracker

106
Q

What are the 3 consistencies of liquids?

A

thin, nectar and honey

107
Q

Why is cervical ausculation limiting?

A

because many sounds of deglutition appear to be silent

108
Q

Whats diagnostic tool shows presence of aspiration?

A

FEES

109
Q

What diagnostic tool shows presence of aspiration and etiology?

A

videofluoroscopy

110
Q

What diagnostic tool shows pharyngeal anatomy?

A

rigid videoendoscopy

111
Q

What diagnostic tool shows pressures?

A

pharyngeal manometry with videofluoroscopy

112
Q

What non-imaging tools are good for biofeedback?

A

EMG and EGG

Dysphagia Test 1 (5 decks)

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