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Dysphagia and Voice Disorders > Dysphagia Management > Flashcards

Dysphagia Management Flashcards

1
Q

What are the goals of intervention?

A

To make sure the person does not die because of dysphagia. This includes making sure they are eating and drinking enough as well as breathing enough.

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2
Q

How are the goals of dysphagia management met?

A

They are met through objectives (i.e., specific parts of the swallow anatomy and physiology are targeted such as hyolaryngeal excursion, duration of UES opening)

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3
Q

How are objectives of dysphagia management met?

A

They are met through action plans (e.g., specific techniques used or frequency of techniques used such as Mendelsohn maneuver (HLE) or Shaker exercise (UES opening))

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4
Q

How is a goal of dysphagia management written?

A

E.g. To establish safe intake of (insert foods and/or liquids) through (insert technique)

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5
Q

What are the 3 main management approaches for dysphagia?

A

Compensatory, therapeutic/rehab, and preventative

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6
Q

What is the focus of the compensatory approach?

A

short-term changes to make it easier to ingest material by mouth

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7
Q

What is the focus of the therapeutic/rehab approach?

A

to improve swallow physiology with therapeutic effects that last

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8
Q

What is the focus of the preventative approach?

A

to minimze negative consequences of dysphagia (e.g., deficits in nutrition/hydration and infections) and to minimize or stop dysphagia from occuring in high-risk populations such as those with degenerative diseases, HNC, and COPD

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9
Q

What is the difference between enteral nutritional support and parenteral nutritional support?

A

While both are compensation strategies, enteral nutritional support refers to food being passed through a tube connected to the GI tract. For parenteral nutritional support, a tube is not connected to the GI tract (it’s not function), but rather to the bloodstream.

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10
Q

Regarding postural adjustments, what can you do to help with oral transport?

A

tilt the head to the side or move/extend the head back

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11
Q

Regarding postural adjustments, what can you do to ensure airway protection?

A

head down or chin tuck; this narrows the entrace to the larynx and closes laryngeal structures which ensures airway protection

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12
Q

Regarding postural adjustments, what can you do to help a person with hemiparesis take food by mouth?

A

tilt their head towards the weaker side

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13
Q

What considerations must be made for dysphagia management?

A

patient characteristics (e.g., prognosis, severity, and etiology); nature of impairment (e.g., phase(s) of swallow affected and swallow physiology); diet plan may change to advance it or restrict; continuation of oral diet (no more oral intake if aspiration on >10% of bolus or takes >10 seconds to swallow bolus); patient empowerment; intervention and treatment that considers the following: risks, benefits, functional outcomes, and relationship to the patient’s etiology

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14
Q

What tubes are used in enteral nutritional support?

A

nasogastric/nasointestinal tube; gastronomy tube; jejunostomy tube

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15
Q

What indications suggest a nasogastric (can be nasointestinal (NI), nasoduodenal (ND), or nasojejunal (NJ)) tube should be used? What are the complications associated with it?

A

Indications: short term use (i.e., 4-6 weeks) and a patient who is cooperative and alert. Complications: risks of aspiration due to irritation of pharyngeal mucosa

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16
Q

What indications suggest a gastrostomy tube should be used? What are complications associated with using a gastrostomy tube?

A

Prolonged and indefinite use; aspiration that is recurrent; complications: diarrhea, aspiration, stomal leak, gastric bleeding, gastric perforation, wound infection; tube can come out

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17
Q

What indications suggest a PEG (percutanoues endoscopic gastrostomy) tube should be used?

A

complicated cases and replaced every 6 months

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18
Q

What indications suggest a jejunostomy tube should be used? What complications can result from using this tube?

A

gastric contents are aspirated constantly and disease of the stomach or esophagus means direct access to the bowels is necessary; complications: diarrhea; abdominal pain; catheter may be displaced; obstruction of small bowels

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19
Q

What indications suggest parenteral support (TPN or PPN)?

A

GI tract does not work and feeding is needed for more than a week;

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20
Q

What are the types of parenteral support

A

TPN (Total parenteral nutrition) through a central vein and PPN (Peripheral parenteral nutrition) through a peripheral vein and feeding is required for 7 to 10 days

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21
Q

What assessment tool is useful for focusing discussions on transitioning to oral diets for the patient?

A

FOIS (Functional Oral Intake Scale)

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22
Q

What are 3 broad therapeutic approaches for dysphagia management?

A

behavioural (voluntary maneuvers and exercise protocols); motor augmentation (electromuscular stimulation and cortical + peripheral stimulation); sensory elicitation (sensory awareness and swallow elicitation)

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23
Q

What are the instructions for the supraglottic swallow? What is its purpose?

A

Sit up straight and take a deep breath —> take a small bite of food or a sip of water —> swallow while holding your breath —-> cough immediately after you swallow —-> swallow again —–> breathe; to close the airway while eating

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24
Q

What are the instructions for the super supraglottic swallow? What is its purpose?

A

Sit up straight and take a deep breath (bear down) —-> take a small bite of food or a sip of water —-> swallow —-> cought right after you swallow —> swallow again —> breathe; to close the airway while eating

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25
Q

What are the instructions for an effortful swallow? What is its purpose?

A

Sit up or stand up straight. Squeeze your neck as hard as you can and then swallow. It strengthens the pharyngeal muscles so that the bolus is squeezed down.

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26
Q

What are the instructions for the Mendelsohn Maneuver? What is its purpose?

A

Sit up or stand up straight. Put your index and middle finger on your hyoid bone. Swallow and squeeze your throat muscles to hold the hyoid bone at the highest point of elevation for 3 seconds. Relax. Repeat as many times as directed. It allows the bolus to pass through the pharynx by lengthening the time the UES is opened and the time of hyolaryngeal elevation. It also leads to maximal hyolaryngeal displacement.

27
Q

What are the instructions for the tongue base ROM (Gargle and yawn)? What is its purpose?

A

Pretend to gargle or yawn and hold your tongue back as far as possible and then repeat. To improve tongue base’s range of motion

28
Q

What are the instructions for the Masako Maneuver? What is its purpose?

A

Sit or stand comfortably—> stick your tongue out as far as possible —–> gently bite your tongue with your front teeth and swallow ——> release your tongue and repeat; to strengthen the muscles at the base of the tongue.

29
Q

What are the instructions for the Shaker exercise?

A

lie down on your back and keep your shoulder flat —-> lift up your head or tuck your chin—-> hold that position for 1 minute and then release. Repeat as much as necessary. This exercise helps to improve the movement of the larynx and hyoid bone, especially during hyolaryngeal excursion. Consequently, there will be no residue left in the pyriform sinuses and therefore no risk of aspiration. It increases the duration of UES opening too.

30
Q

To shift a patient from non-oral feeding to oral feeding, consider the following:

A

document any problems the patient has during oral feeding or complications; document nutrition/hydration and as well as the type, amount and time of material they ingest orally; involve the family and patient in plans to advance their diet; check the patient to see if they have problems breathing as well as their swallowing performance and nutrition/hydration; put them on a specific diet in the beginning and use tube feeding intermittently; identify and choose a safe oral bolus; recommend patient to take food and drink in orally before doing so through a tube; reestablish a normal meal routine

31
Q

What are the prosthetic options to help individuals with dysphagia?

A

palatal prosthesis (to raise soft palate and therefore stop nasal regurgitation or reshape palate to make it easier for the tongue to make contact with it), jaw sling (mastication by increasing jaw support which supports the tongue even more), synthetic saliva, and adaptive feeding tools (for individuals with arm or limb issues),

32
Q

How would you treat/manage mild to moderate dysphagia in patients with dementia?

A

change texture of foods; provide the patient with smaller and more frequent meals; teach caregiver feeding techniques; good mouth care

33
Q

How would you treat/manage severe dysphagia in patients with dementia?

A

feed them carefully by mouth; use a NG or PEG tube; artificial hydration; teach caregiver feeding techniques such as nonverbal cues and reducing distractions; smaller and more frequent meals that include nutritional supplements

34
Q

What are oral sensory awareness strategies?

A

compensatory strategies that help initiate the oral phase of swallowing; it includes providing a bolus that is cold, sore, or large; putting more downward pressure on the tongue; using thermal-tactile stimulation

35
Q

What is the pathophysiology of dementia?

A

it is caused by an accumulation of lewy bodies, neurofibrillary tangles, and/or cerbrovascular disease in the cerebral cortex; this causes a loss of neurons which affects cognition and causes depression and issues with swallowing and other sensorimotor functions

36
Q

What are palliative approaches to dysphagia management?

A

offer food but do not force it; provide them food and drink orally as much as possible; when pt is dying, they may not want or need food, so provide them with ice chips and artifical salivary products. Be aware of mouth hygiene.

37
Q

What types of liquids should be given if a patient shows signs of aspiration?

A

thickened liquids

38
Q

What are the advantages of modifying bolus presentation?

A

you can address issues related to pharyngeal swallow (e.g., delayed swallow using a large bolus for sensation and weakened swallow using a small bolus for more control or less residue) and awareness of food (e.g., presentation hot or cold foods).

39
Q

What are dry/saliva swallows?

A

a compensatory strategy aimed to clear residue from the pharynx and prevent aspiration after swallowing; it is appropriate for someone with weak oral/pharyngeal muscles. However, it lengthens feeding time so it is not appropriate for someone who gets tired quickly.

40
Q

What are liquid washes?

A

a compensatory strategy aimed to clear residue from the pharynx and prevent aspiration after swallowing; thin liquids are used and it is appropriate for someone with weak oral/pharyngeal muscles.

41
Q

What is the purpose of dysphagia therapy?

A

It seeks to help the patient better form a bolus and improve the transport of it through the oral cavity. It also aims to increase pressure of bolus through the pharynx. It involves food and drink (i.e., direct) or saliva (i.e., indirect)

42
Q

How can a sensory facilitation technique be therapeutic and compensatory?

A

Senstory facilitation technique (through air pulse stimulation or thermal tactile stimulation) aims to make it easier to perform a dry swallow. It is assumed that performing a dry swallow improves swallowing, thus making it therapeutic. This is helpful for patients with stroke, TBI, HNC, or has a long time to recover from an illnesss. It can be used to facilitate oral feeding in the short term as well by reducing the time taken to perform a pharyngeal swallow. This makes its compensatory and useful for someone with a degenerative disease.

43
Q

Exercises for muscles of the pharynx and larynx are

A

Airway entrance: fast hard glottal attacks, holding your breath, and bearing down
Vocal fold adduction: speak clearly while bearing down; falsetto; lifting or pushing while speaking

44
Q

Dysphagia in patients with vascular dementia include

A

difficulty forming a bolus and chewing a bolus, silent aspiration, hyolaryngeal elevation, epiglottic inversion,

45
Q

To treat dysphagia in patients with vascular dementia, do the following:

A

improve hyolaryngeal elevation via Shaker exercise, address oral and pharyngeal motor aspects of swallowing, and address bolus formation and chewing

46
Q

What exercise can be used to strengthen suprahyoid muscles?

A

shaker method

47
Q

What exercise can be used to strengthen respiratory muscles?

A

EMST (expiratory muscle strength training): boosts activation of forces of submental muscles; it improves hyolaryngeal excursion too

48
Q

What lingual exercise can be used to improve the propulsion of a bolus?

A

taking a long and thick gauze soaked with juice and having the patient use their tongue to push it upward and backward. A thinner gauze can be used as the ROM improves.

49
Q

What labial exercises can be used to improve the ROM of the lips?

A

retracting lips by saying /i/ or puckering lips as tight as possible

50
Q

What labial exercises can be used to improve the strengthening of the lips?

A

holding the lips as tight as possible for as long as possible or by putting a tongue depressor between the lips and have them held tightly.

51
Q

What are key questions to ask when assessing a person with dementia in acute care?

A

Is the person dying? How have they been functioning the past few days, weeks, and months? Can the person consent to assessment and intervention? What do the caregivers think about the person’s nutrition and hydration? Is their problem an acute one? Why were they admitted into the hospital?

52
Q

What are other key questions to ask when assessing a person with dementia in acute care?

A

Does the person have documentation about advanced stage care? What types and textures of foods and liquid are available at home? Can the patient describe their difficulties? Does the caregiver manage the difficulties? Could medications be causing their swallowing issues? Do you perceive any patterns in their skills and troubles? How does behavior affect the problem?

53
Q

Strength training exercises for each part of the swallow musculature involve three features:

A

intensity, specificity, transference

54
Q

Examples of swallowing exercises are

A

McNeil Dysphagia Treatment Program (MDTP) and Iowa Oral Performance Instrument

55
Q

What is the Iowa Performance Instrument?

A

It uses a device to measure force as a result of increasing tongue strength

56
Q

What is the McNeil Dysphagia Treatment Program?

A

A program that is systematic and exercise-based for individuals with dysphagia. It adds a system ofE progressive overload

57
Q

Examples of motor augmentation are

A

Neuromuscular electrical stimulation and paired associated stimulation

58
Q

What are the parts of the model of medical decision making?

A

Contextual factors, quality of life, patient preferences, and medical indicators

59
Q

What are examples of contextual factors to consider in medical decision making?

A

legal issues, burden on caregivers, economics (e.g., insurance, cost, and availability), and family preferences

60
Q

What are examples of quality of life factors to consider in medical decision making?

A

subjective judgement, determining who decides for the patient when the patient cannot, and external assessment of benefits and burdens

61
Q

What are examples of patient preference factors in medical decision making?

A

patient’s religious and personal values; patient’s ability to make and communicate decisions, advanced directivse, their view of their QOL, what they express they desire, and personal history

62
Q

What are examples of medical indicators to consider in medical decision making?

A

accurate dx and prognosis, and treatment options, and medical history

63
Q

What right do SLPs have with regard to ethical decision making?

A

discharge, counsel, make recommendations, and speak to a risk management specialist

64
Q

What are careful handfeeding strategies?

A

slow, small and steady with feeding, avoid liquid wash if the person is coughing, be wary of temperature of food and utensils used; use medicated mouth rinse if tongue is coated; lip moisturizer should be used; make sure the person is sitting upright; encourage self-feeding

Dysphagia and Voice Disorders (14 decks)

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