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Dysphagia Final > Dysphagia Treatment Part 2 > Flashcards

Dysphagia Treatment Part 2 Flashcards

1
Q

Order of Interventions (5):

A

1) Posture changes (can try in FEES/MBS)/ oral sensory
2) Maneuvers/exercises
3) Diet modifications

4) Prosthetic
5) Surgery

  • try several different things
  • can do these during a diagnostic to get cues for treatment
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2
Q

Oral Dysphagia:

↓ lip closure

A

oral motor (lip ROM/resistance)

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3
Q

Oral Dysphagia:

↓ buccal tension

A

head tilt (to stronger side)

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4
Q

Oral Dysphagia:

↓ jaw mvmt/mastication (2)

A

oral sensory (pressure, cold, sour)

oral motor (jaw ROM/resistance)

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5
Q

Oral Dysphagia:

↓ oral transit time

A

oral motor (tongue ROM)

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6
Q

Oral Dysphagia:

delayed oral onset

A

oral sensory (pressure + cold bolus)

  • wakes things up
    e. g. put pressure on tongue with a cold spoon
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7
Q

Oral Dysphagia:

apraxia of swallow

A

↑ viscosity/chewing; ↑ volume

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8
Q

Oral Dysphagia:

↓ tongue ROM/strength (4)

A

1) chin tuck
2) supraglottic (bc tongue base is retracted)
3) oral motor (tongue ROM/resistance)
4) ↑ viscosity

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9
Q

Oral Dysphagia:

↓ tongue elevation (4)

A

1) head tilt (if Unilateral)
2) oral motor (tongue ROM/resistance)
3) head tilt back
4) palatal prosthetic

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10
Q

Pharyngeal Dysphagia:

pharyngeal delay /absence (2)

A

1) oral sensory (thermal/tactile stim, suck swallow, pressure; sour)
2) chin tuck

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11
Q

Pharyngeal Dysphagia:

premature spillage (3)

A

1) chin tuck (opens the valleculae)
2) oral motor (tongue ROM/resistance-better bolus control and tongue base retraction)
3) ↑ viscosity (diet modification)

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12
Q

Pharyngeal Dysphagia:

short duration airway closure (3)

A

1) supraglottic
2) super-supraglottic
3) effortful

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13
Q

Pharyngeal Dysphagia:

short duration CP opening (2)

A

1) Mendelsohn

2) Shaker

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14
Q

Pharyngeal Dysphagia:

↓ pharyngeal coordination

A

Mendelsohn

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15
Q

Pharyngeal Dysphagia:

short duration laryngeal elevation

A

Mendelsohn

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16
Q

Pharyngeal Dysphagia:

↓ anterior hyoid motion

A

Mendelsohn

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17
Q

Pharyngeal Dysphagia:

↓ superior hyoid motion (2)

A

1) Mendelsohn

2) chin tuck

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18
Q

Pharyngeal Dysphagia:

↓ tongue base to pharyngeal wall (3)

A

1) chin tuck
2) effortful
3) oral motor (tongue base retraction)

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19
Q

Pharyngeal Dysphagia:

delayed triggering of pharyngeal (5)

A

1) chin tuck
2) supraglottic
3) thermal-tactile
4) suck-swallow
5) ↑ viscosity

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20
Q

Pharyngeal Dysphagia:

↓ laryngeal vestibule closure (5)

A

1) chin tuck
2) effortful
3) super-supraglottic
4) Mendelsohn
5) ↑ viscosity

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21
Q

Pharyngeal Dysphagia:

↓ laryngeal closure (true vf’s) (6)

A

1) chin tuck
2) head rotation (to weaker side)
3) supraglottic
4) super-supraglottic
5) ↑ viscosity
6) adduction (LSVT, etc)

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22
Q

Pharyngeal Dysphagia:

Unilateral pharyngeal weakness (6)

A

1) head rotation (to weaker side)
2) cough after swallow (adduction technique to clear residues)
3) multiple swallows to clear
4) side-lying (on stronger side)
5) head tilt (to stronger side)
6) Masako

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23
Q

Pharyngeal Dysphagia:

↓ hyoid mvmt, ↓ laryngeal elevation, CP dysfunction, pyriform residue (6)

A

1) head rotation (if U weakness)
2) Mendelsohn
3) ↑ viscosity
4) head tilt (if U weakness)
5) Shaker
6) chin tuck

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24
Q

Esophageal Dysphagia:

↓ peristalsis, motility in esophagus
esophageal aperistalsis

A

medication

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25
Q

Esophageal Dysphagia:

esophageal stenosis/stricture

A

dilation/stretching

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26
Q

Esophageal Dysphagia:

esophageal reflux/GERD (3)

A

1) positioning
2) medication
3) reflux behavioral guidelines

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27
Q

Esophageal Dysphagia:

LES dysfunction/achalasia (2)

A

1) medication (reflux)

2) surgery

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28
Q

Esophageal Dysphagia:

esophageal ulcers (2)

A

1) medication

2) surgery

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29
Q

Esophageal Dysphagia:

diverticulitis

A

diverticulectomy

30
Q

Esophageal Dysphagia:

esophageal spasm

A

medication

31
Q

Partial Glossectomy (removal of part of tongue) (Treatment-7):

A

1) Head tilt (to stronger side) before food is placed in mouth
2) Placement of food onto existing posterior tongue surface
3) Head tilt back
4) Thermal stim
5) Oral motor (tongue-palate ROM/resistance)
6) Oral motor (chewing – wet gauze)
7) Articulation / Speech sounds /d/, /t/, /g/, /k/ (mid and back sounds)

32
Q

Hemilaryngectomy (removal of part of the larynx) (Treatment-5):

A

1) Chin tuck
2) Head tilt (to strong side)
3) Head rotation (to the weak side)
4) Super-supraglottic (important part = the “effortful” part)
5) Adduction

33
Q

Total Laryngectomy (Treatment-3):

A

1) Oral motor (ROM/resistance-strength)
2) Plosives (/p/, /t/, /k/) - due to decreased intra-oral pressure
3) Neck stretches (tight muscles can cause dysphagia)

34
Q

ALS (Treatment-3):

A

1) No maneuvers or exercises!
2) Compensatory only (thermal-tactile stim; positional; diet modifications)
3) G-tube placement right away (starts as a nutritional supplement; eventually will be only source of nutrition)

35
Q

Stroke (Treatment-9):

A

1) Thermal-tactile stim, pressure, sour
2) Head rotation (to weak side)
3) Chin tuck
4) Mendelsohn
5) Supraglottic
6) Super-supraglottic
7) Oral motor (ROM) - indirect
8) Adduction - indirect
9) Larger bolus size (3 oz = ~90 cc/ml) (~3 medicine cups)

36
Q

PD (Treatment-7):

A

1) Oral motor (ROM) for tongue, lips, larynx
2) Effortful
3) Supraglottic
4) Super-supraglottic
5) Mendelsohn
6) Adduction (LSVT)
7) EMST

  • anything that helps close off the VF
  • can rehabilitate muscles unlike ALS
37
Q

TBI (Treatment-5):

A

1) Counsel family members/caretaker
2) Postural changes
3) Thermal-tactile stim
4) Oral motor (ROM/resistance)
5) ↑ viscosity

38
Q

MS (Treatment-3):

A

1) Oral sensory (thermal-tactile stim)
2) Postural changes
3) Oral motor (ROM)

  • Do strength training when the person is in remission
  • When not in remission, mostly postural changes
39
Q

Alzheimer’s (Treatment-7):

A

1) Counsel caretaker/family members
2) Oral sensory
3) Strong taste (Spicy!), ↑ bolus size
4) Postural
5) Exercises (early)
6) Diet modifications (late)
7) Enteral feeding (e.g.G-tube, but pt might pull it out) (end stage)

40
Q

Post-Neurosurgery (Treatment-4):

A

1) Aggressive oral motor (ROM/resistance for lips, tongue, tongue base, larynx) –> lots of sets, high reps
2) Adduction
3) Effortful
4) Super-supraglottic

41
Q

Cervical Injury/Fusion (Treatment-5)

A

1) Positioning (as close to 90° as possible)
2) Mendelsohn
3) Supraglottic
4) Super-supraglottic
5) Adduction (LSVT)

42
Q

Disorder observed on fluoroscopy:

Inefficient Oral Transit (reduces postpropulsion of bolus by tongue)

A

Posture Applied: Head back

Rationale: Utilizes gravity to clear oral cavity

43
Q

Disorder observed on fluoroscopy:

Delay in triggering the pharyngeal swallow (bolus past ramus of mandible but pharyngeal swallow is not triggered)

A

Posture Applied: Chin down

Rationale: Widen valleculae, narrows airway entrance to prevent bolus entering airway

44
Q

Disorder observed on fluoroscopy:

Reduced postpropulsion motion of tongue base (residue in valleculae)

A

Posture Applied: Chin down

Rationale: Pushes tongue base backward toward pharyngeal wall

45
Q

Disorder observed on fluoroscopy:

Unilateral laryngeal closure (aspiration during the swallow)

A

Posture Applied: Head rotaed to damaged side

Rationale: Places extrinsic pressure on thyroid cartilage, increasing adduction

46
Q

Disorder observed on fluoroscopy:

Reduced laryngeal closure (aspiration during the swallow)

A

Posture Applied: Chin down. Head rotated to damaged side.

Rationale: Puts epiglottis in more protective position; marrows laryngeal entrance; increase vocal fold closure by applying extrinsic pressure

47
Q

Disorder observed on fluoroscopy:

Reduced pharyngeal contraction (residue spread throughout pharynx)

A

Posture Applied: Lying down on 1 side

Rationale: Eliminates gravitational effect on pharyngeal residue

48
Q

Disorder observed on fluoroscopy:

Unilateral pharyngeal paresis (residue on one side of pharynx)

A

Posture Applied: Head rotated to damaged side

Rationale: Eliminates damaged side from bolus path

49
Q

Disorder observed on fluoroscopy:

Unilateral oropharyngeal weakness on the same side (residue in mouth and pharynx on same side)

A

Posture Applied: Head tilt to stronger side

Rationale: Directs bolus down stronger side

50
Q

Disorder observed on fluoroscopy:

Cricopharyngeal dysfunction (residue in pyriform sinuses)

A

Posture Applied: Head rotated to damaged side

Rationale: Pulls cricoid cartilage away fro posterior pharyngeal wall reducing resting pressure in CP sphincter

51
Q

Patient Type:

1) Head and Neck surgical patients
2) Head and Neck chemo-radiation
3) Trauma to the face or neck
4) Neurologic damage in the brainstem or peripheral nerves

(3)

A

Type of Exercise:

1) Resistance
2) Range of Motion
3) Swallow Maneuvers

52
Q

Patient Type:

Parkinson’s Disease

See in Fluoro:

1) decreased VF closure
2) decreased hyolaryngeal excursion
3) decreased tongue base movement

(2)

A

Type of Exercise:

1) Lee Silverman Voice Treatment (LSVT)
2) Range of Motion

53
Q

Patient Type:

Stroke

(3)

A

Type of Exercise:

1) Range of Motion
2) Heightening sensory input
3) Thermal tactile stimulation

54
Q

Patient Type:

1) Motor neuron disease
2) Amyotrophic lateral sclerosis (ALS)
3) Postpolio Syndrome
4) Werdnig-Hoffmann disease (pediatrics)
5) Spinal muscular atrophy (pediatrics)

(3)

A

Type of Exercise:

1) No active exercises
2) Posture
3) Sensory enhancement

55
Q

Patient Type:

Multiple sclerosis

(3)

A

Type of Exercise:

1) Range of Motion
2) Heightening sensory input
3) Thermal tactile stimulation

56
Q

Patient Type:

Head Injury

(1)

A

Type of Exercise:

Any therapy appropriate for the disorders present

57
Q

Patient Type:

General muscular weakness, deconditioning

(3)

A

Type of Exercise:

1) Range of Motion
2) Swallow maneuvers
3) Resistance exercises

58
Q

Patient Type:

Dementia

(initially and later)

A

Type of Exercise:

Initially:
- exercises, postures, diet change
Later:
- postures and diet changes

59
Q

Indirect treatment–>

A

does not require a swallow

60
Q

Direct treatment–>

A

requires a swallow to do

61
Q

Saker (indirect or direct)?

A

indirect

62
Q

Diet modification (indirect or direct)?

A

direct

63
Q

Mendelsohn (indirect or direct)?

A

direct

64
Q

Prostheic (indirect or direct)?

A

indirect

65
Q

At the end of a diagnostic:

A

Pick out with you think will work and your rational

You will get this from doing trials with different interventions

66
Q

goal of supgraglottic =

A

VF closure

67
Q

How do we know if our methods are working?

A

Repeat MBS/FEES after how many weeks 4-6 weeks after treatment to see if the methods are working

68
Q

Some things the Mendelsohn does?

A

strengthens the suprahyoids, infrahyoids, increase CP opening

69
Q

Is there a lot we (SLP) can do for esophageal dysphagias in therapy?

A

No. A lot of treatments are medications, dialations, surgery.

We can do education on positioning, reflux diet, can talk about over the counter PPIs

When we see an esophageal dysphagia, give guidelines and always refer to the GI

70
Q

What do pt with ALS usually die from?

A

respiratory failure

71
Q

What do pt with PD usually die from?

A

aspiration pneumonia

Dysphagia Final (5 decks)

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