dysphagia3 trombly feeding evaluation+

Question 1

After completing the prefeeding assessment what must be decided?

Answer 1

if a feeding evaluation can be safely done or if a vidofluoroscopic evaluation is indicated

Question 2

in general:
-if total oral then?
-if nonoral then?
-if modified diets, are partial oral feeders, or have had previous _______ ______ should be?
ultimately the decision at this point is guided by what?

Answer 2

-total oral - should undergo a feeding evaluation
-nonoral - should have videofluoroscopic evaluation before taking food by mouth
- videofluoroscopic eval - evaluated on an individual basis
-guided by the institutional policy and procedures

Question 3

During the feeding assessment the evaluation will observe (3)

Answer 3

postural control, respiratory function, and alterations in cognition or behaviour as relate to feeding process

Question 4

When determining swallowing capabilities NB to include:

Answer 4

various consistencies, variety of methods of intake, and different bolus sizes

Question 5

If decreased oral control or delayed initiation of swallow response use what type of foods?
these require very little what?
and provide what information to the person?
prevents what from happening?

Answer 5

purees and thickened liquids
very little bolus formation
sensory info to the tongue about taste and texture,
and viscosity prevents premature loss into the pharynx

Question 6

If upper esophageal sphincter dysfunction or decreased pharyngeal constrictor activity is suspected use what type of foods?

Answer 6

thin liquids and thinned purees because of fluid state

Question 7

Bolus size depends on
if no signs of dysfunction with small bolus then …… until what point?

Answer 7

patients performance with various textures and small bolus size(1/4-1/2 tsp)
-then bolus size can be increased until symptoms occur or a normal bolus is swallowed w/o difficulty

Question 8

self feeding will depend on

Answer 8

patient cognitive ability and motor

Question 9

To observe anticipatory phase observe:(3)

Answer 9

patient’s hand to mouth patterning if self feeding, awareness of the feeding process, and anticipatory mouth opening in response to the food.

Question 10

to observe preparatory phase record: (4)

Answer 10

ability to remove food from the utensil, prevent anterior spillage of material, thoroughly masticate food, and swallow bolus w/o leaving residue in cheek or on tongue

Question 11

are clinical observations of feeding definitive in detecting asperation?

Answer 11

no

Question 12

videofluoroscopy defined
able to visualize the:
allows for _____ ______ of the nature and extent of swallow dysfunction, including if _____ is occuring, and the patients _________ to asperation.
Also what strategies can be observed and effectiveness determined?

Answer 12

-highly specialized testing uses radiographic equipment to view swallowing function dynamically
-preparatory, oral, pharyngeal, and esophageal stages of swallow
- accurate identification, asperation, response.
-compensatory strategies

Question 13

Before treatment begins, and before talking with family

Answer 13

the team has to discuss the findings of evaluation and recommendations.

Question 14

feeding eval complete, 3 things needed for treatment team

Answer 14

summarized info obtained, identify problems, and make recommendations to team

Question 15

Summarized info obtained should include:
ex?

Answer 15

-key info from history, prefeeding, and feeding components of eval
-“weight loss, decreased cog, multiple stage swallow impairment, following recommendations are being made”

Question 16

recommendation section of report should include: (10)

Answer 16

feeding status
diet and liquid levels
medication form and method of intake
body position during and following feeding
feeding strategies
compensatory strategies
therapeutic exercises
recommended consults
need for videofluoroscopic eval and reevaluation
and long term therapeutic goals.

Question 17

Team review
multiple issues can be involved: (5)

Answer 17

risk of complications if nonoral feeding source recommended
patient and family refusal
time required to feed safely - burden to caregiver
can nutritional adequacy be achieved on proposed diet
do recommendations take into account disease progression

Question 18

Family and patient education
timing
benefits

Answer 18

receive info and have input as decisions are made
the more info they have about the patients dysphagia the more likely they are to follow guidelines, support and encourage patient

Question 19

Treatment
4 areas

Answer 19

diet modification
equipment
compensatory strategies to maximize safety
remediation and direct treatament

Question 20

why Diet modifications
they can exist with?
work closely with what professional to identify diet level

Answer 20

-attempt to allow for safe oral intake and adequate nutrition and hydration
-multiple levels of food and liquid
-clinical nutritionist

Question 21

progression from nonoral to oral feeding has a typical progression (6)

Answer 21

nonoral - patient recovers swallowing abilities / compensation tech ( increased ability to handle secretions & change in videofloro test) - therapeutic feedings by allied health (intake increases safe feeding behav noted) - eat under supervision of health provider or trained family identified as partial oral feeder - if continue to improve to drink enough fluid and take medication and nonoral feeding source removed - diet consistency upgraded as skills develop w/ goal of returning to normal diet

Question 22

Equipment to assist patient needs what 2 educations with family and patient

Answer 22

how to use
cleaning

Question 23

In addition to treatment, what can be done to stimulate oral cavity and reinforce _____ _____

Answer 23

oral hygiene and prefeeding and feeding activities
normal patterning

Question 24

therapeutic intervention focusing on (4) things will enhance dysphagia interventions

Answer 24

postural and limb control
cognitive, behavioral, and perceptual remediation

Question 25

Progression of treatment should be made based on?

Answer 25

individual performance with appropriate grading to ensure safety

Question 26

effectiveness of intervention?

Answer 26

treatment vs nontreatement was effective in decreasing occurance of aspiration pneumonia in dysphagia

Question 27

problem: Impulsivity
Treatment:

Answer 27

compensatory:
supervise feeding
require placement of utensil on table after each bit4e
present one food item at a time

Question 28

problem: poor judgement
Treatment:

Answer 28

Compensatory:
use small-bowled utensils to decrease bolus size
for liquids use of covered cup with small opening or pinch straw to limit amount

Question 29

problem: poor attending
Treatment:

Answer 29

Compensatory:
feed in a quiet distraction-free environment

Question 30

Problem: facial weakness

Answer 30

Compensatory:
Diet consists of - purees, ground foods with sauce, and thickened liquids for easy control
Place food: toward back of mouth, on stronger side of mouth,
Tilt head: toward stronger side
Therapist places finger around lips to assist with closure

Remediational:
Tactile stim of face: tapping or quick stretch
facial exercises using mirror for feedback
sucking or blowing activities with increasing resistance

Question 31

Problem: poor lingual control

Answer 31

Compensatory:
Diet consists of - food requiring little oral manipulation
Place food: toward the back of mouth
Tilt head: towards the stronger side, forward and backward head mvmt to assist with bolus propulsion
oral inspection after mealtime to check for residue

Remediational:
Tongue: range of motion exercises, resistive exercises, gauze or gum in gauze exercise
(place in patients mouth with tail sticking out, ask to move right to left or foward and back and observe oral manip by watching tail)
encourage precise articulation

Question 32

Problem: Swallow Delay

Answer 32

Compensatory:
Diet excludes thin liquids
Chin tucked to chest to max airway protection
head rotation to weaker side

Remediational:
Thermal stim
(sterile #00 laryngeal mirror dipped in ice water 10 sec, stroke faucial arch 5 - 10 times, and a swallow is requested, alternate between R and L sides, treatment stops after 5 min or fatigue occurs by increased time before initiation or coughing / choking)