chapter 5:Evaluation of Swallowing Disorders Flashcards
screening procedures are used to identify ___________ patients who require more assessment.
high risk
screening procedures do not determine the nature of the patient’s______________
phisiology
the procedure should identify individuals who _____ or have _______, known as true positives or _______________ ___________.
aspirate
residue
procedural sensitivity
individuals who do not have these two symptoms are true negatives or ___________ _____________
procedural specificity
false positive is an individual who:
is said to aspirate when no aspiration occured
false negative is an individual who:
is said not to aspirate but does
table 5.1 (pg 137) provides _______ and ______ results that are equal to other non-invasive procedures
sensitivity
specificity
four abnormal behaviors during a screening procedure that need follow up study are:
a. rejection of food
b. food selectivity (picky eaters)
c. gagging
d. open mouth
MBS is suited to study the ___________ of the swallow
physiology
cineflurosocopy (motion picture film) was initially used before videofluroroscopy. while cine provided a better frame by frame analysis it did not record Voice. It uses higher doses of _______. and is no longer used
radiation
frame by frame analysis and timing data can be provided if you use a _______-
video counter timer
the purpose of an MBS is to 1) define ________ in anatomy or physiology that are causing the symptom and to 2) identify _________ strategies that may immediately improve the swallow
abnormalities
treatment
_______ and ________ transit time are also assessed during an MBS
oral
pharyngeal
also examined is the functioning of the following valves:
Velopharyngeal
laryngeal
UES
the MBS attempts to determine where aspiration may occur from the following four areas:
a) reduced ________function
b) delayed or absent ____________ swallow
c) reduced _____________ closure at the entrance of the vocal folds
d) _______ dysfunction
lingual (spillage)
pharyngeal (trigger)
laryngeal
UES
the clinician generallt places the food in the patients mouth using a plastic ____. special arrangements/ devices have to be made with infants or small children
spoon
generally at least 3 viscosities are used in an MBS:
thin_______, barium __________, and material requiring ________.
some clinicians may add other levels of viscosity materials to swallow
liquid
paste/pudding
chewing
generally for each viscosity, at least two swallows are required. for example logemann recommends two swallows of a thin liquid in these amounts:
__ mL, __ mL, __ mL and __mL.
these are followed by ____ drinking,
1, 3, 5, 10
cup
–some clinicians only do 3 and 5 ml amounts
logemann also recommends two swallows of pudding (___ teaspoon) and two swallows of a cookie ( __ of a cookie)
1/3
1/4
value of liquid is increased until or unless the patient _____
aspirates
if a patient proceddes from liquids to the cookie without aspiration, some clinicians present the patient with honey thickened or _____-thickened liquids, also given in incremental amounts , including cup drinking
nectar
there is little need to use incremental increases of pudding or cookie, because as viscosity of food increases the volume swallowed ______-
decreases
sometimes it is wise to have a patient self feed to determine if there are any issues with the material researching the mouth or if the patient might __________ the mouth with food.
overstuff
patients referred for MBS are often ill, have poor respiratory status, and are probably aspirating. if any large amount (more than__ teaspoon) of barium enters their airway, complications can occur, including respiratory _______
1
arrest
in an MBS beginning with minimal amounts of liquids ensures that the material will not block the ________ if aspirated. some evidence suggests that pnemonia is less likely to result from aspiration of liquids than thicker foods. the lungs are better able to clear liquids than food from the trachea by a ______.
airway
cough
the patient should be seated and initially viewed in the ________ plane.
lateral
most likely the ___________ or the __________ will provide assistance in seating the person especially if accommodations need to be made
radiologist
nurse
the image should show from the ____ to the level of the UES
lips
the arms of the patient should be on the side not on the arms of the chair. elevated arms cause the _____ to also be elevated possibly covering the pharynx on the MBS
shoulders
sometimes an MBS should be taken of the upper esophagus if _______ is suspected
reflux
a lateral view allows for the measure of the oral and _________ transit time
pharyngeal
the oral transit time is measured from the initiation of the posterior movement of bolus thou\rough the oral cavity until the leading edge of the bolus passes the point where the _________ crosses the tongue base.
mandible
the pharyngeal phase/transit time begins when the pharyngeal swallow triggers and terminates when the bolus passes through the _____
UES
the pharyngeal delay time is the time between the end of the ____ transit time until the ________________-
oral
pharyngeal swallow is triggered
Video fluoroscopy permits analysis of patterns of ___________________ movement, gross estimate of the amount of vallecular residue and pyriform residue and an estimate of the amount of material _________per bolus
Lingual, pharyngeal, laryngeal
Aspirated
esophageal disorders are usually treated ________ or surgically
medically
Approximately ______% of normal swallower a swallow down only one side
20
videofluroscopy permits analysis of patterns of ______________ movement, gross estimate of the amount of valecular residue and pyriform residue and an estimate of the amount of material _________ per bolus
lingual, pharyngeal, laryngeal
aspirated
approximately ___% of normal swallowers swallow down only one side
20
the P-A view is helpful in looking at asymmetries in function of the pharyngeal walls and _________ and in viewing residues in the __________ and in one or both _________________.
larynx
valleculae
pyriform sinuses
in the P-A it is best to repeat only swallows that cause disturbances in order to reduce the amount of ___________ exposure
radiation
it is helpful to have the patient tilt the head back and repeat /ah/ in order to determine the vocal folds ability to ________ and ________
abduct
adduct
typically the patient is asked to hold the material in the mouth until told to __________
swallow
_______ are generally the most easily material ___________ and yet the least likely to block the airway.
liquids
aspirated
if a patient aspirates on a particular material/ volume the examiner should attempt __________ strategies on the same material/ volume
treatment
if aspiration is eliminated on several swallows as the result of intervention the volume should be __________
increased
if a patient cannot intake a material from a spoon a ______________ can be used
tongue blade
with masticated material the patient is told to go ahead and swallow as soon as he or she has completed the _________
chewing
in patients with dementia the oral stage may be missed on the videofluoroscopy but the _____________ stage will be captured
pharyngeal
trial therapy includes consideration of attempting the following:
a) position the ____ in a particular direction
b) use sensory-__________ boluses
c) ask the patient to follow specific ________ maneuvers
d) _________ positions
head
enhancing
swallow
postural
total exposure in MBS trials and therap trials is generally less than ___ minutes
5
any patients suspected of aspirating during the bedside exam should be __________.
referred
t or f: the pharyngeal physiology cause of aspiration cannot be defined at bedside
true
approximately ___% of patients who aspirated during video fluoroscopy were not identified as aspirating during the bedside.
40
the ____________ therapist (SLP) and the radiologist should perform the exam together
swallowing
the radiologist is trained to identify _________________
physical abnormalities
the purpose of an MBS is to define the swallow _________ causing the _________
physiology
aspiration
the clinician should select some _____ options that fit the patient’s oropharyngeal swallowing abnormalities.
intervention
postural techniques ________ food flow and change ________ dimensions
redirect
pharyngeal
table 5-2
head positioning
postural techniques work well with ___________ impaired, cancer patients, and patients of all ages
cognitively
postures may also improve ____ and ___________ transit times
oral
pharyngeal
postural effects on residue/aspiration might be seen before and after _____
FEEs
sensory awareness techniques are generally used with the following patients:
a) swallow _______
b) delayed onset of the oral ___________
c) delayed triggering of the ___________ swallow
apraxia
propulsion
pharyngeal
sensory stimuli include : _________ pressure of the spoon, _____ bolus, ____ bolus, bolus requiring __________, larger _________ bolus, and _______________
increasing downward sour cold chewing volume thermal/tactie stimulation
thermal stimulation utilizes size ____ laryngeal mirror that has been held in ___________ ice prior to the presentation of the bolus. the mirror is rubbed against the ________________
00
crushed
faucil pillars
this technique may result in a faster ______ of the pharyngeal swallow, reducing the delay for severl ________ thereafter.
trigger
swallows
swallow maneuvers put the pharyngeal swallow physiology under _________ control
voluntary
four options of swallow maneuvers include:
a) supraglottic swallow designed to ________
b) super supraglottic swallow designed to _______
c) effortful swallow designed to _________
d) mendelsohn maneuver designed to___________
A) close the airway at the level of the vfs
B) close the airway at the top of the larynx
C) increase the posterior movement of tongue base
D) increase the laryngeal elevation
elimination of certain food consistencies from the diet should be the last ______
Resort
range of motion exercises for the lips, tongue and or jaw do not have an immediate effect but typically show an effect after ______ weeks
2-3
the report should include recommendations regarding management of _______ intake, type of _______ procedures to employ and possible _______
Nutrition
Intervention
Referrals
