Dysphagia Study Notes Part 2

Question 2

Oral Transit Time OTT

Answer 2

Time taken form the initiation of tongue movement to begin the voluntary oral stage of the swallow until the bolus stage of the swallow until the bolus head reaches the point where the lower edge of the mandible crosses the tongue base normal is one to one point five sec

Question 3

Pharyngeal Delay Time PDT

Answer 3

Begins when bolus head reaches point where lower edge of mandible crosses the tongue base and ends when swallow is triggered as indicated by laryngeal elevation trigger point until the swallow occurs Indicators that reflex has occurred include ONE hyo laryngeal elevation TWO tongue base retraction to meet the anterior moving posterior pharyngeal wall

Question 4

Pharyngeal Transit Time PTT

Answer 4

Is defined as the time elapsed form triggering the pharyngeal swallow as indicated by laryngeal elevation until the bolus tail passes through the cricopharyngeal region or UES of the pharyngoesophageal PE segment normal is max of one sec usually point thirty five to point forty eight sec

Question 5

Trigger

Answer 5

When the leading edge of the bolus bolus head passes any point between the anterior faucial arches younger people and the point where the tongue base crosses the lower rim of the mandible older people

Question 6

Tippers

Answer 6

Food held between midline of the tongue and hard palate with tip elevated against alveolar ridge

Question 7

Dippers

Answer 7

bolus held on floor of mouth in front of tongue twenty percent

Question 8

Penetration

Answer 8

Enter the vestibule but has not gone past the VF

Question 9

Aspiration

Answer 9

Food or liquid has gone below the level of the VF

Question 10

Silent Aspirator

Answer 10

No visible or auditory signs that something has been aspirated Are those patients whose sensitivity is reduced and who aspirate food or liquid without coughing or any other audible or visible sign

Question 11

Unsafe Swallow

Answer 11

At risk for aspiration

Question 12

Inefficient Swallow

Answer 12

Eating is a lot of work causing the patient to eliminate things malnutrition and dehydration

Question 13

Swallowing Areas

Answer 13

oral cavity Pharynx Larynx esophagus

Question 14

Sulci

Answer 14

Natural pockets or cavities ie cheeks between lips and gums In patients they often collect food or liquid

Question 15

Laryngeal Excursion

Answer 15

The movement of the Adams Apple up and over

Question 16

Therapeutic Strategies and Swallow Maneuvers

Answer 16

These are designed to change the swallow physiology and they can be direct or indirect

Question 17

Compensatory Strategies

Answer 17

Strategies that control the flow of food and eliminate patient symptoms such as aspiration but do not necessarily change the physiology of the swallow Compensating for a problem not curing it

Question 18

Goal of Any Treatment

Answer 18

The continuous goal of any treatment program is the reestablishment of oral feeding wile constantly maintaining adequate hydration nutrition and safe swallowing

Question 19

Steps of a Swallowing Assessment

Answer 19

Screening Full assessment a Chart review b interview c bedside eval d MBSS e FEES optional

Question 20

Info Collected in Oral Exam

Answer 20

a any facial paralysis b patients ability to maintain lip closure c limitations in tongue function that may affect ability to hold bolus or to propel food back d indicate area of oral cavity where food can be positioned for the best tongue control e help in selection of food consistencies you thing the patient will best be able to handle

Question 21

Negative Factors to Bedside Swallow Trials

Answer 21

a Patient is acutely ill b significant pulmonary complications c weak voluntary cough d over 80 years e cannot follow simple directions f suspected pharyngeal swallow disorder

Question 22

Positive Factors to Bedside Swallow Trials

Answer 22

a Can follow directions b can cough on command c good pulmonary function

Question 23

Once you decide to do trail feeding and swallows

Answer 23

a Decide on best posture for food presentation b decide on best textures and foods to administer

Question 24

Postures Dump and Swallow

Answer 24

Tilt head down then throw head back a do not use very often b when you tilt head up you are opening up your airway c The only time you ever use this posture is when you have a severe oral phase issue that is keeping you form getting the bolus to the trigger point at the same time a normal pharyngeal phase

Question 25

Postures Chin Tuck

Answer 25

Tilt head down a helps to pinch the airway b helps promote increased tongue base movement and empty the valleculae c If patient struggles with premature entry Bad if there is labial weakness d slows bolus down and helps with bolus control

Question 26

Postures Turn head toward the affected side

Answer 26

a only for unilateral pharyngeal weakness b pinches the weak side and shunts the food down the stronger side

Question 27

Postures Tilting the head toward the strong side

Answer 27

extreme head tilt will be laying down on your side Using gravity to keep bolus on the strong side

Question 28

About Postures

Answer 28

Food presentation should be to the side with the best function and sensitivity Use of straw pipette tongue blade spoon etc

Question 29

Selection Depends On

Answer 29

a Info collected in HX b info gathered on oral control c info gathered on laryngeal pharyngeal control

Question 30

Tracheostomy Tubes are Normally Placed for

Answer 30

1 upper airway obstruction at or above the level of the TF 2 potential upper airway obstruction 3 provision of respiratory care

Question 31

Tracheostomy Tubes are Normally Placed for

Answer 31

Inserted into the trachea through a surgical incision between the 3rd and 4th tracheal rings

Question 32

3 Parts of Trach

Answer 32

1 outer cannula remains in place 2 inner cannula removed for cleaning 3 An obturator used for initial insertion

Question 33

Cuffed

Answer 33

unable to push air around tube when cuff is inflated Cuff can be deflated Primary purpose is not to prevent aspiration Primary purpose ventilation

Question 34

Uncuffed

Answer 34

Air can usually pass between the outer cannula and walls of the trachea when tube is occluded