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Dysphagia Final > Dysphagia Treatments Part 1 > Flashcards

Dysphagia Treatments Part 1 Flashcards

1
Q

Dysphagia Treatment Types (9):

A

1) Diet modification
2) Positional Strategies
3) Oral sensory Techniques
4) Maneuver
5) Exercise
6) Prosthetic*
7) Surgery*
8) Experimental
9) Other

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2
Q

Diet Modification (compensatory) may include modification to (6):

A

1) volume / Bolus volume (size)
2) viscosity / Bolus viscosity (consistency)
3) texture
4) temperature
5) Taste
6) Possible NPO diet - NG tube, G tube, PEG, J tube, etc.

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3
Q

Positional Changes Types(5):

A

1) posture (Sitting upright at 90°, Lying on side)
2) chin tuck
3) head rotation
4) head tilt
5) Head back

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4
Q

Oral sensory therapy types:

A

tactile/taste/thermal-tactile stimulation

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5
Q

Maneuver Types (4)

A

1) Supraglottic Swallow
2) Super-supraglottic Swallow
3) Mendelsohn Maneuver
4) Effortful Swallow

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6
Q

Exercise Types (3):

A

1) Shaker
2) Masako
3) Oral muscle strengthening

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7
Q

Prosthetic Types (2):

A

1) Palatal lift

2) obturator

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8
Q

Surgery Types (5):

A

1) CP myotomy –> for CP achalasia
2) Diverticulectomy –> for diverticulitis
3) Dilation –> for an esophageal stricture
4) Palatopexy –> surgery of the palate
5) VF medialization –> likely due to VF paralysis

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9
Q

Experimental Therapy Types (4):

A

1) Neuromuscular electrical stimulation-NMES: “VitalStim”
2) Deep pharyngeal neuromuscular stimulation-DPNS
3) myofascial release-MFR
4) Botox

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10
Q

Other Therapy Techniques (5):

A

1) multiple swallows
2) food presentation
3) liquid wash
4) adduction techniques
5) EMST

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11
Q

Compensatory Techniques vs. Therapy Techniques:

Compensatory Techniques –> (4)

A

1) UNDER CONTROL OF CAREGIVER
2) DO NOT Δ MOTOR CONTROL OF SWALLOW
3) DESIGNED TO ELIMINATE SYMPTOMS
4) THERAPEUTIC BECAUSE Δ TIMING OF SWALLOW

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12
Q

Compensatory vs. Therapy Techniques:

Therapy Techniques –> (3)

A

1) Δ SWALLOW ANATOMY/PHYSIOLOGY
2) DESIGNED TO ↑ROM, CONTROL, Coordination, STRENGTH
3) Categorized: DIRECT OR INDIRECT

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13
Q

Compensatory Techniques can include (5):

A

1) Diet Modification
2) Positional Strategies
3) Oral Sensory Techniques
4) Prosthetics
5) Other (multiple swallows, liquid wash)

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14
Q

Diet Modification should be use as a ______ (6)

A
  • “Last resort”
  • If other compensatory strategies or therapies fail
  • If too cognitively impaired
  • If a “building block”
    • Neurom. control/strength
    • ROM ex’s
  • If not possible to rehabilitate them (except if they are end of life–>consider quality of life)

Longterm goal: to get back to a regular diet after treatment

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15
Q

Example of liquid thickener:

A

“Thick it”

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16
Q

Diet Consistencies:

A

Liquids

  • Thin (water, tea, coffee, milkshake)
  • Nectar (V8, nectar fruit juice)
  • Honey (thickest liquid, honey)

Solids

  • Pudding (thick puree)
  • Puree (thin e.g. apple sauce)
  • Mechanical soft (scrabbled eggs)
  • Chopped (corned beef hash)
  • Regular (cookies, crackers, etc.)
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17
Q

Positional Changes (compensatory):

Sitting upright at 90°

A

Contributes to gravity to direct bolus down

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18
Q

Positional Changes (compensatory):

Lying on side

A

Eliminates gravitational effect on pharyngeal residue

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19
Q

Positional Changes (compensatory):

Chin tuck
chin to chest and swallow

A

1) Widens valleculae so it can hold more (to prevent penetration)
2) Narrows airway entrance & ↑ laryngeal elevation (bc of ↑ in pressure) & vf closure
3) Pushes tongue base backward toward pharyngeal wall
4) Puts epiglottis in a more protective position

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20
Q

Positional Changes (compensatory):

Head rotation

A

Used for asymmetry

To weaker side: closes off damaged side & directs bolus down stronger side

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21
Q

Positional Changes (compensatory):

Head tilt

A

Used for asymmetry

Works with gravity

To stronger side: directs bolus down stronger side (by gravity)

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22
Q

Positional Changes (compensatory):

Head back

A

Uses gravity to clear oral cavity

(similar to how some ppl take pills)

Not common but:
e.g. Useful for pts who had glossectomy (lost all or part of tongue)

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23
Q

Oral Sensory Descriptions (compensatory)

A

1) Downward pressure of spoon against tongue
2) Sour bolus (lemon juice)
3) Cold bolus
4) Bolus requiring chewing
5) Suck-swallow
* Measure by duration from command to swallow; oral transit time; pharyngeal delay time

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24
Q

Oral Sensory (compensatory):

Cold Bolus

A

Thermal-tactile stimulation

  • Vertically rub anterior faucial arch 4-5 times with a cold laryngeal mirror or ice sticks
  • Heightens oral awareness & triggers pharyngeal swallow
  • used to address delayed pharyngeal
  • widely used
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25
Q

Oral Sensory (compensatory):

Suck-swallow

A

1) Vertical tongue-jaw sucking with lips closed
2) Triggers pharyngeal swallow, draws saliva to back of mouth
* Not widely used
* Measure by duration from command to swallow; oral transit time; pharyngeal delay time

26
Q

Prosthetics (compensatory): Reason for (2)

A

1) Congenital defects (disease, cleft lip/palate/mandible, bifid uvula)
2) Acquired defects (disease, trauma, burns)

27
Q

Prosthetics (compensatory): What do they do

A

1) Improves speech intelligibility
2) improves oral prep/oral phase (↑ chewing, bolus formation & control, propulsive pressure, rate of swallow; ↓ tongue-palate distance)

28
Q

Prosthetic (compensatory): Help With Dentition –> (3)

A

1) ↑ mastication
2) appearance
3) denture retention

29
Q

Prosthetic (compensatory): Help with Palatal lowering (hard palate) –> (2)

A

1) ↓ volume of oral cavity

2) ↑ bolus transit & tongue-palate contact

30
Q

Prosthetic (compensatory): Help with Soft Palate –> (4)

A

1) Restores contact b/n palate & posterior tongue to maintain bolus control & direct bolus
2) aid in mastication
3) avoid pharyngeal spillage (slow down transit)
4) avoid nasal regurgitation during swallow

31
Q

Prosthetic (compensatory): Help with Lingual –> (4)

A

1) ↓ oral cavity size (↓ pooling)
2) ↑ tongue-soft palate contact (↑ bolus control)
3) ↑ eating
4) ↑ articulation & resonance

32
Q

Therapy Techniques can include (4):

A

1) Maneuvers
2) Exercises
3) Other (EMST, adduction techniques)
4) Surgeries *

33
Q

Maneuvers:

Effortful Swallow –> What does it do? (3)

A

1) Increases posterior tongue base mvmt/retraction &amp
2) Increase epiglottic mvmt &amp
3) ↓ pooling in valleculae

34
Q

Maneuvers:

Effortful Swallow –> How to do it

A

1) Squeeze hard with all of your muscles

2) Swallow with “squeeze”

35
Q

Maneuvers:

Supraglottic Swallow –> What does it do?

A
  • Voluntary breath hold

- Closes vf’s BEFORE & during swallow (if having trouble with apneic period)

36
Q

Maneuvers:

Super-supraglottic: What does it do?

A
  • Effortful breath hold
  • Tilts arytenoids forward, closing vf’s before & during swallow (quickens closure)
  • hopefully quickening the pharyngeal phase back to 1sec
  • false VF are coming together and are being used as a line of defense here (only time this happens)
  • Valsalva maneuver: ↑ false vf closure & shortens swallow
37
Q

Maneuvers:

Super-supraglottic: How do you do it?

A

1) Inhale & hold breath
2) Place bolus in position (at back of tongue)
3) Swallow while holding breath & “bear down”*
4) Cough after swallow before inhaling
5) Swallow again to clear material from cough

  • Valsalva maneuver: ↑ false vf closure & shortens swallow

2 swallows, 1 cough

38
Q

Maneuvers:

Supraglottic Swallow –> How do you do it?

A

1) Inhale & hold breath
2) Place bolus in position (at back of tongue)
3) Swallow while holding breath
4) Cough after swallow before inhaling
5) Swallow again to clear material expelled by cough

  • More protective bc closing off VF before swallow and coughing to clear anything
  • Can’t inhale again until done with 2nd swallowing after your cough
  • only do if they have a strong cough

2 swallows, 1 cough

39
Q

Maneuvers:

Mendelsohn –> What does it do? (3)

A

1) Prolonged laryngeal elevation opens &amp
2) prolongs UES to ↓ pyriform pooling
3) Normalizes/coordinates timing of pharyngeal swallow events

  • good for pts w/CP dysfnc, pyriform pooling, and incoordination of swallow
  • not good for pts w/decreased cognition
40
Q

Maneuvers:

Mendelsohn –> How do you do it?

A

1) Push tongue hard up against roof of mouth
2) Several dry swallows while feeling thyroid lift
3) Hold thyroid up for several seconds

41
Q

Exercises:

Shaker–> What does it do?

A
  • Head lift exercise
  • Increases UES opening & decreases hypopharyngeal intrabolus pressure
  • good for CP dysfunction (if decreased CP opening)
42
Q

Exercises:

Shaker –> How do you do it? (usually do a modified version of this)

A

1) Lay flat on your back on the floor or a bed
2) Without lifting your shoulders, hold your head off the floor & look at your feet for 1 minute
3) Relax your head back down for a 1 minute break
4) Repeat sequence 2 more times
5) Raise your head 30 more times & look at your toes (don’t sustain these head lifts)
6) Repeat entire exercise 3 times per day
* just aiming at the CP opening

43
Q

Exercises:

Masako –> What does it do? (3)

A
  • Anterior posturing of the tongue
  • Strengthens pharyngeal constrictors
  • Done only with dry swallows
    (not safe to do with a bolus)
  • strengthens mostly the superior pharyngeal constrictors, not so much the middle and inferior constrictors
  • number depends on pt. Maybe start with 5-10
44
Q

Exercises:

Oral motor

A

1) ROM
2) Resistance
3) Bolus maintenance:prep/manipulation/propulsion

45
Q

Exercises:

Oral Motor –>Bolus maintenance: prep/manipulation/prolulsion (3)

A

1) Lip seal (obicularis oris)
2) Jaw strengthening
3) Tongue strengthening (elevation/retraction/protrusion/lateral)

*widely used for oral dysphagias

46
Q

Experimental Therapies:

Deep Pharyngeal Neuromuscular Stimulation (DPNS) (4)

A

1) Designed to treat neuromuscular weakness or incoordination
2) Frozen lemon ice stick applied to 9 sites in mouth & throat
- Bitter taste buds (tongue base/back)
- Soft palate
- Superior & medial pharyngeal constrictors
3) Designed to activate muscles
4) Repeated application attempts to strengthen neurom. signals & increase m. strength

47
Q

Experimental Therapies:

Neuromuscular Electrical Stimulation
“VitalStim” “E-Swallow” “Ampcare” “Guardian”
NMES) (2

A

1) Surface electrodes applied over swallowing muscles
2) Stimulation attempts to facilitate motor mvmt (via neurom. transmissions) and strengthen muscles for swallow
* SLPs don’t know how to do electrical stimulation

48
Q

Experimental Therapies:

Myofascial Release (3)

A

1) Manual technique
2) Palpation with joint and soft tissue mobilization/ release of lips, tongue, face, jaw, neck
3) Attempts to loosen tight muscles & fascial adhesions, improve area circulation

Fascials are all connected where muscles are not. Tight fascials in one area can affect/cause problems in another area.

49
Q

Experimental Therapies:

Botox (2)

A

1) Motility disorders
2) CP hypertonicity/dysfunction/achalasia (if the CP won’t relax, if it is spastic)
3) Temporary

50
Q

Other Therapy Strategies:

Food Presentation (feeding)

A

1) Tray positioning
2) “head on” feeding - important when someone else is feeding pt
3) adaptable utensils (thick, loop, etc. handles)
4) speed

51
Q

Other Therapy Strategies:

Multiple Swallows

A

to clear

52
Q

Other Therapy Strategies:

Solid followed by liquid

A

liquid wash

to clear

53
Q

Other Therapy Strategies:

Adduction techniques (↑ laryngeal adduction) (5)

A

1) Cough
2) Throat clear
3) LSVT/increased loudness
4) Hard glottal attack
5) Sustained phonation

54
Q

Other Therapy Strategies:

Expiratory Muscle Strength Training (EMST) (2)

A

1) ↑ cough strength
2) resp. coordination
3) ↑ VP closure

55
Q

CP myotomy (surgery)

A

–> for CP achalasia
CP is cut

Good:
muscle no longer tonic
stuff can get through

Bad:
no longer elastic
no longer keeps air out
no longer keeps out back flow

Another option = Botox

56
Q

Dilation (surgery)

A

–> for a stricture in the esophagus

  • done under “twilight”
  • Common in pt who had ration and/or with reflux
  • can be done when you get an upper endoscopy
57
Q

VF medialization (surgery)

A

–> likely due to VF paralysis

2 Types:
Augmentation (quick fix-injection)

Thyroplasty (permanent-silicone implant))

58
Q

Good side effect of LSVT:

A

Better articulationI

59
Q

Why is “Ampcare” - NMES better than all other NMES?

A

BC dr. c learned about it.

only has 1 channel with 2 electrodes on the suprahyoids

Small electrodes

60
Q

What’s up with “Guardian” NMES?

A

website sucks

no efficacy data

61
Q

VitalStim + NMES and Dr. C’s dissertation:

A

e-stim on normal swallowers with different bolus sizes, intensity levels

swallowing muscles are type 2: fast, small twitch muscles that don’t have good endurance

Dr. C applied electrodes to thyrohyoids and other outside muscles

Found an increase of penetration when VitalStim was on

Found no difference between hyoid movement at 100% level and 75% level

Dysphagia Final (5 decks)

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