Intervention Flashcards
treatment that can improve TBR
lingual resistance
effortful swallow
tongue pull back
pretend to gargle
treatment that can improve laryngeal elevation
Mendelsohn effortful swallow effortful pitch glide supraglottic super-supraglottic Shaker/Head lift Chin tuck EMST
when is the effortful pitch glide used?
reduced laryngeal elevation, pharyngeal stripping wave & contraction
T/F: the Mendelsohn should be used if the patient has a neck injury
False - Mendelsohn should not be used if a patient has ANY neck injury
What physiologies can the Mendelsohn address?
reduced hyolaryngeal motion or excursion
decreased LVC (occurs in patients with reduced hyolaryngeal excursion)
reduced PES opening
What physiologies can the effortful swallow address?
- reduced TBR
- reduced pharyngeal contraction (including pharyngeal shortening & stripping wave)
- decreased epiglottic inversion
- decreased lingual pressures on hard palate
- decreased swallow duration (hyoid excursion, laryngeal closure, PES opening)
the difference between the supraglottic and super-supraglottic swallow?
effortful breath hold in super-supraglottic
cardiac patients or patients who have had a stroke should not be given this intervention
super-supraglottic, supraglottic swallow
physiologies that super-supraglottic address
delayed initiation of pharyngeal swallow
laryngeal elevation
laryngeal vestibule closure
what does supraglottic swallow address?
delayed initiation of the pharyngeal swallow
reduced/delayed laryngeal elevation & LVC
Shaker/head lift should not be used with what patients?
patients. w/cervical spine deficits, reduced movement of neck (head & neck cancer), cognitive limitation or other factors that lead to poor compliance
patients with reduced anterior hyoid excursion/movement and/or PES opening would benefit from
Head lift/Shaker
Masako/Tongue hold improves
the increased contraction of superior pharyngeal constrictor and anterior movement pulls pharyngeal wall forward
Masako/tongue hold targets
PPW by moving towards the BOT to help create pressure to push the bolus through the pharynx (keeping the tongue in place)
What would be the best treatment to use when using Bolus Control exercises?
Practice motor movement using food wrapped in gauze or use a chewy tube
(using gauze is better to use & is a natural reinforcement as food particles come out of the gauze as pt’s chew)
this treatment facilitates movement of the bolus from midline to the lateral portion of the oral cavity
bolus control exercises
strengthens lips & facilitates removal of food from utensils
lip protrusion - retraction
- facilitates strength for lips & cheeks
- strength in cheek reduces pocketing
- strength in lip to reduce anterior spillage
- lips: straw sucking against resistance, holding a screen behind lips against resistance
lips & cheek exercises
- exercises to improve movement of tongue from side to side
- helps w/ bolus manipulation to move bolus to molar
- facilitates bolus manipulation to molar table for chewing
tongue lateralization
- facilitates oral phase & containment of bolus in oral cavity
- helps with anterior oral containment
- strengthens tongue to facilitate clearing of bolus from oral cavity
tongue tip elevation
types of biofeedback
FEES EMST sEMG MDTP IOPI Tongueometer High-resolution monometry
bolus prep/manipulation targets what?
moving bolus around in the mouth (anterior, lateral, posterior)
bolus maintenance targets what?
keeping the bolus from falling over the tongue base, out of the front of the mouth or in the lateral sulci
bolus propulsion targets what?
moving the bolus posteriorly (towards the back)
oral motor exercises are used for what?
to strengthen, stretch, or improve the motor properties of muscles in speech & swallowing
benefits of external pressure to the cheek?
- pressure decreases amount of material falling into weaker lateral sulcus & helps tongue action in formation of a cohesive bolus
- tactile cue to remind pt to check for buccal pocketing or lateral sulcus for material that could have fallen
- compensates for decreased muscle tone
when should you use external pressures to the cheek?
when there is oral cavity weakness
airway closure/laryngeal adduction exercises (pushing exercises, grunting, Ah-ah-ah, pushing pulling while saying “ah” (on a chair w/ clinician), breath hold/Valsalva) should NOT be used with what kind of patients?
patients who have had a stroke or who have a hx of cardiovascular disease
when should airway closure/breath hold/Valsalva maneuver be used
- airway closure is important to reduce risk of aspiration
- pt may penetrate airway w/ materials, but can teach strategies to reduce risk of aspiration
what side do you turn your head for head turn?”
to the WEAKER side so that the weaker side is closed off & bolus is directed down the stronger side
What side do you tilt your head for head tilt?
to the STRONGER side so that the bolus goes down the more intact side
When should you use head turn?
- for patients w/ unilateral pharyngeal paresis or bulging w/ reduced PES opening (decreases pharyngeal space)
When should you use head tilt?
- for patients w/ pharyngeal deficits (e.g., delayed initiation of pharyngeal swallow)
- USE ONLY W/ PATIENTS WITH INTACT COGNITIVE ABILITY & PRESENT AN EFFICIENT, STRONG RESPONSE TO PENETRATION INTO THE AIRWAY
Chin tuck/chin down/head flexion helps improve what?
- widens valleculae
- improves LVC by approximating arytenoids to epiglottic petiole, pushing epiglottis posteriorly
- bring TB & epiglottis closer to PPW
- reduced distance between larynx, hyoid, and mandible
- protects trachea opening from aspiration by tucking airway beneath the TB & epiglottis
- protects trachea opening from aspiration by tucking airway beneath the TB & epiglottis
Chin tuck reduces UES opening because of?
the movement of the long pharyngeal muscles - reduces UES/PES opening
Chin tuck helps with?
- facilitating airway protection & may enhance TBR but possibly reduces UES opening
- horizontal hyoid movement
you should not use a chin tuck/chin down/head flexion?
for patients w/ reduced pharyngeal contraction, reduced tongue control or strength
If the bolus has collected in the pyriform sinuses, the bolus will be dumped in the airway
When should you use chin tuck?
- delayed pharyngeal swallow
- reduced airway closure
- reduced TBR
- helps w/ anterior spillage
chin tuck should not be used with patients who have _ _ deficits
pharyngeal phase deficits (delayed initiation of pharyngeal swallow)
head extension/head back should be used with patients who have?
may be helpful for individuals with oral phase deficits - deficits with posterior propulsion of the bolus
who benefits from mealtime modifications?
patients with dementia
changing atmosphere, change in presentation of foods, level of support are what kinds of intervention?
mealtime modifications
thermal tactile stimulation is used when?
delayed or failure to initiate pharyngeal swallow response
increasing downward pressure on the tongue with a spoon, presenting sour or cold bolus, presenting a bolus requiring chewing, presenting a larger volume bolus, presenting carbonated liquids are all types of what techniques?
oral/sensory awareness
What does altering posture target?
- delay in bolus transport/lingual motion; initiation of pharyngeal swallow; laryngeal elevation; LVC; pharyngeal stripping wave; pharyngeal contraction
- pharyngeal residue
- post-swallow penetration/aspiration
Benefits of altering posture?
- utilizes gravity to clear oral cavity; redirects bolus away from laryngeal vestibule; maintains retention in hypolaryngeal recesses
Carbonation is used for?
delayed initiation of pharyngeal swallow
What’s the purpose of sensory awareness techniques and for what deficit?
alter sensory characteristics of a bolus
- used for patients who have delayed onset of oral pharyngeal swallowing movement
What are the drawbacks for multiple swallow?
may increase length of mealtime and may induce fatigue
Which compensatory strategy helps clear residue?
Multiple swallow
smaller bites/sips help with?
bolus less likely to spill into laryngeal vestibule before the swallow and better control
regular with specific alterations, mechanical soft, puree, liquids, regular/thin, nectar-thick, honey-thick, & change sensory information (temperature, texture, taste) are all kinds of what?
diet modifications
what compensatory treatment improves esophageal clearance?
modify bolus volume, bolus texture, bolus rate
maneuver that is used during MBSS to improve esophageal clearance
effortful swallow
what compensatory treatment improves pharyngeal residue?
modify bolus volume & bolus viscosity; alter posture (head flexion, chin tuck, chin down, head position)
what rehabilitative treatment improves pharyngeal residue?
during MBSS: effortful swallow, Mendelsohn
retraining:
Suprahyoid strengthening & flexibility: Mendelson, Shaker/head lift, CTAR
oropharngeal: effortful swallow, Masako/tongue hold
Pharyngeal shortening: effortful pitch glide
What can improve TBR? (compensatory)
modify bolus volume & viscosity; alter posture
what can improve TBR (maneuver during MBSS)
effortful swallow
What retraining exercise(s) can be used to improve TBR?
oropharyngeal strengthening: effortful swallow, Masako/tongue hold, Mendelsohn
What (compensatory) treatment improves PES opening?
modify bolus volume & viscosity; alter posture
What maneuver (during MBSS) improves PES opening?
Mendelsohn
What retraining exercises can be used to improve PES opening?
suprahyoid strengthening & flexibility: Mendelsohn, Shaker/head lift, CTAR
pharyngeal shortening: effortful pitch glide
oropharyngeal strengthening: effortful swallow
What compensatory strategy improves pharyngeal contraction?
modify bolus volume & bolus viscosity, alter posture
What maneuver (during MBSS) helps improve pharyngeal contraction?
effortful swallow
What retraining exercises can be used to improve pharyngeal contraction?
oropharyngeal strengthing: effortful swallow, Masako/tongue hold
pharyngeal shortening & contraction: effortful pitch glide
What compensatory strategy helps improve pharyngeal stripping wave?
modify bolus volume & viscosity, modify posture (reclined position)
What maneuver (during MBSS) helps improve pharyngeal stripping wave?
effortful swallow
What retraining exercises can be used to improve pharyngeal stripping wave?
oropharyngeal strengthening: effortful swallow, Masako/tongue hold
pharyngeal shortening & contraction: effortful pitch glide
skilled-based training: timing on swallowing
What compensatory strategy improves laryngeal vestibular closure?
modify bolus volume & viscosity; modify posture (reclined position, head flexion/chin tuck, chin down, head rotation/head turn)
What maneuver (during MBSS) helps improve laryngeal vestibular closure?
supraglottic swallow, super-supraglottic swallow, Mendelsohn
What retaining exercises help improve laryngeal vestibular closure?
oropharyngeal strengthening: effortful swallow
suprahyoid strengthening & flexibility: Mendelsohn, NMST
What compensatory strategy improves epiglottic movement?
modify bolus viscosity & volume
What maneuver (during MBSS) improves epiglottic movement?
effortful swallow
What retraining exercises help improve epiglottic movement?
oropharyngeal: effortful swallow, Masako/tongue hold
suprahyoid: Mendelsohn
What compensatory strategy improves anterior hyoid excursion?
modify bolus viscosity
What maneuver (during MBSS) improves anterior hyoid excursion?
Mendelsohn
What retraining exercises improves anterior hyoid excursion?
suprahyoid strengthening & flexibility: Shaker/head lift, Mendelsohn, EMST, CTAR, NMES
compensatory strategies that help with laryngeal elevation
modify bolus viscosity, alter posture
maneuver (during MBSS) that helps w/ laryngeal elevation?
supraglottic, super-supraglottic swallow, Mendelsohn
retraining tx that helps improve laryngeal elevation
thyrohyoid strengthening & flexibility: Mendelsohn, NMES
pharyngeal shortening & contraction (assists laryngeal elevation): effortful pitch glide
compensatory strategy that helps improve soft palate elevation
modify bolus volume & bolus viscosity; use of prosthetic (palatal obturator)
retraining tx that helps improve soft palate elevation
oropharyngeal & strengthening: effortful swallow, Mendelsohn, EMST
compensatory strategy that helps improve initiation of pharyngeal swallow
modify bolus volume & viscosity; sensory stimulation; alter posture; postural combinations
maneuver to employ (during MBSS) to help improve initiation of pharyngeal swallow
supraglottic swallow, super-supraglottic swallow, Mendelsohn
retraining tx to help improve initiation of pharyngeal swallow
lingual strengthening: resistive exercise
lingual flexibility: ROM exercise
compensatory treatment that helps improve clearance of oral residue
modify bolus volume & viscosity; optimizing intra-oral placement - syringe; experimenting w/ various placements of food/liquid in oral cavity to facilitate best oral containment
retraining tx to help improve clearance of oral residue
lingual strengthening: resistance exercises, IOPI, tongueometer
tongue flexibility: ROM exercises
compensatory treatment that helps improve bolus transport/lingual motion
modify bolus volume & viscosity; alter posture; optimize intra-oral placement; syringe; bolus propulsion
retraining tx to help improve bolus transport/lingual motion
lingual strengthening: resistive exercise, IOPI, tongueometer
lingual flexibility: ROM Exercise
compensatory tx that help improve mastication
modify bolus volume & texture, utilize prosthesis, optimize intra-oral placement; bolus prep/manipulation; bolus control exercise; tongue lateralization
retraining tx to help improve mastication
lingual strengthening: resistive exercise, tongue pressure w/ IOPI or tongueometer
lingual flex: ROM exercise
mandibular strength: CTAR
mandibular flex: ROM exercise, therabite
compensatory treatments that help improve tongue control
modify bolus volume, bolus viscosity, bolus maintenance, bolus prep/manipulation, bolus propulsion
retraining tx that help improve tongue control
lingual strength: resistive exercises (improve strength or improving pt’s awareness to contain bolus within oral cavity as a strategy to give more time to initiate goal-directed tongue movement), tongue press w/ IOPI or tongueometer (feedback)
train tongue to palatal seal: anterior tongue tip elevation, tongue elevation, bolus control exercises, tongue lateralization
compensatory strategy that improve lip closure
modify bolus volume & viscosity; mode of administration; lip & chin support
retraining tx that improve lip closure
strength: resistive exercise (straw sucking against resistance, holding screen behind the lips against resistance), IOPI, EMST, lip protrusion/retraction
flexibility: ROM exercises
