Dysphagia Flashcards
Dysphagia questionnaire tools
Mann Assessment of Swallow Ability (MASA)
- rates clinical symptoms of dysphagia
- helps quantify the severity of dysphagia (e.g., mild, mod, severe) and tracks progress
- 24 questions –> lip seal, cough strength, oral transit time, voice, etc.
Functional Oral Intake Scale (FOIS)
SWAL-QOL
- 44 item questionnaire that assesses a person’s quality of life in regards to eating. Questions cover areas such as the burden of eating, fear of eating, dysphagia symptoms, social concerns.
- helps when judging the overall target and effects of dyphagia therapy.
Bedside swallowing tasks
Speyer 2013
Trial swallow- water
-boluses of increasing size (5 mL, 10mL, 20mL)
Trial swallow- varying viscocity
-bolus of increasing size and consistencies
- Speyer found these methods to have high sensativity for detecting the presence of dyphagia as compared to VFSS (>70%)
- observe oxygen desaturation (>2%), wet vocal quality, coughing which would identify individuals who require further instrumental evaluation
Compensatory vs. Rehabilitative Treatment
Compensatory strategies are aimed at increasing swallow safety but, as of yet, have not been found to create lasting functional changes to swallow physiology.
Rehabilitative techniques, such as exercises, are designed to create lasting changes in the individuals swallow over time by improving underlying physiological functions.
Rehabilitative Strategies (list)
Shaker Chin Tuck Against Resistance Masako Thermal/Tactile Stimulation EMST
Compensatory Strategies (list)
Volume Control Diet Modification Sensory Stimulation Posture/Positioning Modifications -head turn -chin tuck Swallowing Maneuvers -effortful swallow -supraglottic -super-supra swallow -mendelson
Volume Control
(Robbins et. al., 2008; Johnson et. al., 2014)
- type?
- who is it good for?
- what does it do?
- Controlling or reducing the volume of food and liquid presented to the patient during oral feeding can help reduce the risk of aspiration secondary to delayed pharyngeal swallow or reduced oral-lingual control.
- Reducing volume sizes helps increase control of bolus if patient has poor coordination/control of bolus or delayed swallow initiation.
- Increasing the volume helps if patient requires increased sensory input to trigger pharyngeal swallow or bolus propulsion (e.g., tongue pumping?). May also alter taste/temperature of food.
Diet Modification
(Steele et. al., 2015; Johnson et. al., 2014; Swan et. al., 2015)
- type?
- who is it good for?
- what does it do?
** Stress the importance of testing the effects of compensation strategies during instramental evaluation!
•Thicker liquids reduce the risk of penetration/aspiration, but also increase the risk of post-swallow residue in the pharynx (Steele, 2015)
Designed to minimize aiway invasion BEFORE the swallow due to poor oral lingual control or delayed pharyngeal swallow initiation (Johnson, 2014)
- Thickened liquids reduce the speed of bolus flow from the mouth to the pharynx, which allows more time for airway closure before the liquid arrives at the larynx and airway passage (Steele, 2015)
- Thickened liquid and solid foods required more strength and effort in terms of mastication, tongue propulsion, and pharyngeal constriction (Steele, 2015)
Solid food: consider properties of hardness, cohesivness, and sliperiness relevant for swallowing physiology and flow patterns. Thicker and harder items arequire more effort and oral procesing…
Quality of Life (Swan et. al., 2015)
•Increased modification of food leads to decreased quality of life
•This information suggests that it is best to consider the use swallowing maneuvers and postural adjustments in addition to the least restrictive diet possible that promotes safe swallowing.
Sensory Enhancement
(Robbins et. al., 2008; Johnson et. al. 2014)
- type?
- who is it good for?
- what does it do?
- VFSS recordings have shown that there are specific physiological changes that occur in normal and neurologically impaired swallows with varying sensory input (temperature, carbonation, sour bolus)
- Temperature: Cold boluses may improve oral transit time in those with reduced oral sensation.
- Carbonation: Shown to reduce pharyngeal transit time, reduce aspiration, and reduce pharyngeal residue.
- Sour Bolus: Has been found to increase the timing of bolus propulsion, faster trigger of the pharyngeal swallow, increased tongue propulsion, increased spontaneous dry swallows ect.
Chin Tuck
(Johnson, 2014; Ashford et. al., 2009)
- type?
- who is it good for?
- what does it do?
Originally this positioning was thought to widen the vallecular space thereby capturing the bolus in the vallecular space to contain the pooled liquid; however Johnson states that more recent research found…
- Increased the duration of laryngeal closure and narrows entrance to the larynx.
- *Helps with POOLING IN THE VALLECULAE, but should not be used if pooling is found in the pyriform sinuses becuase when hypopharynx in shorted and narrowed material can overflowing into the larynx.
- Increased BOT retraction towards the posterior pharyngeal wall.
- *Helps with REDUCING VALLECULAR RESIDUE secondary to REDUCED BOT RETRACTION.
•This strategy has been found to be the LEAST EFFECTIVE in preventing aspiration in Parkinson’s; thickened liquid was the most effective (Ashford et. al., 2009) and should always be testing during instramental evaluations.
Head Turn
(Johnson et. al., 2014; Ashford et. al., 2009)
- type?
- who is it good for?
- what does it do?
•Helps with poor vocal fold adduction and decreased UES opening. Turn head to the weaker side for vocal fold abduction and to either side for poor UES opening.
-Good for people who have unilateral VF closure and pooling in the pyriform sinuses due to poor UES relaxation/opening.
•Limited evidence for neurological disordered population (Ashford et. al., 2009)
Effortful Swallow
(Johnson et. al., 2014)
- type?
- who is it good for?
- what does it do?
- Contracting muscles of swallowing with great effort to increase oral and pharyngeal pressures.
- Goal is to increase base of tongue retraction in order to increase the pharyngeal and lingual pressures during swallowing resulting in REDUCED RESIDUE IN VALLECULAE and INCREASED DURATION OF UES OPENING.
- “swallows hard and pushes their tongue in a upward and backward motion.”
Supraglottic Swallow
(Johnson et. al., 2014)
- type?
- who is it good for?
- what does it do?
- Protects airway from aspiration at the level of the TRUE VFs.
- Good for reduced airway protection or aspiration during swallows; people who have delayed VF closure or delayed pharyngeal reflex.
•Patient takes a deep breath, holds breath before, during, and after swallows, then cough at the end.
*not good for people with heart conditions; good comprehension, cognition, and enduracne is required and may not be appropriate for all patients.
Super-supraglottic Swallow
(Johnson et. al., 2014)
- type?
- who is it good for?
- what does it do?
- Provides airway protection at the level of the laryngeal vestibule
•Good for reduced airway protection or aspiration before or during swallow.
•Patient takes a deep breath, bears down, swallow, cough, and swallow hard.
•*not good for people with heart conditions; requires sequencing of multiple steps so may not be appropriate for patients with cognitive or memory problems.
Mendelson Maneuver (Johnson et. al., 2014; Ashford et. al., 2009)
- type?
- who is it good for?
- what does it do?
- Voluntarily prolong laryngeal elevation to help with UES relaxation or residue in the pyriform sinus area.
- Patient dry swallows, hold swallow at the peak of laryngeal elevation, swallows, and holds a few seconds after swallow (not recommended to use with food).
- Shown to have some improvements transitioning to oral diet after CVS in the neurological disordered population. May work best when paired with biofeedback (Ashford et. al., 2009)
Shaker Excersize
(Johnson et. al. 2014; Logemann, 2008)
- type?
- who is it good for?
- what does it do?
- Good for increasing UES opening and hyolaryngeal movement (protects airway). Thus, this exercise is recommended for people with residue in their pyriform sinuses or post swallow aspiration due to decreased hyolaryngeal movement resulting in reduced UES opening.
- Patient lies down in supine position, lifting their head enough to see their toes and hold this position for 1 minute. Repeat this exercise 30 times 3 times a day for 6 weeks.
- Patients who are too weak to complete this exercise may need to gradually increase endurance or complete CTAR or jaw opening exercises.
