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Dysphagia > final exam review > Flashcards

final exam review Flashcards

1
Q

Management/Compensation/Treatment Example 1 – what would antibiotics for PNA fall under?

A

management

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2
Q

Management/Compensation/Treatment Example 2 – what would 2 swallows per bite/sip fall under?

A

compensation

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3
Q

What would Masako to strengthen BOT/PPW fall under?

A

treatment

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4
Q

Why is oral care the best predictor of aspiration PNA?

A

oral bateria increases the risk of aspiration PNA. dysphagia is an important risk factor for developing aspiration PNA but is not sufficent to cause it without other risk factors present

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5
Q

T/F Oral bacteria flourishes in a dry mouth

A

T

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6
Q

What is the name for aspiration of stomach contents?

A

Aspiration pneumonitis

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7
Q

What factors do you need to consider when deciding whether to implement free water protocol?

A

Management technique; QoL; patient is on thickened liquids but can have free access to water after oral care; factors to consider: support of oral care, cognition, ambulatory status, etc.

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8
Q

T/F Lateral tilting is a strategy that targets pharyngeal weakness.

A

False; lateral tilting of head physioligcal target is unilateral impairment of lingual movement, sensation or anatomy; ex: right side impairment –> tilt head laterally to left (tilt head to strong side)

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9
Q

T/F Chin tuck is a potentially good strategy for someone who aspirates before or during swallow

A

True; keeps bolus in mouth until actviely compressed by the tongue; compresses airway closed; physioligcal target is premature spill, poor airway closure, penetration/aspiration before/during swallow

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10
Q

Who might benefit from posterior head tilt?

A

impaired anterior-posterior bolus transport but with good airway protection

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11
Q

Who might benefit from a larger bolus or carbonated liquids?

A

patients with impaired sensory awareness; large bolus size may trigger mechanical receptors in mucosa (central pattern generator in NTS); carbonated water improves esophageal cleanrane and shortens pharyngeal transit time

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12
Q

T/F – TPN is a method of providing nutrients intravenously

A

True; TPN = total parenteral nutrition; nutrional formula containing ciritcal nutrients in high concentration delvered through large vein; very thick takes 10-16 hrs/day

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13
Q

What is the typical duration of an NG tube?

A

Nasogastric Tube; short duration < 6-8 weeks because nasal passage has low tolerance for edema, infecion, etc.; used with no evidence of GERD; most common

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14
Q

Why is TPN short term?

A

Invasive, infection risk; the liquid is very thick and can only be adminstered through larger vein

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15
Q

Define treatment

A

activitly changin swallow. targets changing the strength, timing and coordination of swallow to make it safer/efficeint

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16
Q

Define compensation

A

strategies representing band-aid approach. we manipulate a feature to make swallowing safer/efficient hwoever we DO NOT change the underlying swallowing physiology

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17
Q

define management

Update this slide to include examples

A

methods of reducing the impact of dysphagia and/or manifestation of its sequelae (def of sequela: A pathological condition resulting from a prior disease, injury, or attack)

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18
Q

name a few bolus delivery compensatory strategies

A

positioning, multiple swallows per bolus, alternate liquids and solids, reduce distractions, verbal reminders of strategies, slow rate, no straw, small sips/bites

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19
Q

4 positioning compensatory stratgeies

A
  1. lateral tilting
  2. anterior tilting (chin tuck)
  3. Posterior tilting
  4. Head/neck rotation
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20
Q

True/False Chin tuck is effective for patient with lots of post-swallow residue;

A

False, not effective b/c may push more residue into pharynx; must test with instrumentation

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21
Q

What is head rotation compenstaory strategy

A

compressed weak muscles against pharyngeal wall making all strong muscles do the work; physiologic target –> unilateral impairment in pharyngeal constriction and/or UES opening; unilateral post-swallow residue; must confirm with instrumentation

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22
Q

Tucking chin

A

compresses the airway closed

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23
Q

Tilting the head laterally

A

targets impaired unilateral lingual deficits

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24
Q

Tilting head back

A

targets poor anterior to posterior bolus manipoulation within the oral cavity

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25
Q

Turning the head maximally to one side

A

pushes the bolus to the unimpaired (strong) side to improve pharyngeal constriction and/or bolus flow through UES

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26
Q

T/F – The VFSS radiation exposure is about as much as someone might get on a transatlantic flight

A

T

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27
Q

How many frames per second is best for VFSS studies?

A

30 pulses per second

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28
Q

What are some ways you as a clinician limit your radiation exposure while completing these exams?

A

wear lead! stand behind wall, wear dosimeters

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29
Q

Why is it important to use a controlled density of barium in the study?

A

the higher the density the more residue; controlled consistency is important because it standardizes the consistency across all studies/patients; mixing substance by eye does not work

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30
Q

What does lateral view show that AP view doesn’t show as well?

A

best to view aspiration penetration; bolus flow; lateral views shows oral prep, oral, and pharyngeal phases of swallow; high as nasal cavity and as low as cervical esophagus

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31
Q

What does AP view show that lateral view doesn’t?

A

best for observing asymmetries in physiology and post-swallow residue; esophageal clearance; pharyngeal contraction

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32
Q

What term will you see in clinical practice to describe a 2 on the PAS?

A

PAS is a method for quanitfying swallowing safety; it an 8 point oridnal rating scale that quanitifies the depth of airway invastion and the body response;

important to comment on timing in relation to the swallow;

1-2 normal –> 3-4 penetration –> 6-8 aspiration;

2 = flash or transient penetration

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33
Q

Which PAS score is quite rare and why?

A

Penetration #5 - material enters the airway, contract the vocal folds and is not ejected from the airway –> rare b/c materail just can’t sit there

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34
Q

What score is silent aspiration?

A

Aspiration #8 - material enters airway, passes below the vocal folds and no efforts is made to eject

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35
Q

What are two reasons for aspiration before swallow?

A
  1. spill of material from the mouth
  2. delayed swallow initiation
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36
Q

T/F - the VFSS does not diagnose the etilogy of the swallowing disorder; instead it determines the detials of oropharyngeal swallow dysfunction and helps guides dicision sregarding behavioral swalllow theray based on those findings

A

True; what is the underlying phyisology and what can we do about it

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37
Q

Oral impairment MBSI components 1 - 6

A

true

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38
Q

Pharyngeal impairments mbsi components 7 - 16

A

true

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39
Q

Esophageal impairment component 17

A

true

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40
Q

What are the benefits of FEES and/or some reasons you might choose it over VFSS?

A

FEES and VFSS are complimentary exams

one might choose FEEs over VFSS because FEES:
- can be done bedside,
- can be used with more food/liquid variety,
- allow you to observe post-swallow residue for long periods to assess aspiration risk,
- fees home view allows us to see left and right,
- value of ‘online’ biofeedbacksensory integration of larynx/pharynx

41
Q

Explain the debate about use of anesthetic in FEES exams and current research findings.

A

may lead to sensory changes of pharynx and swallow initiation due to post nasal drip f numbing agent; current resarch suggests lidocaine does not worsen PAS or residue bt does increase patient comfort level

42
Q

T/F – ASHA’s position on FEES includes that FEES should only be done in a setting where medical personnel are available

A

true

43
Q

What tasks would you complete while the scope is still in the nasal cavity?

A

scope b/w inferior and middle turbinates observe the velar elevation and constriction of the lateral and posterior pharyngeal walls during the following tasks:
- sustained vowel
- sustained /s/
- non-nasal senstence ‘is Sassy sick’ (tests tighter/maintaining closure of VFs)

44
Q

What might you test if the pt has pooled secretions? How can you tell if the pooled secretions are a result of sensory impairment or motor impairment?

A

touch area of pharynx here pooling is occuring to assess senation and then ask patient to swallow –>
- if cleared after swallow sensnation may be impaired b/c patient didn’t feel pools - if not cleared after swallow the motor function may be impaired

45
Q

What are you looking for when examining the larynx prior to PO trials?

A

have patient phonate /i/ to observe glottis closure, laryngeal elevation and vocal quaility;

observe true and false VF closure during breath holding task and coughing

46
Q

What can you assess with liquid boluses?

A

bolus containment, premature spill, post-swallow residue in pharynx,

47
Q

What does Shaker exercise target?

A

head raising exercise done supine to target improved UES function; targets poor UES opening resulting in post-swallow residue typicaly in pyriform sinuses

48
Q

What is the name of the device to target tongue strengthening?

A

Iowa Oral Performance Instrument (IOPI) tongue resistance exercises - can be placed anterioroly or posteriorly - posterior tarets BOT, bolus control preventing premature oral seal in back of tongue

49
Q

Who would benefit from using the IOPI?

A

target popuation includes poor bolus formation, premautre spill, oral residue, poor base of tongue to posterior pharyngeal wall, pharyngeal residue

50
Q

Why should you not do the Masako with a bolus?

A

removing tongue movement from swallow decreases safety and effcieiny of swallow

51
Q

Why would pairing NMES (e-stim) with a swallow possibly increase hyolaryngeal elevation?

A

pairing e-stim with a swallow because e-stim stabilizes hylolargeanl complex and the swallow must overcome the resistance as a strenthening task

52
Q

T/F – neural stimulation has been utilized in some areas of speech/language treatment

A

True - neural stimulation can be ysed for swallowing and aphasia treatment

53
Q

Discuss why effortful swallow can be considered a facilitative technique or a behavioral treatment

A

target population includes signitificant post-swallow residue, poor pharyngeal constriction, poor BOT to PPW;

can be used on initial swallow or 2nd clearing swallow ;

it is facilitative b/c it immediately increases swallowing pressures and residue clearance; it is behavioral b/c it increases tongue strength after 4 weeks of training

54
Q

What could be helpful in teaching the Mendelsohn maneuver?

A

Verbal cueing due to the multi step direction
-Sit or stand comfortably.
-Start to swallow normally.
-When your Adam’s apple is at its highest point, squeeze your throat muscles to hold it in that position for 3 counts, and then relax. …
-Repeat these steps as many times as directed.

targets early UES closure, incomplete UES opening, poor pharyngeal constriction both resulting in post-swallow residue

BREAK IT DOWN - practice step by step before moving on

Breath hold - big breath in, bear down like you are lifting, close VFs and lifts larynx

55
Q

Who might benefit from the super supraglottic as opposed to the supraglottic swallow and why?

A

super supraglottic swallow adds increased effort of airway closure by bearing down when swallowing; closes both true and false VFs –> extra recruitment for VF closure; super supraglottic targets difficulty with VF closure whereas supraglottic targets delayed VF closure

Supraglottic swallow —> holding breath closes VFs preventing bolus from entering laryngeal vestibule; task - bolus enters mouth, hold breath, swallow while holding breath, let go of breath and cough to clear VFs

56
Q

What can cause CP Bar?

A

failure of cricopharyngeus muscle (vagus X -RLN) to relax during swallowing as a result of fibrosis, GERD, neuromusclar disease;

57
Q

What textures do pts with CP Bar have difficulty with?

A

cuases increasing difficulty with increasing texture viscosity and signficant post-swallow residue

58
Q

Why do we often see Zenker’s Diverticulum with CP bar?

A

Zenkers is a ballooning out ofhte pharyngeall wall due to high pressure cuasing a diverticulum (pouch); CP bar may cause Zenkers because there’s a problem of the insertion of the CP muscle not the lower pharyngeal constircotr causing potentail for high pressure enviroment to cause out-pouching

59
Q

What are two examples of health markers that could be used as dysphagia outcome measures?

A

nurtrition, hydration, lung status

60
Q

Which measure combines safety and efficiency into one rating?

A

DIGST - Dynamic Imaging Grade of Swallowing Toxicity - breaks down pharyngeal phase into safety and efficiency

61
Q

Name two diet-based outcome measures

A

functional oral intake scale (FOIS) –> level 1 NPO through level 8 no restrictions on oral diet;

ASHA-NOMs scale –> level 1 –> not able to swallow anything by mouth use non-oral means for nutrition, level 7 able to eat independently, no limitations ot swallow function

62
Q

Name some etiology specific scales

A

MD Anderson Dysphagia Inventory for HNC;

DYMUS Questionnaire for MS;

NIH SSS for stroke severity

63
Q

what is behavioral therapy

A

done as therapy technique to change function;

the same techinque can be facilitative or behavioral depending on context and in the moment or overtime

64
Q

what is facilitative technique

A

utilized as a band-aid in the moment

ex: - effortful swallow done under VFSS to clear pharynx -mendhelson manuever

  • postures like chin down or head turn are always faciliative
65
Q

what is the goal of behaviorial therapy and name 6 treatments

A

goal is to improve strength/mobility/endurance for components of swallowing
1. shaker exercise
2. tongue strengthening
3. masaka maneuver
4. EMST
5. transcutaneous e-stim
6. effortful pitch glide

66
Q

what is the masako manuever

A

swallow intitiated ith the tongue held firmly between the teeth to improve PPW constriction not BOT;

target pop includes poor tongue to posterior pharyngeal wall contact, poor pharyngeal constriction, pharyngeal residue

67
Q

T/F effortful pitch glide is a behavioral treatment targeting poor pharyngeal constirction and poor laryngeal elevation

A

true - low to high gliding pitch causes elevation of arytenoids/larynx and constirction of the pharynx

68
Q

what is supraglottic swallow

A

goal is to close the airway prior to bolus entry into the pharynx and to keep the airway closed for the duration of bolus transport;

holding breath closes VFs preventing bolus from entering laryngeal vestibule;

task - bolus enters mouth, hold breath, swallow while holding breath, let go of breath and cough to clear VFs

69
Q

Why do we refer to “feeding and swallowing” when discussing the pediatric population as opposed to adults?

A

feeding and swallowing for infants is one process;

swallowing disorder is impaired oral, pharygneal and/or esophageal phases of swallowing

feeding disorders include disrupted or disordered ability to gather food and prepare for sucking, masitcation or swallowing

70
Q

Why might the prevalence of pediatric dysphagia be on the rise?

A

on the rise due to improved survival rates of children born prematurely, low birth weight or complex medical conditions

71
Q

Why might SLPs work closely with OT for a pediatric client?

A

OTs evaluate and treat problems related to posture, tone and sensory issues

72
Q

T/F The hyoid of a baby is in a more posterior position than that of an adult

A

false; infant hyoid is elevated and more anterior than adults (adults are more inferior)

73
Q

List the other differences between adult/child anatomy

A

infant’s oral cavity is smaller, tongue fills oral cavity, larynx is elevated descending over the first 4 years

74
Q

Why is it safe to lay a baby flat while feeding?

A

the velum and epiglottis can touch creating their own vestibule allowing the infant to breath through nose while sucking

75
Q

What is the typical ratio of suck to swallow for infants?

A

suck–swallow–respiration is attained with a consistent suck–swallow ratio (1:1)

76
Q

Why is instrumental Ax not indicated if a child’s symptoms indicate sensory preference issues?

A

a child with sensory preference issues may not comply with diagnositic testing

77
Q

When does the rooting reflex disappear?

A

3-5 months

78
Q

When does the bite reflex disappear?

A

3-5 months

79
Q

When does rotary mastication start to develop?

A

5-7 months

80
Q

Why is the tongue thrust reflex protective at a young age? Discuss what swallowing might look like in an older child who still (abnormally) displays the tongue thrust reflex.

A

seen as protective from birth to ~ 4 months to prevent unwanted material in the oral cavity; tongue thrust in older kids may look like mouth breathing, open mouth posture at rest, dentalizing /s z/

81
Q

What is a self-pacing system for an infant and why might you recommend that technique?

Slow flow vs high flow

A

self-pacing allows child to take in the amount they want rather than a prescribed amount

promotes efficiency safety and comfort; slow flow = better for dysphagia;
high flow = helps if baby fatigues easily

82
Q

Who might you refer someone to if they need a palatal prosthesis?

A

prosthodontist

83
Q

Who might you refer someone to if you suspect esophageal dysphagia?

A

Gastroenterologist

84
Q

What the name for the medical specialty focused on rehabilitation?

A

physiatrist coordinates rehab team during recovery from acute illenss or follow those with chronic diseases on an ongoing basis

85
Q

What is a challenge that was mentioned about being a clinician treating dysphagia in the school setting?

A

lack of medical staff

86
Q

What is a challenge that was mentioned about being a clinician treating dysphagia in acute care?

A

fast paced; need to be a generalist

87
Q

What are pill delivery options for people with dysphagia?

A

taking pills with applesauce/puree or suggest asking pharmacy about liquid ofrm of Rx

88
Q

What class of medications might cause someone to become a silent aspirator?

A

meds that worsen swallow function include depressants or other meds affecting central nervous system; NSAIDS

89
Q

Discuss the choice of using barium vs water with a barium pill in VFSS.

A

use water with barium pill to assess pill getting stuck; use barium pill with barium liquid if concerned swallowing pill alters safety/efficiency

90
Q

What is the name for reduced jaw opening and what device works to improve ROM?

A

trismus –> Current methods used to increase mouth opening include unassisted jaw ROM exercises, finger-assisted stretching exercises, stacked tongue depressors, and mechanical assistance with a device such as Therabite

91
Q

What is our role in dealing with patients who are end-of-life?

A

comfort, consult,

92
Q

What would you do if a patient or family is non-compliant with your recommendations?

A

inform patient about current condition and inform them of treatment options and how those treatments will aid their condition; it is the patients choice to follow recommendations

93
Q

What would you do if your assessment methods were culturally insensitive to a specific client/patient?

A

Our role as SLPs need to be understood from the perspective of the patient.; use ethnographic interviewing. This is a method for asking questions in a way that can facilitate an effective interview and build rapport between you and your client.; learn how my culture and biases create my personal cultural lens

94
Q

What are some components to ethnographic interviewing?

A

Tell me about a typical mealtime; Give me an example of what you are forgetting; Use open-ended questions; Restate what the client says by repeating the client’s exact words; do not paraphrase or interpret; Summarize the client’s or parent’s statements and give them the opportunity to correct you if you have misinterpreted something they have said; avoid multiple questions

95
Q

what is the compensation for this deficit?

inefficient oral transit (reduced posterior propulsion of bolus by tongue)

A

head tilted back

96
Q

what is the compensation for this deficit?

delay in triggering the pharyngeal swallow (bolus past ramus of mandible before pharyngeal swallow is triggered)

A

chin tuck aka chin down

97
Q

what is the compensation for this deficit?

unilateral oropharyngeal weakness on the same side (residue in mouth and pharynx on same side)

A

Head tilt to strong side

98
Q

what is the compensation for this deficit?

unilateral laryngeal dysfunction and reduced laryngeal closure

A

head turn to weak side + chin tuck

99
Q

what is the compensation for this deficit?

unilateral pharyngeal paresis (residue on one side of pharynx)

A

head rotation/turned to weak side

Dysphagia (4 decks)

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