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Dysphagia > Dysphagia Treatment > Flashcards

Dysphagia Treatment Flashcards

1
Q

What are the two main branches/approaches to dysphagia treatment?

A

Compensation

Rehabilitation

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2
Q

What is the compensation approach?

A

Use of strategies that compensate for lost/impaired functions. Cope with what they have.
Short-term adjustments to patient, food, or swallowing activity. The focus is on safe swallowing.

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3
Q

What is the rehabilitation approach?

A

Use exercises to improve the strength of the musculature.

Rehabilitation efforts do intend to improve swallowing physiology and by extension enhance swallow function.

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4
Q

How many commonly used exercises are used in dysphagia treatment?

A

5

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5
Q

What does the Masako Maneuver improve?

A

Improved tongue pressures and improved anterior movement/bulging of the PPW.

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6
Q

Describe the Masako Maneuver.

A

Place the tongue tip between the teeth and try to dry swallow 10 times in a row. This strengthens the BOT-PPW movement.

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7
Q

What is an Effortful Swallow?

A

Literally what it sounds like. A hard or effortful swallow with intention. The goal of this technique is to recruit more motor units, increase the demand and create a muscle training/strengthening effect. (Initially a dry swallow)

“Pretend you have a golf-ball in your mouth and you need to swallow it whole.”

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8
Q

What does the Effortful Swallow impact/help?

A

That effortful swallows impact the velopharyngeal and UES areas during swallowing

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9
Q

What is the purpose of the Supraglottic Swallow?

A

Airway protection

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10
Q

What demographic is the supraglottic swallow contraindicated for? Why?

A

Contraindicated in patients post stroke because of potential cardiac abnormalities induced by the Valsalva

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11
Q

What are the four steps of the supraglottic swallow?

A
  1. Hold Breathe (Closes the airway)
  2. Swallow Hard
  3. Cough
  4. Swallow Again
    * ALL DONE IN ONE BREATH!!*
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12
Q

Should you use boluses/food for these rehabilitation exercises?

A

You shouldn’t at the beginning, but depending upon the patient’s progress, you could introduce a bolus (Probably just small sips of water) by the 3rd or 4th session.

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13
Q

What is the purpose of the Mendelsohn maneuver?

A

Evidence shows:
Greater improvements in hyolaryngeal elevation than anterior excursion, with non-significant improvements in duration and extent of UES opening in patients post-stroke.

Improvements in hyo-laryngeal excursion assessed with HRM.

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14
Q

Of the 5 exercises discussed in class, which two have the greatest evidence base?

A

Mendelsohn Maneuver

Shaker (Pronounced /shakir/)

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15
Q

Describe the Mendelsohn Maneuver.

A

This maneuver is performed by having the patient hold the larynx up, either using the muscles of the neck or with the hand, during the swallow for an extended period of time. (Can document # of swallows or time elevated.)

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16
Q

What is the most objective way to do the Mendelsohn Maneuver?

A

Using EMG’s during a VFSS!

Palpation will be helpful too if those aren’t available.

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17
Q

What are the two parts of the Shaker exercise?

A

Isotonic Component

Isometric Component

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18
Q

What is the purpose of the Shaker exercise?

A

Increased Hyolaryngeal excursion and UES opening.

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19
Q

Describe the Shaker exercise.

A

Isotonic:
The patient lies flat and, keeping the shoulders on the bed/mat, raises the head to look at the toes. The patient maintains this position (the goal is 60 seconds) and then repeats this 2 more times.
Isometric:
The second part of the exercise is a repetitive movement. In the same starting position, the patient raises the head to look at the chin, lowers the head back to the bed and then repeats this 30 times. Three sets of 30 are the goal.

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20
Q

What exerices should be used to improve oral stage deficits?

A

Iowa Oral Performance Instrument (IOPI). There is an isotonic component and an isometric component.

Jaw strengthening using TheraBite.

21
Q

What is the primary goal of dysphagia treatment?

A

Airway protection!

22
Q

What are the 3 goals in Dysphagia treatment?

A

The primary goal is airway protection.
Maintain nutrition and hydration needs.
Maintain general health status.

23
Q

Why is oral hygiene important?

A

Someone with poor oral hygiene has a higher chance of developing pneumonia because of aspiration.

Poor oral hygiene + aspiration = higher chance of pneumonia

Good oral hygiene + aspiration = less chance of pneumonia

24
Q

What are the 5 strategies for dysphagia treatment?

A 
Oral Hygiene
Teach feeding strategies
Restricting certain viscosities
Therapeutic and Postural Intervention
Ongoing counseling and education
25
Q

List some compensatory strategies.

A 
Chin tuck
Head back.
Small sips and bites
Repeat swallows
Thickening
Head tilt
Head rotation.
26
Q

Movement is the function of the interaction of what three elements?

A

The Learner​
The task​
The environment

27
Q

Improving swallowing requires…

A

SWALLOWING!!

28
Q

What is the IOPI?

A

Iowa Oral Performance Instrument.

It is a device used for improving oral strength and pressure.

29
Q

What are some techniques for improving a delayed initiation of the swallow?

A

Thermal-tactile stimulation: to provide immediate and temporary improvement in stage transition duration in individuals post stroke (Rosenbek, Roecker, Wood & Robbins, 1996)—the operative and essential word being temporary.

Air pulse application

30
Q

Describe thermal-tactile simulation.

A

Thermal–tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow.

31
Q

What three exercises are used for BOT-PPW impairments?

A

Tongue back/Masako.

Effortful Swallow.

Tongue pull-back maneuver (just one piece of evidence for this one)

32
Q

What three exercises are used for impaired hyolaryngeal excursion and UES opening?

A

Mendelsohn maneuver

Shaker exercise

Chin-tuck against resistance (CTAR)

(EMST too!)

33
Q

What two exercises are used for airway protection?

A

Supraglottic Swallow

Super supraglottic swallow

34
Q

What is NMES?

A

Neuromuscular Electrical Stimulation or NMES uses a device that sends electrical impulses to nerves. This input causes muscles to contract. The electrical stimulation can increase strength and range of motion, and offset the effects of disuse. It is often used to “re-train” or “re-educate” a muscle to function and to build strength after a surgery or period of disuse.

35
Q

Is NMES an effective Dysphagia treatment?

A

Yes, to a point. You must use it adjunctively, not on it’s on.
It is only really effective if you are doing exercises while having the NMES on.

36
Q

Discuss the “Free Water Protocol”

A

Specific Patients who demonstrate certain characteristics are permitted to drink water and likely aspirate. Pneumonia is of concern when there are microbes and other nasties getting into the lungs with the thin liquid. But if it is all clean and just water, then it is more likely that they will be fine!

This is a quality of life issue.

Patient candidacy issues:
Oral hygiene
Water is permitted between meals (not during or until 30 minutes after).
No thin liquids given with medications.

Aspiration is a benign event.

60% of the body contains water.

Langmore et al. (1988): Not all patients who aspirate develop pneumonia

37
Q

Describe the Penetration-Aspiration Scale.

A

An 8-point, equal-appearing interval scale to describe penetration and aspiration events. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled.

38
Q

What is the FOIS?

A

Functional Oral Intake Scale.
Completed by an interview with paients or family or a chart review.

Levels:

  1. Nothing by mouth (NPO)
  2. Tube dependent with minimal attempts of food or liquid
  3. Tube dependent with consistent intake of liquid or food
  4. Total oral diet of a single consistency
  5. Total oral diet with multiple consistencies but requiring special preparation or compensations.
  6. Total oral diet with multiple consistencies without special preparation, but with specific food limitations.
  7. Total oral diet with no restriction.
39
Q

Describe the DOSS.

A

The Dysphagia Outcome and Severity Scale (DOSS) is a simple, easy-to-use, 7-point scale developed to systematically rate the functional severity of dysphagia based on objective assessment and make recommendations for diet level, independence level, and type of nutrition.

40
Q

What is the minimum expected width of jaw opening?

A

44 mms

41
Q

How can pitch gliding exercises help with swallowing?

A

When you gliding up in pitch, you lengthening your vocal folds, bringing them closer together, potentially improving airway protection.

42
Q

What is pitch gliding?

A

Glide from a low to high pitch on sustained phonation.

Use feedback.

43
Q

What does pitch gliding target?

A

Targeted to improve pharyngeal muscles and airway protection. (Malandraki and colleagues, Langmore and colleagues).

44
Q

Describe Myofascial release.

A

Similar to circumlaryngeal massaging.
Targeted to release tightness in muscles by principles used in PT.

Beneficial for individuals with fibrosis. Research evidence is growing.
(Used by Physical therapists. Recently used by SLP as well.)

45
Q

What is Expiratory Muscle Strength Training (EMST) beneficial for?

A

Research (Sapienza and colleagues) indicates improved respiratory pressures, improved strength of cough, improved sub-mental (underneath your jaw) activity, better airway protection.

46
Q

What does the LSVT improve?

A

Loudness – sub-glottal pressure.

Targeted to improve VF and laryngeal vestibule closure, and may improve pharyngeal transit too.

47
Q

What is the free water protocol?

A

You can give a patient some water, even if they aren’t “safe” to have it, as long as you follow certain criteria: cognitive awareness of patient, good oral hygiene, not before/after meals, etc.

48
Q

Why would the LSVT improve swallowing?

A

Improving loudness is improving subglottal pressure, when you improve subglottal pressure, you’re improving the vestibular squeeze, the cough strength, airway protection, etc.

Dysphagia (17 decks)

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