Dysphagia

Question 1

Videofluoroscopic Swallow Study

Answer 1

Provides direct visualization of the
bolus throughout the oral, pharyngeal, and esophageal
swallow phases

Question 2

Cervical Auscultation

Answer 2

Provides auditory information about the pharyngeal phase of the
swallow

Question 3

Surface Electromyography

Answer 3

Provides indirect visual information about muscle
activity during the oral and pharyngeal phases of the
swallow

Question 4

Fiberoptic Endoscopic
Evaluation of Swallowing

Answer 4

Provides direct visualization of
the bolus during portions of the
pharyngeal phase of the swallow
Uses a laryngoscope to visualize
the throat during swallowing,
identifying laryngeal penetration,
aspiration, and residue. A
“whiteout” during peak laryngeal
elevation temporarily blocks
view.

Question 5

Oral Preparatory Phase

Answer 5

1. Lip closure
2. Tension in the buccal
   and facial musculature
3. Mandibular movement
4. Lingual ROM; including
   BOT
5. Anterior velar
   movement

Question 6

Oral Phase

Answer 6

1. Begins when bolus is formed
2. Tongue cups and moved
   superiorly then slides
   bolus posteriorly
3. Bolus propelled posteriorly
4. Bolus to anterior faucial
   arches

Question 7

Pharyngeal Phase

Answer 7

1. VP closure to avoid nasal regurgitation
2. Pharyngeal
   constriction/contraction
3. BOT excursion
4. Airway protection:
   -Vocal folds
   -Ventricular folds
   -Epiglottis
   -Laryngeal upward &
   anterior excursion

Question 8

Esophageal Phase

Answer 8

1. Bolus moves to
   esophagus via UES = cricopharyngeal muscle (CP)
2. UES relaxes/CP muscle relaxes by hyolaryngeal excursion

Question 9

Supraglottic Swallow

Answer 9

1. Hold your breath while
   you swallow to protect your airway.
   * Airway protection at TVF level
   -Reduced or late vocal fold closure
   -Reduced laryngeal
   vestibular closure
   -Delayed swallow
   onset

Question 10

Effortful Swallow

Answer 10

1. Squeeze your swallowing muscles as you swallow.
   *improve base of tongue retraction & pressure, bolus clearance

Question 11

Super - Supraglottic Swallow

Answer 11

1. Inhale, hold breath and bear down while swallowing, cough after swallow
   *Airway protection at laryngeal vestibule
2. Provides added arytenoid tilt and increased laryngeal vestibule closure for those with reduced laryngeal vestibular closure

Question 12

Mendelsohn Maneuver

Answer 12

1. Manually lift your larynx up during the swallow.
   -Reduced laryngeal
   movement
   *Improve UES opening and bolus flow

Question 13

Masako Maneuver

Answer 13

1. Place your tongue tip
   between your teeth and then swallow.
   - Reduced pharyngeal
   contraction
   - Ineffective anterior- to-posterior tongue movement
   - Enhances pharyngeal muscle contraction
   - Improves coordination of the
   tongue and pharyngeal muscles
   during swallowing

Question 14

3-Ounce Water Swallow Test

Answer 14

1. patient drinks 3 ounces of
   water without stopping. Failure is
   indicated by inability to complete
   the task or signs of aspiration
   (like a “wet” voice or cough).
2. Screening for dysphagia; quick,
   initial assessment to identify
   potential swallowing problems.

Question 15

Yale Swallow Protocol

Answer 15

1. Combines an oral-motor
   examination, a cognitive
   screening, and the 3-ounce water
   swallow test.
2. Comprehensive initial
   screening to evaluate risk of
   aspiration pneumonia in
   adults.

Question 16

Modified Barium Swallow Study

Answer 16

dynamic X-ray procedure that
observes the swallowing process
using barium-enhanced food and
liquid to highlight the path from
mouth through the esophagus.

Question 17

Penetration- Aspiration Scale

Answer 17

8-point scale that quantifies
the severity of penetration (entry
of material into the laryngeal
vestibule) and aspiration (entry
of material below the vocal folds)
during swallowing.

Question 18

Reduced Lip Closure

Answer 18

cannot hold food in the mouth anteriorly

Question 19

Reduced Tongue ROM

Answer 19

cannot form a cohesive bolus

Question 20

Reduced Labial Tension

Answer 20

food falls into anterior sulcus

Question 21

Reduced Buccal Tension

Answer 21

food falls into lateral sulcus

Question 22

Zenker’s Diverticulum

Answer 22

pharynx herniation where food collects in pouch during esophageal phase

Question 23

tracheoesophageal fistula (TEF)

Answer 23

abnormal hole/connection between trachea and esophagus

Question 24

Lingual Resistance

Answer 24

strengthening tongue; may use tongue depressor device such as IOPI

Question 25

CTAR (Chin Tuck Against Resistance)

Answer 25

Designed to improve UES opening

Question 26

Shaker Head Lift

Answer 26

Improve UES opening

Question 27

EMST

Answer 27

improve maximal expiratory pressure and strengthen expiratory muscles

Question 28

Shaker Exercise (Head Lift)

Answer 28

The patient rests in a supine position and lifts their head to look at the toes to facilitate an increased opening of the upper esophageal sphincter and strengthen suprahyoid muscles

Question 29

Chin Down Posture

Answer 29

chin is tucked down toward the neck during the swallow, which may bring the tongue base closer to the posterior pharyngeal wall, narrow the opening to the airway, and widen the vallecular space. may reduce penetration/aspiration in some patients

Question 30

Chin-up posture

Answer 30

chin is tilted up, which may facilitate movement of the bolus from the oral cavity. The chin-up posture may improve oral bolus transport

Question 31

Head rotation

Answer 31

head is turned to either the left or the right side, typically toward the damaged or weak side (although the opposite side may be attempted if there is limited success with the first side) to direct the bolus to the stronger of the lateral channels of the pharynx

Question 32

Head tilt

Answer 32

head is tilted toward the strong side to keep the food on the chewing surface.