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Exam 4 Flashcards

1
Q

What percent of at-risk children have feeding/swallowing issues?

A

33-80%

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2
Q

What are some example situations where an infant’s feeding would be interrupted?

A

Intubation, reflux, structural differences, international adoption, allergies, etc.

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3
Q

Contrast feeding vs. swallowing disorders.

A

Feeding: communication and social experience, bonding, pleasure, how you get food to mouth, growth and development, OM skills.

Swallowing: oral phase, pharyngeal phase, esophageal phase.

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4
Q

An infant is considered premature if the gestational period is less than how many weeks?

A

37

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5
Q

What is kangaroo care/what is it good for?

A

Skin to skin contact between infant and mother; promotes bonding, warmth, heartbeat, and prepares for nursing.

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6
Q

What are three of the main priorities in therapy for a child with pierre robin sequence?

A

Determine the best feeding system for the infant/parents, educate the parents on changes to come based on surgical repairs, and assist with texture transitions.

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7
Q

What is GERD?

A

When the contents of the stomach are returned into the esophagus because the LES isn’t functioning.

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8
Q

What are 4 different things GERD can lead to?

A

1 - respiratory complications
2 - esophageal/gastrointestinal problems
3 - failure to thrive
4 - dental erosion

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9
Q

At what age do normal, healthy infants stop regurgitating (pretty much)?

A

6 months

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10
Q

What are some examples of dysphagia management by other professionals?

A 
Tube feedings - physicians and RD
Diet modifications - RD
Trach involvement - respiratory therapist
Adaptive feeding equipment - OT
Positioning - PT
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11
Q

What is the only standardized assessment of swallowing ability?

A

Mann Assessment of Swallowing Ability (MASA)

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12
Q

What are the two ways to evaluate the effectiveness of dysphagia treatment?

A

1 - decreasing or eliminating aspiration (safety of swallow as seen on VFSS)
2 - reduction or elimination of residue (efficiency of swallow as seen on VFSS)

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13
Q

Why is it important to educate other staff members in a hospital about your patients’ treatment?

A

We want them to understand the diet/modifications/strategies we’ve implemented for our patient so they can implement them as well and help adhere to them.

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14
Q

If a patient and family don’t understand their swallowing disorder, what will likely be a result?

A

Less likely to follow through on your recommendations

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15
Q

What is the goal of sensory stimulation?

A

Aimed towards heightening the sensitivity of sensory receptive fields that are involved with swallowing

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16
Q

With increasing or modifying some aspect of sensory stimulation, what will be the result?

A

The patient will have a better initiation of swallow response or improved efficiency or improved swallow.

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17
Q

Why might we modify food placement?

A

Some patients may have partial or complete sensory loss within the oral cavity and won’t feel where the bolus is. Luckily it’s usually unilateral, so we can change the placement of the food and then there’s a greater chance they’ll sense it and safely and efficiently initiate the pharyngeal swallow.

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18
Q

What are 4 main things SLPs do in terms of modifying bolus characteristics?

A

Modifying the viscosity, volume, temperature, or texture

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19
Q

What does an increased bolus volume do?

A

It increases the extent and duration of the pharyngeal phase.

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20
Q

Why might we modify the bolus temperature?

A

In patients with poor oral sensation and poor initiation of the bolus, a cold stimulus may facilitate more rapid posterior tongue movement.

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21
Q

If a patient is in pain during swallowing, what can an SLP do to help with therapy?

A

Request that their pain medication be administered prior to when you go into see them.

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22
Q

What is thermal stimulation? What is it based on the idea of?

A

Stroking of the faucial pillars to facilitate a pharyngeal swallow. Based on the hypothesis that there are mechanical and thermal sensory receptors in the anterior oral pharynx.

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23
Q

What is physiotherapy applied to?

A

Striated muscles

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24
Q

What is the goal of physiotherapy?

A

To strengthen and improve the range, speed, and coordination of movements.

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25
What must a patient have in order to complete physiotherapy?
Patient must have the cognitive abilities to follow one step directions and the ability to imitate isolated oral movements.
26
What is one of the most effective exercises for strengthening the base of the tongue?
Telling the patient to "swallow hard"
27
What are 2 of our most commonly used strengthening exercises?
Shaker exercise and Masako maneuver
28
What is the Shaker exercise?
The patient lies down on their back and is required to lift their head and hold it for one minute.
29
What is the purpose of the Shaker exercise?
To strengthen the pharyngeal musculature
30
What is the Masako maneuver?
The patient sticks their tongue between their teeth and holds their tongue and then swallows.
31
What is the purpose of the Masako maneuver?
To increase posterior movement of the tongue base and anterior pharyngeal wall movement
32
What is the chin tuck compensatory posture effective for? How (anatomically)?
Airway protection; it draws the tongue forward, widens the valleculae, and the epiglottis stick out more into the pharynx.
33
The chin tuck is effective for what type of patients?
Patients with a delayed pharyngeal swallow
34
The head back chin up position is for what type of patients?
Patients with poor lingual motility or difficulty propelling the bolus posteriorly into the pharynx.
35
What does tilting the head back take advantage of?
Gravity - it moves the bolus back into the pharynx
36
What must patients have in order to do the chin up position?
Good airway closure and pharyngeal clearance! If they don't, tilting the head back will result in aspiration or a greater risk of aspiration.
37
What type of patients is the head turned to damage side of pharynx posture effective for?
For patients suffering from unilateral impairment of the pharynx or unilateral laryngeal paralysis.
38
What does turning the head to the damaged side of the pharynx do anatomically?
Closes off the damaged side which takes more advantage of the stronger, normal side. Also, by turning the head to the damaged side, it pushes the paralyzed cord towards midline and makes it easier for the more functioning cord to achieve closure.
39
What other, more surprising population is the head turned to the damaged side of the pharynx good for?
Patients with UES dysfunction; it reduces the resting pressure of the UES.
40
What type of patients is the head tilted toward the stronger side posture good for?
Useful for patients who have oral AND pharyngeal weakness on the SAME side.
41
What, anatomically, does the head tilted to the stronger side posture do?
It utilizes gravity to keep food on the normal, stronger side of the oral cavity and pharynx.
42
What type of patients is the lying down supine posture good for?
It's the best posture for patients who exhibit generalized reduction in pharyngeal contraction or bilateral reduced pharyngeal contraction or patients with residue throughout the pharynx.
43
Anatomically, how does lying down supine help swallowing?
Gravity helps keep the bolus/residue in the pharynx rather than falling into the airway.
44
What type of patients is the lying down supine position contraindicated for?
Patients who have successive buildup of residue on successive swallows because the pharynx will fill and then it will go into the airway; also for patients who have problems with GERD
45
What type of patients should use the combined chin down with head turned to the damaged side posture?
Best posture for patients with unilateral laryngeal damage to ensure airway protection.
46
How does the head and trunk at 45 degree angle position work?
The patient is lying down with their head elevated 45 degrees; results in drainage of residue from the valleculae down the posterior wall into the pyriforms, therefore hopefully avoiding laryngeal penetration and aspiration.
47
What type of patients is the 45 degree angle posture good for?
Patients that have a steady amount of pharyngeal residue but don't have the cognitive ability to use another posture or swallow maneuver.
48
What skills are needed for a patient to use any swallowing maneuver?
Needs to be able to follow 2-3 step directions, remember the directions over time, and understand the rationale for the maneuvers.
49
What is the double swallow maneuver used for?
For patients who have incomplete pharyngeal clearance (residue). E.g., patients with reduced tongue base contraction or reduced pharyngeal contraction or residue in the pyriforms.
50
What is the hard/effortful swallow used for?
For patients who have incomplete pharyngeal clearance due to incomplete tongue base retraction
51
What is the supraglottic swallow maneuver?
Voluntarily closing the larynx before the patient swallows; involves exertion of voluntary control over otherwise involuntary swallow events.
52
What type of patients was the supraglottic swallow maneuver designed for?
For patients who have undergone a supraglottic laryngectomy (epiglottis missing with VF intact).
53
What are the 6 sequence of events involved in hte supraglottic swallow?
``` 1 - hold your breath 2 - food in mouth 3 - swallow 4 - clear your throat/exhale 5 - swallow again 6 - breathe ```
54
What is the difference between the supraglottic swallow and the super-supraglottic swallow?
Super supraglottic is the same except it combines a hard breath hold with the sequence. You tell the patient to "bear down" while holding their breath.
55
What type of patients is the Mendelsohn maneuver for?
Patients who show incomplete opening/premature closing of the UES
56
What is the anatomic principle of the Mendelsohn maneuver/what do we tell the patients to do?
Based on the anatomic relationship between the hyoid and larynx and UEs; in this maneuver, we ask the patients to prolong laryngeal elevation. *Not easy to do!
57
Review - what are the 4 different types of therapy to employ with adults with swallowing problems?
1 - sensory stimulation (e.g., changing bolus characteristics, thermotherapy, etc.) 2 - physiotherapy (techniques we use to improve the physiology of swallow, like Masako or Shaker) 3 - postures and positioning (short term fixes) 4 - swallow maneuvers
58
What are the 4 objectives of nutritional support?
1 - maintain organ function 2 - promote healing 3 - increase defenses against infection 4 - increase well-being of patient
59
What are the 3 different routes for nutrition?
1 - oral 2 - IV (parenteral) 3 - tube (enteral)
60
Explain parenteral feedings
Form of feeding that goes directly into the circulatory system. It's very expensive. Only done for 3-4 weeks, max. Patient will lose a lot of weight. Use if need to bypass intestines.
61
Explain enteral feedings
Tube feedings; formula must be digestible depending on where it's given into the system. Must go in at correct rate or else the patient will reflux and aspirate.
62
What are the 5 different types of feeding tubes?
``` 1 - nasogastric (NG) 2 - gastrostomy (G) 3 - jejunostomy (J) 4 - pharyngostomy 5 - esophagostomy ```
63
What is a G tube?
Gastrostomy - long term solution for severe swallowing problem. Hole in abdomen and tube is inserted directly into the stomach.
64
What is an NG tube?
Nasogastric - more short term fix; inserted through nasal cavity and down into esophagus. Tubes are narrow and don't necessarily interfere with swallowing.
65
What is a J tube?
Jejunostomy - inserted directly into the small intestine and bypasses the stomach.
66
What is a pharyngostomy?
Hole is in the side of the neck and tube is inserted through the hole directly into the pharynx.
67
What are the 6 different diet consistencies a patient might be placed on?
``` 1 - clear liquid 2 - full liquid 3 - pureed 4 - mechanical soft 5 - soft diet 6 - regular diet ```
68
If a patient has a delayed pharyngeal reflex, what is a good diet recommendation?
Thickened liquids
69
If a patient has decreased laryngeal closure, what type of liquid are they more likely to aspirate: thin or thick?
Thin... DUH
70
If a patient is complaining that food is stuck high in their throat, where is it likely? Low in throat?
``` High = Valleculae Low = UES ```
71
Review - How do we know that we have improved the flow of food?
Efficiency based on residue and safety based on aspiration.
72
What are four swallowing disorders that could result in residue in the pyriforms?
1 - UES dysfunction 2 - reduced laryngeal elevation 3 - reduced pharyngeal contraction 4 - reduced pulsion force of the bolus
73
What is the lump in the throat sensation called?
Globus hystericus

Dysphagia (4 decks)

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