Class 11 - Exam 2 Flashcards
Treatment decisions based upon:
- Best available evidence from published literature
- Patient’s wishes
- Clinician’s experience with similar problems
Treatment decisions based upon:
- Best available evidence from published literature
- Patient’s wishes
- Clinician’s experience with similar problems
Questions to ask yourself:
- Are the patients in the study similar to my patient?
- Is the technique described in sufficient detail that I may use it in the same way?
- Is the technique applied in an environment similar to the one where I practice?
- Does the technique require technology that is available to me?
- Are the outcomes obtained in the study the same as those I want to obtain for my patient?
- Are failures and reasons for failure described in the study?
- What are the risk to my patient?
- Do I have the clinical skills to apply this technique as it is described in the study or is specific training required?
- Is the technique practical for my patient and environment?
- Does it have time or intensity demands that exceed the reality of my workload or my patient’s endurance of compliance?
General Treatment Considerations
- -Are they ____?
- -___ ____
- -Nutrition & ____
- -___ vs ____ Treatment
1. ____: Does not introduce foods but rather uses exercises, stimulation, environmental adaptations.
2. ____: Involves presenting food or liquid to the client and asking him/her to swallow
- Are they aspirating?
- Airway protection
- Nutrition & hydration
- Indirect vs. Direct Treatment
1. Indirect: Does not introduce foods but rather uses exercises, stimulation, environmental adaptations.
2. Direct: Involves presenting food or liquid to the client and asking him/her to swallow
Indirect Management
- TEXT:
- ____ management
- Structuring the ___ ___
- Modifying ____
- Specifying the degree of ____
- _____Therapy Techniques
- THE SOURCE: Includes all of the above PLUS……
1. ___ Modification
2. ___ ____ Protocol
3. _____
- TEXT:
- Secretion management
- Structuring the eating environment
- Modifying utensils
- Specifying the degree of supervision for safe oral intake
- Indirect Therapy Techniques
- THE SOURCE: Includes all of the above PLUS……
1. Diet Modification
2. Frazier Water Protocol
3. Positioning
Direct Management
~Sensory Stimulation
1. Modifying ___ ____
2. Modifying ___ ___(texture, volume, temperature, taste)
3. ___ ____ treatment (Thermal stimulation)
~___/____ exercises therapy
1. __ __ ___
2. _____
~Compensatory ___ or ____- chin down, head back, head tilt, head rotation, etc.
~___ ____- double swallow, hard swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver
~___ ____- palatal augmentation
~Sensory Stimulation
1. Modifying food placement
2. Modifying bolus characteristics (texture, volume, temperature, taste)
3. Direct sensory treatment (Thermal stimulation)
~Oral-motor/physiotherapeutic exercises therapy
1. Range of motion
2. Strengthening
~Compensatory postures or positioning- chin down, head back, head tilt, head rotation, etc.
~Compensatory maneuvers- double swallow, hard swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver
~Assistive devices- palatal augmentation
Considerations for choosing a specific treatment technique
- ____
- Clinical ____
- Anticipated ___ and ____
- _____ outcomes
- ___ ____
- Options
- Clinical indicators
- Anticipated risks and benefits
- Functional outcomes
- Patient empowerment
Medical Options
~\_\_\_ Modifications 1. Special \_\_\_ 2. Regulation of \_\_\_ and \_\_\_ 3. Possible interaction with \_\_\_ \_\_\_ ~\_\_\_\_ Management 1. \_\_\_\_ medications 2. \_\_\_\_ agents 3. \_\_\_\_ management
~Dietary Modifications 1. Special diets 2. Regulation of nutrition and hydration 3. Possible interaction with feeding route ~Pharmacologic Management 1. Anti-reflux medications 2. Prokinetic agents 3. Salivary management
Surgical Options
~Improved __ ___
- Medialization ____ (teflon/collegen injections)
- Injection of ____ (fat or collagen)
~Improved ____ segment ___
- ___
- Cricopharyngeal/UES ___ or ___
- __ ___ injections
~Improved glottal closure
- Medialization thyroplasty (teflon/collegen injections)
- Injection of biomaterials (fat or collagen)
~Improved pharyngo-esophageal segment opening
- Dilation
- Cricopharyngeal/UES Myotomy or dilation
- Botulinum Toxin injections
Extreme Cases
~Logemann….only in ”unremitting cases of aspiration…” Protection of the airway is paramount
- Stents
- ____ separation
- ____ tubes
- ____ tubes
- ____ suspension
- ____ Pull-down
- __ ___ ___
- Suturing _____
- __ ___
- Tracheostomy:
1. With a cuff
2. Without a cuff - ___ ____
~Logemann….only in ”unremitting cases of aspiration…” Protection of the airway is paramount
- Stents
- Laryngotracheal separation
- Tracheostomy tubes
- Feeding tubes
- Laryngeal suspension
- Epiglottic Pull-down
- Suturing vocal folds
- Suturing False Vocal Folds
- Laryngeal Bypass
- Tracheostomy:
1. With a cuff
2. Without a cuff - Total Laryngectomy
Behavioral Options
- ___ ____
- Modifying ___ ___
- ____ modifications
- ____ modification
- ____ modifications
- Food modification
- Modifying feeding activity
- Patient modifications
- Swallow modification
- Mechanism modifications
National Dysphagia Diets
Level 1: _____
Level 2: _____
Level 3: ______
Level 4: ______
Level 1: Dysphagia Pureed
Level 2: Dysphagia Mechanically altered
Level 3: Dysphagia advanced
Level 4: Regular Diet
Making Treatment Decisions
- Steps in developing a ___
- ___ ____
- ______ functional level
- Factors that contribute to ___ ___
- Desired functional level at the of treatment: ____
- Specify ___ ___ objectives
- Select ___ ___, action plans, ___
- Evaluate ____ of specific treatments
- Develop a __ ____
- Steps in developing a treatment plan
- Pharyngeal Dysphagia
- Pre-treatment functional level
- Factors that contribute to functional level
- Desired functional level at the of treatment: Goal
- Specify treatment targets objectives
- Select treatment techniques, action plans, monitors
- Evaluate risks of specific treatments
- Develop a treatment plan
Changing the swallow
~Improving the mechanism: -\_\_ \_\_\_ \_\_\_ 1. \_\_\_ device 2. \_\_\_ \_\_\_ 3. \_\_ \_\_\_\_ stimulation ~Prolonging the Swallow: -\_\_\_ \_\_\_\_ ~Increasing the effort: -Effortful \_\_\_\_ -\_\_\_\_ swallows ~Protecting the airway: -\_\_\_ \_\_\_ -Supraglottic and Super-supraglottic swallows ~Improving \_\_\_ opening: -\_\_\_\_\_\_
~Improving the mechanism: -Oral motor exercises 1. IOPI device 2. Masako Maneuver 3. Thermal Tactile stimulation ~Prolonging the Swallow: -Mendelsohn Maneuver ~Increasing the effort: -Effortful swallow -Multiple swallows ~Protecting the airway: -Breath hold -Supraglottic and Super-supraglottic swallows ~Improving PES opening: -Shaker Maneuver
Thermo-tactile stimulationThe latest word…..
- Original 1983 Logemann technique
- Primary outcome: ________
- Original 1983 Logemann technique
- Primary outcome:
- Decreased delay in initiation of the swallow.
