Clinical Decision Making & Management of Swallowing

Question 1

5 ways to treat dysphagia

Answer 1

Positioning

Strategies

Diet

Exercises

Stimulation

Question 2

How to tx unilateral pharyngeal weakness

Answer 2

Head turn… during swallow turn to weak side, after swallow turn to strong side

Question 3

What is a super supra glottic swallow

Answer 3

Includes a throat clear, closing VFs

Question 4

List some swallow strategies

Answer 4

Sit upright 90 degrees for all oral intake

Small bites/sips (1 drink at a time)

Chin tuck downward with liquids (may use a straw)

Hard-Effortful Swallow

Repeat-extra swallows with head turned to the left

Alternate solids with liquids

Periodic throat clears

Question 5

strategy for a swallow delay

Answer 5

chin tuck

Question 6

strategy for Decreased posterior tongue retraction?

Answer 6

Hard/effortful swallow

After swallow: repeat extra swallows, or alternate solids with liquids to wash residue on post tongue down

Question 7

strategy for Decreased pharyngeal wall contraction?

Answer 7

During: Hard swallow, repeat swallow (residue on post pharyngeal wall). Repeat. Alternate swallow with liquids

Question 8

Exercise for decreased laryngeal elevation

Answer 8

Mendelson Maneuver

Question 9

strategy for residue in the valleculae?

Answer 9

Head turn during and after swallow
Repeat extra swallows
Alternate swallows with liquids

Question 10

Strategy for Paralyzed vocal fold?

Answer 10

Super supra-glottic swallow

Periodic throat clears

Question 11

Strategy for Residue in the pyriform sinuses?

Answer 11

Head turn during and after swallow
Repeat extra swallows
Alternate swallows with liquids

Question 12

Types of NPO diets?

Answer 12

Orogastric (OG)- very rare
Nasogastric (NG)- very common
Percutaneous Endoscopic Gastrostomy (PEG) different than a G-tube b/c of where it’s placed
Gastrostomy (G-tube)
Jejunostomy (J-tube)
Total Parenteral Nutrition (TPN) directly into veins

Question 13

Studies show feeding tubes are NOT effective in:

Answer 13

Preventing malnutrition
Preventing the occurrence or increase healing of pressure sores
Preventing aspiration pneumonia
Providing comfort
Improving functional life
Extending life

Question 14

What is the frazer water protocol?

Answer 14

Basically, allows clients/patients to drink water but with certain parameters.

Question 15

What are the rules of the frazer protocol?

Answer 15

Oral water is permitted until the first bite of a meal.
No water, unless it is thickened as prescribed, is allowed during the meal or until the mouth is cleaned/disinfected again.
The PRESCRIBED thickened liquid is used during meals.
PATIENTS MUST HAVE CLEAN MOUTH

Question 16

What’s HAP?

Answer 16

Hospital acquired pneumonia caused by the inhalation of Oropharyngeal secretions colonized by pathogenic bacteria.

Question 17

Labial Oral motor exercises

Answer 17

• Open/Close
• Pucker/Smile
• Puff cheeks out w/ air
• Purse lips then relax
• Blow cotton swab with a straw
• Sucking thick liquid or puree through a straw

Question 18

Lingual Oral Motor Exercises

Answer 18

• In/Out
• Up/Down (nose to chin)
• Side to side (ear to ear)
• Around lips w/ mouth open in both directions
• Around outside of teeth in both directions

Question 19

Vocal fold closure exercises

Answer 19

• Lee-Silverman type exercises
  
  • Shouting
  • ah-ah-ah
  • Holding your breath
  • Bear down onto chair w/ voicing

Question 20

Masako exercise

Answer 20

strengthen pharyngeal wall contraction

Patient or therapist anchors tongue tip (between teeth or held with gauze/cloth) and perform a dry swallow.

Question 21

Thermal-Tactile Stimulation

Answer 21

Designed to heighten oral awareness & provide an alerting sensory stimulus to the cortex and brainstem such that, when the pt. initiates the oral stage of swallow, the pharyngeal swallow will trigger more rapidly. It has been shown to reduce the delay for several swallows thereafter.

Question 22

Myofascial release

Answer 22

It’s a manual therapy technique to correct restrictions in muscle and connective tissue and improve a patient’s ability to develop muscular tension for functional pressure generation and success in swallowing.

Question 23

What is NMES?

Answer 23

Neuromuscular Electrical Stimulation:

Goals to strengthen and reeducate the muscles and improve motor control of the swallow mechanism.