Clinical Decision Making & Management of Swallowing Flashcards
5 ways to treat dysphagia
Positioning
Strategies
Diet
Exercises
Stimulation
How to tx unilateral pharyngeal weakness
Head turn… during swallow turn to weak side, after swallow turn to strong side
What is a super supra glottic swallow
Includes a throat clear, closing VFs
List some swallow strategies
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
strategy for a swallow delay
chin tuck
strategy for Decreased posterior tongue retraction?
Hard/effortful swallow
After swallow: repeat extra swallows, or alternate solids with liquids to wash residue on post tongue down
strategy for Decreased pharyngeal wall contraction?
During: Hard swallow, repeat swallow (residue on post pharyngeal wall). Repeat. Alternate swallow with liquids
Exercise for decreased laryngeal elevation
Mendelson Maneuver
strategy for residue in the valleculae?
Head turn during and after swallow
Repeat extra swallows
Alternate swallows with liquids
Strategy for Paralyzed vocal fold?
Super supra-glottic swallow
Periodic throat clears
Strategy for Residue in the pyriform sinuses?
Head turn during and after swallow
Repeat extra swallows
Alternate swallows with liquids
Types of NPO diets?
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
Studies show feeding tubes are NOT effective in:
Preventing malnutrition Preventing the occurrence or increase healing of pressure sores Preventing aspiration pneumonia Providing comfort Improving functional life Extending life
What is the frazer water protocol?
Basically, allows clients/patients to drink water but with certain parameters.
What are the rules of the frazer protocol?
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
What’s HAP?
Hospital acquired pneumonia caused by the inhalation of Oropharyngeal secretions colonized by pathogenic bacteria.
Labial Oral motor exercises
- 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
Lingual Oral Motor Exercises
- 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
Vocal fold closure exercises
- Lee-Silverman type exercises
- Shouting
- ah-ah-ah
- Holding your breath
- Bear down onto chair w/ voicing
Masako exercise
strengthen pharyngeal wall contraction
Patient or therapist anchors tongue tip (between teeth or held with gauze/cloth) and perform a dry swallow.
Thermal-Tactile Stimulation
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.
Myofascial release
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.
What is NMES?
Neuromuscular Electrical Stimulation:
Goals to strengthen and reeducate the muscles and improve motor control of the swallow mechanism.
