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Swallowing > Intervention > Flashcards

Intervention Flashcards

1
Q

treatment that can improve TBR

A

lingual resistance
effortful swallow
tongue pull back
pretend to gargle

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2
Q

treatment that can improve laryngeal elevation

A 
Mendelsohn
effortful swallow
effortful pitch glide
supraglottic
super-supraglottic
Shaker/Head lift
Chin tuck
EMST
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3
Q

when is the effortful pitch glide used?

A

reduced laryngeal elevation, pharyngeal stripping wave & contraction

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4
Q

T/F: the Mendelsohn should be used if the patient has a neck injury

A

False - Mendelsohn should not be used if a patient has ANY neck injury

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5
Q

What physiologies can the Mendelsohn address?

A

reduced hyolaryngeal motion or excursion
decreased LVC (occurs in patients with reduced hyolaryngeal excursion)
reduced PES opening

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6
Q

What physiologies can the effortful swallow address?

A
  • 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)
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7
Q

the difference between the supraglottic and super-supraglottic swallow?

A

effortful breath hold in super-supraglottic

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8
Q

cardiac patients or patients who have had a stroke should not be given this intervention

A

super-supraglottic, supraglottic swallow

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9
Q

physiologies that super-supraglottic address

A

delayed initiation of pharyngeal swallow
laryngeal elevation
laryngeal vestibule closure

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10
Q

what does supraglottic swallow address?

A

delayed initiation of the pharyngeal swallow

reduced/delayed laryngeal elevation & LVC

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11
Q

Shaker/head lift should not be used with what patients?

A

patients. w/cervical spine deficits, reduced movement of neck (head & neck cancer), cognitive limitation or other factors that lead to poor compliance

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12
Q

patients with reduced anterior hyoid excursion/movement and/or PES opening would benefit from

A

Head lift/Shaker

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13
Q

Masako/Tongue hold improves

A

the increased contraction of superior pharyngeal constrictor and anterior movement pulls pharyngeal wall forward

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14
Q

Masako/tongue hold targets

A

PPW by moving towards the BOT to help create pressure to push the bolus through the pharynx (keeping the tongue in place)

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15
Q

What would be the best treatment to use when using Bolus Control exercises?

A

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)

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16
Q

this treatment facilitates movement of the bolus from midline to the lateral portion of the oral cavity

A

bolus control exercises

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17
Q

strengthens lips & facilitates removal of food from utensils

A

lip protrusion - retraction

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18
Q
  • 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
A

lips & cheek exercises

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19
Q
  • 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
A

tongue lateralization

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20
Q
  • facilitates oral phase & containment of bolus in oral cavity
  • helps with anterior oral containment
  • strengthens tongue to facilitate clearing of bolus from oral cavity
A

tongue tip elevation

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21
Q

types of biofeedback

A 
FEES
EMST
sEMG
MDTP
IOPI
Tongueometer
High-resolution monometry
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22
Q

bolus prep/manipulation targets what?

A

moving bolus around in the mouth (anterior, lateral, posterior)

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23
Q

bolus maintenance targets what?

A

keeping the bolus from falling over the tongue base, out of the front of the mouth or in the lateral sulci

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24
Q

bolus propulsion targets what?

A

moving the bolus posteriorly (towards the back)

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25
Q

oral motor exercises are used for what?

A

to strengthen, stretch, or improve the motor properties of muscles in speech & swallowing

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26
Q

benefits of external pressure to the cheek?

A
  • 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
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27
Q

when should you use external pressures to the cheek?

A

when there is oral cavity weakness

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28
Q

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?

A

patients who have had a stroke or who have a hx of cardiovascular disease

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29
Q

when should airway closure/breath hold/Valsalva maneuver be used

A
  • airway closure is important to reduce risk of aspiration

- pt may penetrate airway w/ materials, but can teach strategies to reduce risk of aspiration

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30
Q

what side do you turn your head for head turn?”

A

to the WEAKER side so that the weaker side is closed off & bolus is directed down the stronger side

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31
Q

What side do you tilt your head for head tilt?

A

to the STRONGER side so that the bolus goes down the more intact side

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32
Q

When should you use head turn?

A
  • for patients w/ unilateral pharyngeal paresis or bulging w/ reduced PES opening (decreases pharyngeal space)
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33
Q

When should you use head tilt?

A
  • 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
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34
Q

Chin tuck/chin down/head flexion helps improve what?

A
  • 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
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35
Q

Chin tuck reduces UES opening because of?

A

the movement of the long pharyngeal muscles - reduces UES/PES opening

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36
Q

Chin tuck helps with?

A
  • facilitating airway protection & may enhance TBR but possibly reduces UES opening
  • horizontal hyoid movement
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37
Q

you should not use a chin tuck/chin down/head flexion?

A

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

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38
Q

When should you use chin tuck?

A
  • delayed pharyngeal swallow
  • reduced airway closure
  • reduced TBR
  • helps w/ anterior spillage
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39
Q

chin tuck should not be used with patients who have _ _ deficits

A

pharyngeal phase deficits (delayed initiation of pharyngeal swallow)

40
Q

head extension/head back should be used with patients who have?

A

may be helpful for individuals with oral phase deficits - deficits with posterior propulsion of the bolus

41
Q

who benefits from mealtime modifications?

A

patients with dementia

42
Q

changing atmosphere, change in presentation of foods, level of support are what kinds of intervention?

A

mealtime modifications

43
Q

thermal tactile stimulation is used when?

A

delayed or failure to initiate pharyngeal swallow response

44
Q

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?

A

oral/sensory awareness

45
Q

What does altering posture target?

A
  • delay in bolus transport/lingual motion; initiation of pharyngeal swallow; laryngeal elevation; LVC; pharyngeal stripping wave; pharyngeal contraction
  • pharyngeal residue
  • post-swallow penetration/aspiration
46
Q

Benefits of altering posture?

A
  • utilizes gravity to clear oral cavity; redirects bolus away from laryngeal vestibule; maintains retention in hypolaryngeal recesses
47
Q

Carbonation is used for?

A

delayed initiation of pharyngeal swallow

48
Q

What’s the purpose of sensory awareness techniques and for what deficit?

A

alter sensory characteristics of a bolus

- used for patients who have delayed onset of oral pharyngeal swallowing movement

49
Q

What are the drawbacks for multiple swallow?

A

may increase length of mealtime and may induce fatigue

50
Q

Which compensatory strategy helps clear residue?

A

Multiple swallow

51
Q

smaller bites/sips help with?

A

bolus less likely to spill into laryngeal vestibule before the swallow and better control

52
Q

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?

A

diet modifications

53
Q

what compensatory treatment improves esophageal clearance?

A

modify bolus volume, bolus texture, bolus rate

54
Q

maneuver that is used during MBSS to improve esophageal clearance

A

effortful swallow

55
Q

what compensatory treatment improves pharyngeal residue?

A

modify bolus volume & bolus viscosity; alter posture (head flexion, chin tuck, chin down, head position)

56
Q

what rehabilitative treatment improves pharyngeal residue?

A

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

57
Q

What can improve TBR? (compensatory)

A

modify bolus volume & viscosity; alter posture

58
Q

what can improve TBR (maneuver during MBSS)

A

effortful swallow

59
Q

What retraining exercise(s) can be used to improve TBR?

A

oropharyngeal strengthening: effortful swallow, Masako/tongue hold, Mendelsohn

60
Q

What (compensatory) treatment improves PES opening?

A

modify bolus volume & viscosity; alter posture

61
Q

What maneuver (during MBSS) improves PES opening?

A

Mendelsohn

62
Q

What retraining exercises can be used to improve PES opening?

A

suprahyoid strengthening & flexibility: Mendelsohn, Shaker/head lift, CTAR
pharyngeal shortening: effortful pitch glide
oropharyngeal strengthening: effortful swallow

63
Q

What compensatory strategy improves pharyngeal contraction?

A

modify bolus volume & bolus viscosity, alter posture

64
Q

What maneuver (during MBSS) helps improve pharyngeal contraction?

A

effortful swallow

65
Q

What retraining exercises can be used to improve pharyngeal contraction?

A

oropharyngeal strengthing: effortful swallow, Masako/tongue hold
pharyngeal shortening & contraction: effortful pitch glide

66
Q

What compensatory strategy helps improve pharyngeal stripping wave?

A

modify bolus volume & viscosity, modify posture (reclined position)

67
Q

What maneuver (during MBSS) helps improve pharyngeal stripping wave?

A

effortful swallow

68
Q

What retraining exercises can be used to improve pharyngeal stripping wave?

A

oropharyngeal strengthening: effortful swallow, Masako/tongue hold
pharyngeal shortening & contraction: effortful pitch glide
skilled-based training: timing on swallowing

69
Q

What compensatory strategy improves laryngeal vestibular closure?

A

modify bolus volume & viscosity; modify posture (reclined position, head flexion/chin tuck, chin down, head rotation/head turn)

70
Q

What maneuver (during MBSS) helps improve laryngeal vestibular closure?

A

supraglottic swallow, super-supraglottic swallow, Mendelsohn

71
Q

What retaining exercises help improve laryngeal vestibular closure?

A

oropharyngeal strengthening: effortful swallow

suprahyoid strengthening & flexibility: Mendelsohn, NMST

72
Q

What compensatory strategy improves epiglottic movement?

A

modify bolus viscosity & volume

73
Q

What maneuver (during MBSS) improves epiglottic movement?

A

effortful swallow

74
Q

What retraining exercises help improve epiglottic movement?

A

oropharyngeal: effortful swallow, Masako/tongue hold
suprahyoid: Mendelsohn

75
Q

What compensatory strategy improves anterior hyoid excursion?

A

modify bolus viscosity

76
Q

What maneuver (during MBSS) improves anterior hyoid excursion?

A

Mendelsohn

77
Q

What retraining exercises improves anterior hyoid excursion?

A

suprahyoid strengthening & flexibility: Shaker/head lift, Mendelsohn, EMST, CTAR, NMES

78
Q

compensatory strategies that help with laryngeal elevation

A

modify bolus viscosity, alter posture

79
Q

maneuver (during MBSS) that helps w/ laryngeal elevation?

A

supraglottic, super-supraglottic swallow, Mendelsohn

80
Q

retraining tx that helps improve laryngeal elevation

A

thyrohyoid strengthening & flexibility: Mendelsohn, NMES

pharyngeal shortening & contraction (assists laryngeal elevation): effortful pitch glide

81
Q

compensatory strategy that helps improve soft palate elevation

A

modify bolus volume & bolus viscosity; use of prosthetic (palatal obturator)

82
Q

retraining tx that helps improve soft palate elevation

A

oropharyngeal & strengthening: effortful swallow, Mendelsohn, EMST

83
Q

compensatory strategy that helps improve initiation of pharyngeal swallow

A

modify bolus volume & viscosity; sensory stimulation; alter posture; postural combinations

84
Q

maneuver to employ (during MBSS) to help improve initiation of pharyngeal swallow

A

supraglottic swallow, super-supraglottic swallow, Mendelsohn

85
Q

retraining tx to help improve initiation of pharyngeal swallow

A

lingual strengthening: resistive exercise

lingual flexibility: ROM exercise

86
Q

compensatory treatment that helps improve clearance of oral residue

A

modify bolus volume & viscosity; optimizing intra-oral placement - syringe; experimenting w/ various placements of food/liquid in oral cavity to facilitate best oral containment

87
Q

retraining tx to help improve clearance of oral residue

A

lingual strengthening: resistance exercises, IOPI, tongueometer
tongue flexibility: ROM exercises

88
Q

compensatory treatment that helps improve bolus transport/lingual motion

A

modify bolus volume & viscosity; alter posture; optimize intra-oral placement; syringe; bolus propulsion

89
Q

retraining tx to help improve bolus transport/lingual motion

A

lingual strengthening: resistive exercise, IOPI, tongueometer
lingual flexibility: ROM Exercise

90
Q

compensatory tx that help improve mastication

A

modify bolus volume & texture, utilize prosthesis, optimize intra-oral placement; bolus prep/manipulation; bolus control exercise; tongue lateralization

91
Q

retraining tx to help improve mastication

A

lingual strengthening: resistive exercise, tongue pressure w/ IOPI or tongueometer
lingual flex: ROM exercise
mandibular strength: CTAR
mandibular flex: ROM exercise, therabite

92
Q

compensatory treatments that help improve tongue control

A

modify bolus volume, bolus viscosity, bolus maintenance, bolus prep/manipulation, bolus propulsion

93
Q

retraining tx that help improve tongue control

A

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

94
Q

compensatory strategy that improve lip closure

A

modify bolus volume & viscosity; mode of administration; lip & chin support

95
Q

retraining tx that improve lip closure

A

strength: resistive exercise (straw sucking against resistance, holding screen behind the lips against resistance), IOPI, EMST, lip protrusion/retraction
flexibility: ROM exercises

Swallowing (1 decks)

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