L9 Treatment Part 1 Flashcards
List the 6 types of dysphagia therapy
1) compensatory
2) swallow maneuvers
3) supplemental dimensions
4) active exercises
5) surgical
6) pharmacological
Of the 6 types of therapy, SLPs are responsible for which ones?
1-4
T or F: compensatory therapy improves underlying physiology
False
T or F: swallow manœuvres can be compensatory or rehabilitative?
true
List the types of compensatory interventions
- posture
- increased sensory awareness
- controlled intake
- intraoral prosthesis
- pharyngeal clearance
- adaptive utensils
- environment
- food consistency
- alternative feeding mode
- oral hygiene
describe tilt head forward (chin tuck)
- increases airway closure
- moves base of tongue towards PPW
- can make it worse in people who have pyriform sinus reside
Describe tilt head backward
- gravity helps overcome oral transport issues
- we need to know that their pharyngeal swallow is prompt and reliable
- use preparatory breath hold
- **wouldn’t want to do this for someone who has difficulty following directions
Describe turn head to impaired side
- used with one sided weakness
- blocks of weak side, taking it out of the equation
- aids with UES opening
Describe tilt or lean head to stronger side
-helps direct bolus to good side preventing oral spillage
Describe lie down on side
-more intense version of tilt head to good side, not used often
How might you implement these strategies for someone who has cognitive deficits?
-sit where you want their head to turn or bring spoon a bit lower so they have to chin tuck
Compensatory posture strategies are very effective in people who are _________
cognitively intact
T or F: compensatory postures can be used in combination
true
What food properties are used to increase sensory awareness
- hot/cold
- fine/course
- sweet/bitter/sour
- carbonation
What are 3 ways that we can control intake
- rate
- amount
- placement of food
Intraoral prostheses are used to compensate for ________ deficits
structural
What are two common compensatory strategies to aid in pharyngeal clearance
- multiple swallows
- liquid/puree wash
What are some compensatory interventions about modifying the environment
- increase external cues
- decrease distractions
- strategic placement at table
List the different food consistencies from thin to solid
thin liquids nectar thick liquids honey thick pureed solid ground/minced chopped soft solid regular solid
Jello is considered a _________ food
transitional
What are the reasons we eat?
- nutrition/hydration
- pleasure
- social reasons
- emotional reasons
- practice (if they have dysphagia)
What are two systems that quantify different textures/ viscosities?
- national dysphagia diet
- International dysphagia diet standardization initiative (IDDSI)
When considering alternative feeding interventions must what we consider?
- what is their likelihood of aspiration
- can they tolerate aspiration
- is their swallowing efficient/
- fatigue
- nutritional intake
- QOL and patient preferences
What are the 2 types of tube feeding?
- enteral - NG, G tube, PEG, J tube
- Parenteral - TPN
What are complications of enteral feeding?
- infection at site of insertion
- tube dislodgement can lead to aspiration
T or F: parenteral feeding is common in treatment of dysphagia
False
Why is oral hygiene so important?
-the bacteria in our mouth can be aspirated and lead to aspiration pneumonia
What are the benefits of oral care?
- reduce unfavourable oral bacteria
- reduce risk of aspiration pneumonia
- increases desire to eat
- increases ability to swallow
List the 4 swallow maneuvers discussed in class
- supraglottic swallow
- super-supraglottic swallow
- effortful swallow
- Mendelsohn maneuver
What is the purpose of the supraglottic swallow
to close the airway entrance before and during the swallow
What is the purpose of the super-supraglottic swallow
to FORCEFULLY close the airway entrance before and during the swallow
What is the purpose of the effortful swallow
to increase posterior motion of the tongue base during the pharyngeal swallow and thus improve bolus clearance form the valleculae
What is the purpose of the Mendelssohn maneuver
To increase the extent and duration of laryngeal elevation and thereby increase the duration and width of cricopharyngeal opening. It also increases the overall coordination of the swallow.
what are the two factors of supplemental interventions/
- intensity
- timing
What were the general results of the free water protocol question?
low quality evidence that there is no significant increase in odds of having lung complications in rehab setting
- low quality evidence of increase in fluid intake
- increased QOL and satisfaction scores
What were the results from the General Dysphagia Program,?
- trend in favour of swallowing treatment > usually care
- increased recovery of functional swallow, and decrease in chest infection in high intensity > low intensity > usual care
What are the evidence based compensatory & supplemental therapies?
- intensity
- decontamination
- timing (early identification from screening)
- posture, texture, taste, Temperature, controlled intake, maneuvers
T or F: Earlier screening for dysphagia leads to changes in health outcomes of pneumonia, malnutrition, dehydration and mortality
True - earlier screening leads to earlier diagnostic work up and then treatment
