L10 Treatment Part 2

Question 1

List the types of active treatments interventions

Answer 1

a) oral exercises

b) sensory stimulation

Question 2

Describe the masako maneuver and its purpose

Answer 2

• Involves placing tongue between front teeth and holding it in place while swallowing saliva
• meant to exercise PPW to help compensate for poor movement in the base of tongue

Question 3

What is one caveat of the masako maneuver

Answer 3

-the maneuver decreases airway closure, increases pharyngeal delay and vallecular reside, so it should NEVER be used during eating

Question 4

Describe the shaker exercise and its purpose

Answer 4

• goal is to strengthen the supra hyoid muscles and thereby aid in opening of UES
• involves lying down and either doing sustained or repetitive head lifting

Question 5

IS the shaker exercise beneficial

Answer 5

Yes?

-increase in anterior movement of the larynx and an increase in UES diameter opening

Question 6

What are other

programs/instruments that you can also use for oral exercises

Answer 6

• IOPI
• MOST (Madison Oral strengthening therapeutic) device
• sEMG
• EMST (expiratory muscle strength trainer) device
• Sapienza protocol
• Jaw opening exercises

Question 7

Sensory stimulation can be along the pharyngeal wall, faucial pillars etc. What are some of the types of sensory stimulation?

Answer 7

• thermal
• magnetic
• tactile
• electrical

Question 8

Neuromuscular electrical stimulation, pharyngeal electrical stimulation are types of ________ neurostimulation

Answer 8

peripheral

Question 9

TMS and transcranial direct current stimulation are types of ___________ neurostimulation

Answer 9

central

Question 10

List the fundamental principles that guide rehabilitation

Answer 10

-Use It or Lose It
• Use It and Improve It
 • Specificity
• Repetition Matters
• Intensity Matters
• Time Matters
• Salience Matters
• Age Matters
• Transference
• Interference

Question 11

What is a cricopharyngeal myotomy? What are its risks?

Answer 11

incision of the CP muscle down to the level of the submucosa -results in permanent relaxation of the CP

• done in response to zenkers or severe CP bar
• Risks: aspiration of gastric contents

Question 12

Surgical interventions at the laryngeal stage can be either ___________ or ________

Answer 12

conservative

radical

Question 13

What are conservative procedures in the larynx?

Answer 13

both speech and swallowing are spared

Question 14

What are radical procedures in the larynx?

Answer 14

permanently divert bolus stream from the airway

Question 15

Laryngeal closures occur at what 3 levels?

Answer 15

supraglottic
glottic
subglottic

Question 16

In a total laryngectomy, what are the consequences of dysphagia?

Answer 16

• dysphagia in terms of reduced bolus propulsion and reduced efficiency still occurs
• pseudoepiglottis can result in pharyngeal stasis
• but aspiration no longer a problem

Question 17

In terms of pharmacological interventions - improvement in dysphagia may occur when the _____________ is treated

Answer 17

underlying cause

Question 18

T or F: medications can also cause dysphagia

Answer 18

True - due to xerostomia, involuntary movements etc.

Question 19

In order to design an effective therapy we need to consider the _________ of the dysphagia

Answer 19

etiology

Question 20

Is there evidence for EMST as an effective swallowing tx?

Answer 20

-yes but in its infancy

Question 21

Is there evidence for NMES as an effective swallowing tx?

Answer 21

no