Final Flashcards
Partial Glossectomy
Removes less than 50% of tongue, causes difficulty holding and preparing the bolus
Total Glossectomy
Removes more than 50% of the tongue, causes difficulty moving materials from the oral cavity, and reduces tongue driving force, also may show reduced pharyngeal clearance
Palatal Resection
removal of less than 50% of the soft palate, causes velar leak which results in retrograde movement of materials into the nasopharynx
Removal of the anterior/lateral floor of mouth
reduced anterior tongue range, reduced control of bolus, unable to lateralize tongue
Hemilaryngectomy (Vertical Laryngectomy)
removal of one vertical half of the larynx (one false vocal fold, one ventricle, and one true fold) unilateral resection, causes unilateral pharyngeal weakness and reduced airway protection
Supraglottic Laryngectomy (Horizontal Laryngectomy)
Remove all or part of the hyoid bone, epiglottis, aryepiglottic folds, false folds; causes incomplete posterior tongue movement, delay in bolus propulsion, and reduced airway protection
Total Laryngectomy
removal of the larynx, airway and swallowing tract are surgically separated, removal of vibratory source, causes issues with negative pressure and bolus transit, decreased swallowing issues because airway and swallowing tract are separated
Life changes after total laryngectomy
cosmetic issues with stoma site, change in respiratory patterns, aphonic initially
Effects of chemotherapy on the swallow
dry mouth, altered taste, and bolus control deficits
Effects of Endotracheal Tubes on the swallow
may cause damage to vocal folds or the pharyngeal mucosa
could also cause reduced laryngeal elevation or desensitization of the larynx
How long is prolonged intubation?
beyond 48 hours
Sign vs Symptom
signs are measurable whereas a symptom is not measurable and is patient-reported
screening vs evaluation
a screening is a short assessment that determines whether they need to have further testing whereas an evaluation is a full assessment and is longer and more thorough and typically results in a diagnosis
Signs or symptoms that would raise concern in a screening
gurgly voice, coughing, poor control of secretions, infrequent swallowing, fatigue
Water test
have the patient drink 3 oz of water without stopping and then have them cough one minute later and listen for a gurgly vocal quality
you would use this for a patient who seems to be aspirating after the swallow to see if that is true or not
Limitations: cannot be done on a patient who is on thickened liquids
Blue dye test
put blue dye in the patient’s food and then see if there is blue when you suction their trach
Used when aspiration is suspected in a person with a trach
Limitations: does not always show aspiration
MBS
modified barium swallow, x-ray of the swallow
Limitations: expensive, lots of personnel
FEES
Fiberoptic Endoscopic Evaluation of Swallowing, use of a flexible tubed endoscope to visualize the pharynx from the nasopharynx to hypopharynx, teh base of the tongue, and the larynx during the swallow
Limitations: cannot see the pharyngeal phase due to a white out
Bedside Swallow Eval (CSE)
assesment that is not instrumental
Limitations: does not show all phases of the swallow
NOMS
National Outcome Measurement Scale, system of measure that is designed by ASHA, 7 levels
FIMS
Functional Independence Measure
18 point measure of status upon admission and discharge, 7 levels
G-codes
Medicare Part B, system of measurement, 7 levels
IDDSI
The International Dysphagia Diet Standardization Initiative, they provide a standardized measurement of thickened liquids
IDDSI levels
regular thin, nectar thick, honey thick, pudding thick
Compensatory Strategy
compensate for present problems with the swallow, do not change physiology of swallow, used with food intake
Therapeutic/facilitation techniques
result in permanent improvement in the swallowing mechanism, actually improves the function of muscles, not utilized with food
Swallow Maneuvers
Compensatory and potentially therapeutic, may be indirect or direct
Types of compensatory strategies
Posture Changes, Texture/Sensory Changes,
Presentation Changes, Environmental Changes
Compensatory Strategies
chin tuck, chin up, IDDSI diet, alternate liquids and solids, multiple swallows, frequency of meals
Types of Therapeutic Techniques
oral motor exercises, laryngeal exercises, pharyngeal exercises, and neuromuscular stimulation
