dysphagia trombly prefeeding evaluation

Question 1

deglutition define

Answer 1

semi-automatic action of respiratory and gastrointestinal tract muscles to propel food from the oral cavity to the stomach

Question 2

5 phases of deglutition

Answer 2

preparatory, oral, pharyngeal, and esophageal
preceding the other phases is anticipatory phase

Question 3

Anticipatory phase is ______ and includes multisensory processing of the food in regard to (4 things)?

Answer 3

volitional
food appeal and acceptance, hand to mouth patterning, memory for the food item or similar food item, and mouth opening in response to the eating utensil

Question 4

Anticipatory phase is important in developing a ______ ______ about what will happen once the food reaches the mouth. This in turn results in?
what information is needed by the person to develop this plan?
____ and ____ is determined during this phase for self-feeders

Answer 4

-preliminary plan
-the preactivation of specific motor pathways and saliva
-gain visual, olfactory, and tactile and proprioceptive info about the food to be eaten by visually inspecting, smelling and stirring as well as other strategies to determine if food is swallow safe
-bite size and rate of intake

Question 5

what happens in the second phase, Preparatory phase?

Answer 5

Food is taken into the mouth and formed into a ball or bolus.

Question 6

what determines how the bolus is formed?
give food type examples
after formed where is it held?

Answer 6

the type of food, solid food items like peanuts require rotary chewing to mash them before the bolus is formed. Pureed food like apple sauce and pudding require little oral manipulation to form bolus.
held in the anterior part of the mouth until oral stage begins

Question 7

the oral phase #3 occurs when?
oral transit time is usually?
during this stage _____ pressures change, and the toungue does what?

Answer 7

-the bolus is moved by the tongue from the front of the mouth to the back of the mouth
-1sec
-oral, tongue squeezes the bolus against the soft palate until it reaches the area around the anterior faucial arches

Question 8

pharyngeal phase #4
normally when bolus reaches the area of the anterior faucial arches initiation of what occurs?
normal pharyngeal transit time is?
list the order of involuntary responses during this phase (6) the breathing stops during swallow and how is airway protected?

Answer 8

-swallow response
-1sec
-soft palate elevates to close off the nasopharynx, the larynx elevates and retracts, epiglottis inverts, true and false vocal cords adduct, pharyngeal constrictors contract, upper esophageal sphincter relaxes.
-by epiglottis and true and flase vocal cords.

Question 9

the esophageal phase begins once?
what happens in this phase?
normal time to complete phase?

Answer 9

-the bolus passes the upper esophageal sphincter
-upper esophageal sphincter returns to its tonic state, peristaltic contraction of the esophagus assists gravity in propelling bolus towards stomach.
-8-20sec

Question 10

therapist needs to have knowledge of normal and abnormal

Answer 10

head and neck anatomy, & neurophysiology

Question 11

key Signs and symptoms?

Answer 11

coughing, choking during or after mealtime, increased time to complete meals, refusal to eat, difficulty managing secretions, self-modification of diet, weight loss, frequent respiratory tract infections, changed vocal quality during or after eating, vomiting, comlaints of food sticking in throat

Question 12

disease process that have high incidence of dysphagia

Answer 12

Bulimia nervosa, cancer head and neck, cerebral vascular accident (right hem, left hemi, lacunes), huntington’s disease, parkinson’s disease, rheumatoid arthritis & cervical subluxation, spinal cord injury & cervical spondylosis & cervical fusion, tracheostomy, traumatic brain injury TBI

Question 13

OT role in dysphagia for comprehensive management

Answer 13

ADL: feeding and medication intake, adaptive equipment precription and use, cognition, gustation (tasting), motor control of posture, face and limbs; and psychosocial factors.

Question 14

Evaluation process in 4 categories

Answer 14

history, prefeeding evaluation, feeding evaluation, and videofluoroscopic evaaluation

Question 15

History should be obtained from what 3 areas?

Answer 15

patient, care providers, and medical record

Question 16

medical history - obtain the following info:

Answer 16

general health, medications, and nutritional status

Question 17

General health information should include:
these suggest potentially life-threatening form of dysphagia or affect oral intake

Answer 17

frequency of respiratory tract infections, complaints of heartburn / other gastrointestinal complaints, facial fractures, laryngeal trauma, weight loss

Question 18

Medication info should include:
which enhance swallowing? which negatively affect it?
what are some drug side affects that can affect dysphagia?

Answer 18

-what medication, form (caplet, capsule, tablet, liquid suspension, crushed, whole)and any difficulty with intake
-enhance:dopaminergic agents
-negative: psychotropics and muscle relaxants
-certain drugs alter taste, depress appetite, and induce vomiting

Question 19

nutritional history should include:

Answer 19

food allergies, preferences, current method of nutritional intake, type of diet, level of assistance needed, foods that are difficult to swallow, foods easy to swallow, time required to complete a meal, subjective info about feeding process

Question 20

prefeeding is without the presence of food and includes the following areas of assessment:

Answer 20

cognitive sttaus, motor control, respiratory status, oral structural function, oral reflexes, sensation, laryngeal function, pharyngeal function

Question 21

prefeeding, cognitive - look for:
also watch _____ state, and _____ management.

Answer 21

level of arousal, self-discipline (impulse control), judgement, orientation, memory, sequencing, ability to follow commands.
-emotional state, and behavioural management

Question 22

prefeeding, postural control - look for:
what is optimal posture for eating

Answer 22

can be observed when patient is sitting in clinic, skeletal deformities, abnormal patterns of muscle tone (tonic neck reflexes), weakness, difficulty with postural control
-sitting upright, trunk midline, 90deg of hip flexion, knee flexion to 90, feet flat on the support surface.

Question 23

prefeeding, respiratory status - info should include:
What suggests possible aspiration?

Answer 23

breathing pattern, respiration rate, oxygen requirements, trachesotomy history, suctioning requirements, respirator use.
-Apnea, bradycardia, choking, coughing, chronic noisy breathing, recurrent wheezing

Question 24

prefeeding sensory eval - includes: (3)
-extraoral and intraoral sensation should be tested for: (2)
-also look for _____ _____ inside mouth during oral structural evaluation
-in a nonverbal or cog impaired what reactions should be noted for oral tactile perception and what do they mean?

Answer 24

-olfactory, gustatory, and tactile senses
screen olfactory and - if alterations then formal testing
-temperature and touch
-bite marks - possible decreased sensory processing
-withdrawal; hypersensitivity, nonresponse: hyposensitivity

Question 25

what are the 4 methods of nutritional intake?

Answer 25

Total Oral
Partial Oral
therapeutic feedings
nonoral

Question 26

What is total oral nutritional intake

Answer 26

all nutrition, hydration and medication taken orally, can be self-fed or fed by care provider

Question 27

What is partial oral nutritional intake

Answer 27

A nonoral feeding source is used to ensure adequate nutrition and hydration and safe medication intake, patients can se self-fed or are fed by care provider

Question 28

What is therapeutic feedings - nutritional intake?

Answer 28

Oral intake is limited and done by therapeutic staff only; primary nutrition, hydration, and meds intake is nonoral source

Question 29

what is nonoral method of nutritional intake?

Answer 29

all nutrition, hydration, and meds given by nonoral source

Question 30

The oral structural eval begins by observing:
then the patient is asked to imitate various _____ _____ and the degree of _______ or _____ is recorded
Grading facial muscle function can be done but avoided in _____ _____

Answer 30

if the face is symmetric at rest.
facial movements
paralysis or strength
facial fracture

Question 31

Jaw control is evaluated after ____ ____evaluation.
palpate the ______ joint, ask patient to?
note the following symptoms:

Answer 31

oral structure
temporomandibular joint, open and close mouth slowly
popping, asymmetry in opening, or other symptoms

Question 32

What is quantified by the jaw control evaluation?

Answer 32

ability to perform lateral, graded, and rotary movements, the patient jaw strength

Question 33

Labial (lip) function is then assessed, patient is asked to:
If asymmetry or _______ is noted then formal _____ testing is indicated.
Coordination of control is assessed by asking patient to :

Answer 33

-pucker / purse, retract (show teeth while making an E sound), and round the lips and to maintain lip closure while simulating chewing.
-weakness, formal muscle testing
-alternate rapidly btwn rounding and retracting his lips 4 times, observe timing and symmetry of response

Question 34

lingual control is eval, initially note the appearance of the _______.
ppl with dysphagia may present with: (7) things

Answer 34

tongue
discoloration, coating, enlargement, surgical revisions, tremors, fasciculations (muscle twitch), or atrophy of tongue.

Question 35

Lingual control - after appearance of tongue, ask the patient to (4 things) his tongue while recording (3) things
-what can be noted while checking lingual control?

Answer 35

-protrude, retract, elevate, and lateralize tongue
-range, deviations (hemiparesis tongue deviates to weak side), speed of mvmt
-dental condition

Question 36

the soft pallet can be assessed by using a _____ ______. observe what? what sound should the make to observe strength

Answer 36

tongue depressor
at rest: a tremor, high vault
watching for symmetry, amount of excursion, and ability to maintain the ahhhh recorded, decreased ability in maintianing or performing suggests weakness.

Question 37

laryngeal screening - assessing what function?
assess the patients ____ quality, ability to ____ and ____ throat.
palpate the laryngeal excursion during ______
vocal quality should be assessed for: (6)

Answer 37

-protective mechanism during feeding
-vocal, cough, clear
-swallowing
-clarity, wetness, hoarseness, breathiness, and volume of speech, changes in vocal quality with fatigue

Question 38

patient history should include noting if a change in what has occurred since disease or dysphagia? why is this important?

Answer 38

vocal quality
changes in vocal quality suggest an alteration in vocal cord function, which may result in decreased airway protection when swallowing

Question 39

laryngeal screening-
Volitional ____ and ____ clearing are then assessed.
observe and comment on:
document if this is happening spontaneously, including the following observations:

Answer 39

coughing and throat clearing
-ability and strength or response
-frequency, strength, and if it was productive to bring material to the oral cavity

Question 40

throat clearing and coughing are _____ responses to irratants within the ____ and ____.

Answer 40

protective responses, pharynx or larynx

Question 41

Assess patients ability to prefeeding swallow:
the swallow response can only be screened during what 2 evaluations?
How to evaluate the swallow, the therapist should stand and place hand where?
What do you ask the patient to do and what are you evaluating? if exceeds 1sec then suspect?
feel for the ____ to return to resting position. and ask patient to?

Answer 41

-prefeeding and feeding evaluations
-sit or stand next to patient and place fingers like figure 44.2 on structures under chin and on front of neck.
-ask patient to swallow
-count (one one thousand, two one thousand…)from inital posterior tongue mvmt until laryngeal elevation occurs
- if exceeds 1sec may suspect delayed initiation of swallow response
-larynx to resting position
-ask patient to vocalize record changes in vocal

Question 42

prefeeding Swallow assessment con’t
If there is a change in vocal after palpation with swallow, this suggests?
If wetness request what?
observe what?
if voce quality changed then either

Answer 42

if prefeeding then saliva and if feeding then food, has entered the laryngeal vestibule and is resting on the vocal cords.
- a second swallow
-ability to trigger a swallow,
-material in larynx has either been swallowed or aspirated

Question 43

last prefeeding evaluation is of the _____ reflexes
Normal reflexes are:

Answer 43

oral reflexes
gag, and palatal reflexes

Question 44

oral reflexes-
define gag reflex
how to elicit the gag reflex and accompanied proper response?
document two things?
what abnormal reflex could occur?

Answer 44

-is a protective response that prevents aspiration of regurgitated material
-apply pressure to the tongue, posterior pharyngeal wall, or palate
-observe elevation of pallet, rolling of tongue, and tearing of eyes
-where elicited and if symmetrical
-bite reflex, and rooting reflex

Question 45

oral reflex
palatal gag reflex is done how and what is the response?

Answer 45

sterile swab and stoke palate
typically elevation without overt gagging should occur

Question 46

After finishing the prefeeding evlauation, summarize areas of impairment, why? ex?

Answer 46

used to help plan further evaluation nd treatment
ex if right hemifacial weakness, decreaased lingual control and limited movement of right side of tongue, hypotonic soft palate…. might want to start feeding assessment with purees on the left side of mouth.