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Dysphagia Final > Class 12- Dysphagia Part IV > Flashcards

Class 12- Dysphagia Part IV Flashcards

1
Q

Evidence: “Information that has been …

Treatment decisions based upon:

  1. Best available_____from published literature
  2. Patient’s ____
  3. Clinician’s _____with ______

Literature -
Effectiveness/efficacy

A

filtered systematically through scientific processes and meets minimum standards of rigor.”

  1. Evidence
  2. wishes
  3. Experience; similar problems

Efficacy: gone through a rigorous set of trials

Effectiveness: it does seem to help

Example: use of OME may be effective for your particular patient, but it is not efficacious (meaning it is not always supported by the literature)

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2
Q

Evidence-based?

1998 Dutch Neurological Society Guidelines
(Note 12-1, pg. 232)

____ of water

______

After _____, PEG tube

No ________

No _______

A

50 ml of water

NG Tube

After 21 weeks, PEG tube

No Videofluoroscopy

No swallowing therapy

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3
Q

Questions to ask yourself:

Are the patients in the study ______to my patient?

Is the technique described in ________that I may use it in the same way?

Is the technique ________ similar to the one where I practice?

Does the technique require technology that is _________?

Are the ______ obtained in the study the same as those I want to obtain for my patient?

Are _____ and ______for failure described in the study?

What are the ____to my patient?

Do I have the ______to apply this technique as it is described in the study or is specific training required?

Is the technique ______for my patient and environment?

Does it have time or intensity demands that __________or my patient’s endurance of compliance?

A

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?

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4
Q

General Treatment Considerations

Are they _____?

Airway _____

_____ & ______

_____vs. _____Treatment

A

Are they aspirating?

Airway protection

Nutrition & hydration

Indirect vs. Direct Treatment

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5
Q

Indirect:

Direct:

A

Indirect: Does not introduce foods but rather uses exercises, stimulation, environmental adaptations.

Direct: Involves presenting food or liquid to the client and asking him/her to swallow

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6
Q

Indirect Management

TEXT:
______management

Structuring the ______

Modifying _____

Specifying the degree of supervision for _______

_____Therapy Techniques

THE SOURCE: Includes all of the above PLUS……

____Modification

_________

_________

A 
Indirect Management
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……

Diet Modification

Frazier Water Protocol: can have an unlimited amount of water; must brush their teeth before drinking; specific limitations; good reliability

Positioning

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7
Q

Direct Management

1.
2.
3.
4.
5.
A
  1. Sensory stimulation
  2. Oral-motor/physiotherapeutic exercises therapy
  3. Compensatory postures or positioning
  4. Compensatory maneuvers
  5. Assistive devices
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8
Q

Sensory Stimulation

  1. Modifying…
  2. Modifying…
  3. Direct…
A

Modifying food placement

Modifying bolus characteristics (texture, volume, temperature, taste)

Direct sensory treatment (Thermal stimulation)

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9
Q

Oral-motor/physiotherapeutic exercises therapy

A
  1. Range of motion

2. Strengthening

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10
Q

Compensatory postures or positioning:

A

chin down, head back, head tilt, head rotation, etc.

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11
Q

Compensatory maneuvers-

A

double swallow, hard swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver (tighten hyoid and laryngeal structures and elevate larynx)

*** Look these up in book/ handouts

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12
Q

Assistive devices-

A

palatal augmentation

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13
Q 
Considerations for choosing a specific treatment technique
1.
2.
3.
4.
5.
A

Options

Clinical indicators

Anticipated risks and benefits

Functional outcomes

Patient empowerment

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14
Q

Medical Options

1.
2.

A
  1. Dietary Modifications

2. Pharmacologic Management

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15
Q

Dietary Modifications

A

Special diets

Regulation of nutrition and hydration

Possible interaction with feeding route

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16
Q

Pharmacologic Management

A

Anti-reflux medications

Prokinetic agents

Salivary management

17
Q

Surgical options

1.
2.

A
  1. Improved glottal closure

2. Improved pharyngo-esophageal segment opening

18
Q

Improved glottal closure

A

Medialization thyroplasty (teflon/collegen injections)

Injection of biomaterials (fat or collagen)

19
Q

Improved pharyngo-esophageal segment opening

A

Dilation

Cricopharyngeal/UES Myotomy or dilation

Botulinum Toxin injections

20
Q

Extreme Cases

Logemann….only in ”unremitting cases of aspiration…” Protection of the airway is paramount:

A

Stents

Laryngotracheal separation

Tracheostomy tubes

Feeding tubes

Laryngeal suspension

Epiglottic Pull-down

Suturing vocal folds

Suturing False Vocal Folds

Laryngeal Bypass

Tracheostomy:
With a cuff
Without a cuff
Total Laryngectomy

21
Q

Behavioral Options

1.
2.
3.
4.
5.
A

Food modification

Modifying feeding activity

Patient modifications

Swallow modification

Mechanism modifications

22
Q

National Dysphagia Diets

Level 1:
Level 2:
Level 3:
Level 4:

A

Level 1: Dysphagia Pureed

Level 2: Dysphagia Mechanically altered

Level 3: Dysphagia advanced

Level 4: Regular Diet

23
Q

Making Treatment Decisions

Steps in developing a _____

_______Dysphagia

Pre-treatment _____level

_______that contribute to functional level

Desired functional level at the of treatment: Goal

Specify ______targets objectives

Select treatment techniques, action plans, _____

Evaluate ______of specific treatments

Develop a ______plan

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

24
Q

Which technique to use?

A

Table 14-2 Page 293

Hand-out from Cherney

25
Q

Changing the swallow

1.
2.
3.
4.
5.
A
  1. Improving the mechanism
  2. Prolonging the Swallow
  3. Increasing the effort
  4. Protecting the airway
  5. Improving PES opening
26
Q

Thermo-tactile stimulationThe latest word….

Original 1983 Logemann technique:

Primary outcome:

Decreased delay in initiation of the swallow:

A

Lazzara, et al. : faster pharyngeal and total transit after tx.

Rosenbek, et al.- did not find strong support to tx effect. No improvement in aspiration or penetration

Immediate effect of cold and decrease in delay

27
Q

Adjunctive Modalities:New Directions

A
  1. McNeill Dysphagia Therapy Program (MDTP):
    a) Frequent tx sessions and intense practice
    b) Materials introduced sequentially
    c) Specific rules to advance clients during tx.
  2. Surface electromyography: biofeedback
  3. Neuromuscular electrical stimulation (NMES)
  4. Deep Pharyngeal Stimulation

Dysphagia Final (2 decks)

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