Dysphagia Study Notes Part 2 Flashcards
Oral Transit Time OTT
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
Pharyngeal Delay Time PDT
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
Pharyngeal Transit Time PTT
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
Trigger
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
Tippers
Food held between midline of the tongue and hard palate with tip elevated against alveolar ridge
Dippers
bolus held on floor of mouth in front of tongue twenty percent
Penetration
Enter the vestibule but has not gone past the VF
Aspiration
Food or liquid has gone below the level of the VF
Silent Aspirator
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
Unsafe Swallow
At risk for aspiration
Inefficient Swallow
Eating is a lot of work causing the patient to eliminate things malnutrition and dehydration
Swallowing Areas
oral cavity Pharynx Larynx esophagus
Sulci
Natural pockets or cavities ie cheeks between lips and gums In patients they often collect food or liquid
Laryngeal Excursion
The movement of the Adams Apple up and over
Therapeutic Strategies and Swallow Maneuvers
These are designed to change the swallow physiology and they can be direct or indirect
Compensatory Strategies
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
Goal of Any Treatment
The continuous goal of any treatment program is the reestablishment of oral feeding wile constantly maintaining adequate hydration nutrition and safe swallowing
Steps of a Swallowing Assessment
Screening Full assessment a Chart review b interview c bedside eval d MBSS e FEES optional
Info Collected in Oral Exam
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
Negative Factors to Bedside Swallow Trials
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
Positive Factors to Bedside Swallow Trials
a Can follow directions b can cough on command c good pulmonary function
Once you decide to do trail feeding and swallows
a Decide on best posture for food presentation b decide on best textures and foods to administer
Postures Dump and Swallow
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
Postures Chin Tuck
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
