Evaluation of swallow Flashcards
during the screening you determine?
does the ptnt have dysph sign & symptoms chart review observation (3oz test)/time swallowed test and if further observation is needed
what is a false positive?
you think someone is aspirating but they aren’t
what is a false negative?
you think someone is NOT aspirating but they are
what are they symptomatology for valleculae hesitation/pooling?
- base of tongue/epiglottic area
- stuck high in throat
what are the symptomatology for pyriforms?
just bellow larynx
stuck in the middle of the throat
What are the symptomatology for UES dysfunction?
pain in upper chest or inches below larynx
“stuck” in middle of throat
what are they symptomatology for aspiration?
coughing
choking
50% aspirate without cough
bedside exam?
- medical dx, hx, pt’s perception
- pt’s medical status: nutritional, respiratory
- pts oral anatomy
- pts respiratory fnctn
- control/fxn: labial,lingual, palatal, pharyngeal, laryngeal
- cognitive status
- sensory: taste, temp, text
- signs/symptoms during swallow attempts
when should you not do a trial swallow?
acutely ill 80+ decrease pulmonary very weak cough suspect silent aspiration
what do you note during the trial swallows?
ptnts reaction to food oral mvments coughing/throat clearing before/during meal time secretion levels meal duration and amount respiration and swallow coordination
what do you determine during the bedside what are your results?
posture for best safest swallow best positioning for food in mouth best food consistency hypothesis as to the nature of swallowing dis. recommendations for dx (direct)
what are the indications for MBS videofluoroscopy? ( why do you do one)
- to identify normal and abnormal a&p of swallow
- to evaluate airway protection before/during/after swallowing
- to evaluate the effectiveness of postures, maneuvers, bolus modification and sensory enhancements in improving swallowing safety and efficiency
- to provide recommendations regarding the optimum delivery of nutrition and hydration ( oral vs. nonoral)
- to determine appropriate therapeutic techniques
- to obtain info in order to collaborate with and educate other team members, referral sources, caregivers, and patients regarding recommendations for optimum swallow and efficiency.
what are the contraindications of a MBS?
- medically unstable, lethargic, unoriented, agitated, uncooperative, cognitive def
- when the information obtained from the study is unlikely preferences-SNR, chronic disease or end-of-life situations
- patient is unable to be adequately positioned
- size of patient
- allergy to barium
What are the limitations of videofluoroscopy?
- time constraints due to radiation exposure
- as the procedure only samples swallow function, it does not fully represent meal time function
- contrast materials such as barium increase the viscosity and alter liquid and solid food composition and are not natural foods
- limited ability to evaluate a fatigue effect on swallowing
- barium is an unnatural food bolus with potential for rejection (constipation)
What are the positives and negatives of FEES?
+
examines a&p before and after swallow
no radiation exposure
excellent view of VF’s
- no oral stage visible
- white out during pharyngeal phase
what are the pos and neg of an ultrasound?
+
tongue function
+ oral transit time
+ hyoid motion
- cant image pharynx
- see oral stage only
What does fMRI stand for?
functional magnetic resonance imaging (used more for research purposes)
- neural basia/mechanisms
- neural mapping/cortical control
PET?
positron emission tomography
neural activity associated with motion
-radiation exposure
scintigraphy?
radioactive gamma rays amount of aspiration and residue mouth and pharynx not well visualized -cant id where dysfunction is can dz esophageal (GURD)
–don’t do too much radiation (gamma rays)
what are some non-imaging dx instruments?
EMG
EGG
acoustics (accelerometer or stethoscope)
manometry
