L9 Treatment Part 1

Question 1

List the 6 types of dysphagia therapy

Answer 1

1) compensatory
2) swallow maneuvers
3) supplemental dimensions
4) active exercises
5) surgical
6) pharmacological

Question 2

Of the 6 types of therapy, SLPs are responsible for which ones?

Answer 2

1-4

Question 3

T or F: compensatory therapy improves underlying physiology

Answer 3

False

Question 4

T or F: swallow manœuvres can be compensatory or rehabilitative?

Answer 4

true

Question 5

List the types of compensatory interventions

Answer 5

• posture
• increased sensory awareness
• controlled intake
• intraoral prosthesis
• pharyngeal clearance
• adaptive utensils
• environment
• food consistency
• alternative feeding mode
• oral hygiene

Question 6

describe tilt head forward (chin tuck)

Answer 6

• increases airway closure
• moves base of tongue towards PPW
• can make it worse in people who have pyriform sinus reside

Question 7

Describe tilt head backward

Answer 7

• 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

Question 8

Describe turn head to impaired side

Answer 8

• used with one sided weakness
• blocks of weak side, taking it out of the equation
• aids with UES opening

Question 9

Describe tilt or lean head to stronger side

Answer 9

-helps direct bolus to good side preventing oral spillage

Question 10

Describe lie down on side

Answer 10

-more intense version of tilt head to good side, not used often

Question 11

How might you implement these strategies for someone who has cognitive deficits?

Answer 11

-sit where you want their head to turn or bring spoon a bit lower so they have to chin tuck

Question 12

Compensatory posture strategies are very effective in people who are _________

Answer 12

cognitively intact

Question 13

T or F: compensatory postures can be used in combination

Answer 13

true

Question 14

What food properties are used to increase sensory awareness

Answer 14

• hot/cold
• fine/course
• sweet/bitter/sour
• carbonation

Question 15

What are 3 ways that we can control intake

Answer 15

• rate
• amount
• placement of food

Question 16

Intraoral prostheses are used to compensate for ________ deficits

Answer 16

structural

Question 17

What are two common compensatory strategies to aid in pharyngeal clearance

Answer 17

• multiple swallows

- liquid/puree wash

Question 18

What are some compensatory interventions about modifying the environment

Answer 18

• increase external cues
• decrease distractions
• strategic placement at table

Question 19

List the different food consistencies from thin to solid

Answer 19

thin liquids
nectar thick liquids
honey thick 
pureed solid
ground/minced
chopped
soft solid
regular solid

Question 20

Jello is considered a _________ food

Answer 20

transitional

Question 21

What are the reasons we eat?

Answer 21

• nutrition/hydration
• pleasure
• social reasons
• emotional reasons
• practice (if they have dysphagia)

Question 22

What are two systems that quantify different textures/ viscosities?

Answer 22

• national dysphagia diet

- International dysphagia diet standardization initiative (IDDSI)

Question 23

When considering alternative feeding interventions must what we consider?

Answer 23

• what is their likelihood of aspiration
• can they tolerate aspiration
• is their swallowing efficient/
• fatigue
• nutritional intake
• QOL and patient preferences

Question 24

What are the 2 types of tube feeding?

Answer 24

• enteral - NG, G tube, PEG, J tube

- Parenteral - TPN

Question 25

What are complications of enteral feeding?

Answer 25

- infection at site of insertion | - tube dislodgement can lead to aspiration

Question 26

T or F: parenteral feeding is common in treatment of dysphagia

Answer 26

False

Question 27

Why is oral hygiene so important?

Answer 27

-the bacteria in our mouth can be aspirated and lead to aspiration pneumonia

Question 28

What are the benefits of oral care?

Answer 28

- reduce unfavourable oral bacteria - reduce risk of aspiration pneumonia - increases desire to eat - increases ability to swallow

Question 29

List the 4 swallow maneuvers discussed in class

Answer 29

- supraglottic swallow - super-supraglottic swallow - effortful swallow - Mendelsohn maneuver

Question 30

What is the purpose of the supraglottic swallow

Answer 30

to close the airway entrance before and during the swallow

Question 31

What is the purpose of the super-supraglottic swallow

Answer 31

to FORCEFULLY close the airway entrance before and during the swallow

Question 32

What is the purpose of the effortful swallow

Answer 32

to increase posterior motion of the tongue base during the pharyngeal swallow and thus improve bolus clearance form the valleculae

Question 33

What is the purpose of the Mendelssohn maneuver

Answer 33

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.

Question 34

what are the two factors of supplemental interventions/

Answer 34

- intensity | - timing

Question 35

What were the general results of the free water protocol question?

Answer 35

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

Question 36

What were the results from the General Dysphagia Program,?

Answer 36

- 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

Question 37

What are the evidence based compensatory & supplemental therapies?

Answer 37

- intensity - decontamination - timing (early identification from screening) - posture, texture, taste, Temperature, controlled intake, maneuvers

Question 38

T or F: Earlier screening for dysphagia leads to changes in health outcomes of pneumonia, malnutrition, dehydration and mortality

Answer 38

True - earlier screening leads to earlier diagnostic work up and then treatment