HC5 Treatment by SLP - rehabilitation Flashcards
What’s the goal of our treatment?
- identify risk factors to safe and effective swallowing
- potential for oral eating (quality of life!)
What is the treatment plan based on?
−Diagnostic tests
−Prognosis: e.g. fast recovery after stroke vs progressive disease
−Medical & physical status: e.g. fragile patient with poor pulmonary status
−Social and living situation: e.g. caregivers, need to prepare food type
−Cognitive status: e.g. independent use of strategies or maneuvers
−Additional diagnostic studies needed? -> refer
−Professional concerns + patient’s complaints/questions
What classification do we see in treatment?
- behavioral treatment:
- SLP
- physical therapist in case of concerns regarding head/neck or body posture, or about appropriate seating during eating
- occupational therapist for the use of feeding utensils or adaptive devices
- medical treatment
- surgical treatment
What do we consider prior to recommending a behavior treatment?
Understand and careful investigate:
- the individual patient’s swallow: what’s impaired? what goes well? what are possible strengths that can be maximized?
- the basic terms
- availability of appropriate and effective compensatory mechanisms
- ability to utilize treatment strategy. This depends on
- the potential for restoration of neuromuscular integrity
- the ability to use and train a strategy
In which ways can we devide behavioral treatment?
- indirect vs direct treatment
- compensation vs rehabilitation
Explain the difference between indirect and direct therapy
- INDIRECT:
- there is no use of liquids/solids during training
- train to improve or keep swallow of saliva -> introduce oral feeding
- e.g. Shaker, oral excercises,…
- DIRECT:
- use of liquids/solids during training
- e.g. posture, food adjustments, use of a maneuver during eating,…
What’s the difference between compensation and rehabilitation?
- COMPENSATION:
- ensuring a safe swallow without changing the physiology
- e.g. chin tuck, changes in bolus consistency,…
- REHABILITATION:
- reactivation of damaged structures and functions
- changing the physiology
- e.g. oral excercises, use of IOPI, EMST,….
Explain why the treatment depends on the stage of illness
What do we do in rehabilitation? For which domains?
- restoration and improvement of function by exercising
- improving structural strength - mobility - endurance
- possible use of feedback tools and/or external stimulation
- possible domains:
- elevation of larynx and increasing UES opening (train suprahyoid muscles)
- tongue strength and endurance
- tongue-pharynx contact
- pharynx constriction during swallow
- cough strength
- oral motor training
What are the principles of neural plasticity?
- use it and improve it (training)
- use it or lose it (detraining)
- repetition
- intensity (resistance, size, duration)
- specificity: close to training task and target
- transfer: training other functions to reach the goal
- interference: block target by training certain functions
How could we train elevation of the larynx and increasing UES opening?
- Shaker swallow exercise:
- Isometric = sustained head elevation: patient is lying on the back and elevates his head (not shoulders) to observe his toes, holds for 1 minute (3x with 1 minute pause)
- Isotonic = repetitive head elevation: same position, 30 sit-ups with head only
- 3 times a day for 6 weeks
- CTAR chin tuck against resistance: same exercise with ball
When is working on tongue strength and endurance indicated? How?
−Residue posterior part of the tongue
−Residue in valleculae
−Ressidue in piriform sinuses
−Delayed oropharyngeal transport
—> IOPI
Explain: Masako maneuver
= maneuver to strengthen the tongue-pharynx contact
- indication: pharyngeal residue
- how: swallowing with tongue between teeth
- hardly evidence: contact is important, but does not ensure the sequential action of the tongue and pharynx
How could we train the pharynx constriction during swallow?
- by sRED (Swallow Resistance Exercise Device)
- device worn on the neck, adjusted to alter the resistance load of the hyoid and larynx during swallowing
How could we train the cough strengths?
- EMST:
- benefits both airway protection + swallow-related behaviors (elevation hyoid and larynx)
- goal: exhale/blow against resistance
- improved respiratory driving forces (cough)
- LSVT/LOUD:
- improve vocal loudness and perception of the patients own loudness levels
- 51% reduction in the number of oropharyngeal swallow abnormalities (e.g. transit times, bolus formation, residue)
