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663 Midterm 2 > Lecture Slides (Pos. Changes / Manu., Tx, and Biofeedback) > Flashcards

Lecture Slides (Pos. Changes / Manu., Tx, and Biofeedback) Flashcards

1
Q

rationale behind postural changes and compensatory maneuvers

A

to improve airway protection; to improve oral and / or pharyngeal transit of food / liq

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2
Q

chin tuck

A

gravity facilitates reduced premature spillage; vallecular space widens to hold more food; improved BOT to PPW contact; decreased opening of the laryngeal additus / vestibule

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3
Q

head turn to left / to right

A

extrinsic pressure increases TVC closure; bolus passes through stronger side of pharynx; pulling cricoid further away from PPW reduces resting pressure of CP segment

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4
Q

when to use head turn

A

most often used when there is pyriform sinus and pharyngeal wall residue, particularly when residue collection is asymmetrical

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5
Q

what happens when you combine chin tuck and head turn

A

increased clearance and improved airway protection

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6
Q

effortful swallow

A

stronger tongue to palate contact and stronger BOT to PPW contact

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7
Q

how to supraglottic swallow

A

hold your breath prior to and during swallowing, then cough immediately after, then dry swallow; helps to protect against aspiration before the swallow (premature aspiration)

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8
Q

super supraglottic swallow

A

effortful swallow + supraglottic swallow

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9
Q

mendelson maneuver

A

prolong the duration of laryngeal elevation; results in increased duration / extent of laryngeal elevation and therefore increases duration / extent of CP opening

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10
Q

the “final decision,” based on beside eval, medical hx, and MBSS, includes:

A

NPO or PO (if PO, what kind of diet); aspiration precautions; compensatory postures / maneuvers; level of supervision needed during meals / feeding; whether or not to follow client; whether or not to repeat MBSS (and when); whether the pt is a candidate for dysphagia tx

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11
Q

final decision: NPO vs PO

A

assess occurrence of aspiration, how much, silent or not silent, effectiveness of cough; assess postures / maneuvers that help to reduce aspiration and / or improve swallowing

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12
Q

an MBSS report contains the following sections:

A

medical hx; diet hx; consistencies given during eval; oral stage observations; pharyngeal stage observations; aspiration type; impression statement; prognosis; diet / precautions / comp starts recommendations; tx and / or follow up goals

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13
Q

dysphagia tx is divided into

A

medical treatments and behavioral treatments

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14
Q

dysphagia medical treatments

A

includes prescription medications or invasive surgeries

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15
Q

dysphagia behavioral treatments

A

includes diet changes, postures / maneuvers, oral-facial exercises (relevant to swallowing), and stimulation-biofeedback

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16
Q

dysphagia behavioral treatments using food

A

indirect : without food :: direct : with food

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17
Q

oral phase treatment: bolus maintenance / lip seal; sx: drooling

A

tx: alternate puckering / spreading lips with and w/o resistance, opening mouth wide and then puckering slowly, pressing lips tightly together for a few seconds

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18
Q

oral phase treatment: bolus maintenance / control; sx: poor mastication / formation of bolus, maintenance of bolus, posterior bolus propulsion, premature spillage, oral residue

A

tx: to increase tongue strength, ROM, and coordination

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19
Q

oral phase treatment: bolus maintenance / control; tx: to increase tongue strength, ROM, and coordination

A

tongue lateralization with and w/o resistance; tongue tip elevation / deelevation into the anterior sulci / buccal sulci; use body of tongue to press a tongue depressor wrapped in gauze against the hard palate; manipulation of a button tied to a string throughout oral cavity

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20
Q

oral sensation tx

A

there is no definitive evidence of long term improvements in therapies directed at improving oral sensation

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21
Q

stimulation of the oral cavity with ___ may effect an improvement for the next swallow

A

sour, cold substance

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22
Q

if food tends to collect in one of the sulci, ___ can be used

A

external digital pressure: using your hands or fingers in the mouth to remove food

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23
Q

posterior bolus propulsion; sx: tongue pumping with premature spillage

A

tx: instruct pt to consciously try and reduce pumping action and initiate a hard, deliberate post tongue movement; straw use; sEMG biofeedback

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24
Q

straw usage is not a ___, it’s a ___

A

treatment; compensation

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25
Q

straw usage

A

places the bolus more posteriorly into the oral cavity and circumvents the tongue behaviors

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26
Q

what do you do if straw usage (placing the bolus more posteriorly) causes even more premature spillage

A

stop using straws

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27
Q

delayed pharyngeal swallow; sx: pooling of food / lie into hypo pharynx before the swallow

A

tx: presenting cold-sour boluses (more sensory input, less delay), stroking faucial arches with cold laryngeal mirrors (subsequent swallows less delayed)

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28
Q

delayed pharyngeal swallow tx:

A

chin tuck widens the vallecular space; allows more food / liquid to be held safely until swallow is triggered

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29
Q

tx of pharyngeal phase characterized by vellecular residue

A

dx: BOT weakness; tx: effortful swallow, chin tuck, masako maneuver (holding tongue tip gently between front teeth while swallowing)

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30
Q

tx of pharyngeal phase characterized by weak pharyngeal contraction; sx: PPW residue and pyriform sinus residue

A

tx: effortful swallow, masako maneuver (strengthens superior constrictor), sEMG biofeedback, head turn to the weak side

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31
Q

if there’s a lot of residue in the valeculae, it is likely a ___ issue

A

BOT

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32
Q

if residue is dispersed in the pharynx and pharyngeal wall, it is likely a ___ issue

A

pharyngeal constrictor

33
Q

masako maneuver may strengthen ___

A

superior constriction

34
Q

what is the downside of FEES

A

we don’t see the oral stage; we don’t see the swallow (only see what’s immediately before and after the swallow)

35
Q

___ is not a treatment

A

biofeedback: it is a way of showing someone their performance (a more enhanced feedback to the pt); compare to effortful swallow, which is an actual treatment

36
Q

a form of advanced feedback; is not a diagnostic tool

A

biofeedback

37
Q

tx of pharyngeal phase characterized by laryngeal penetration / aspiration

A

tx: chin tuck, effortful swallow, repeat dry swallow, head turn posture, thermal-gustatory or thermal-tactilestim during meals, supraglottic and super supraglottic swallow

38
Q

tx of cricopharyngeal dysfunction

A

tx: botox injections, surgical anatomy, head turn (may help to pull UES open), exercises to increase laryngeal elevation when poor UES opening is due to poor elevation (for example, shaker exercise which works out the suprahyoid muscle)

39
Q

regarding diet, as patients show improvement in either direct or indirect tx, the clinician should determine ___

A

when to re-assess and / or advance the patient’s diet (for example, NPO, PO, thick liquids, are solids, etc.)

40
Q

according to Robbins, “the best exercise for swallowing is ___”

A

swallowing

41
Q

interdisciplinary treatment of dysphagia

A

MD has ultimate responsibility; SLP is the dysphagia team lead; OTs usually covers pediatric swallowing and hand to mouth issues; radiologists help perform MBSS with the SLP

42
Q

the technique of making unconscious or involuntary bodily processes perceptible to the senses in order to manipulate them by conscious mental control

A

biofeedback

43
Q

according to AAPB, biofeedback tx includes:

A

non-harmful treatments; uses scientific instruments to measure physiological feedback; leads to self-regulation (and is the learned skill / primary goal of biofeedback); tx always includes a therapist, pt, and monitoring instruments

44
Q

biofeedback applications in speech pathology

A

stuttering, voice, dysarthria, aphasia, dysphagia

45
Q

biofeedback modalities in dysphagia rehab (Huckabee)

A

fluoroscopy; endoscopy; auscultation (the clunking sound of the normal swallow); sEMG (shown on a line - the where the peak = the pt’s activated swallow)

46
Q

what are the pros of fiberoptic endoscopic examination of swallowing (FEES)?

A

view structures in real time; visualize bolus residue post swallow; observe postural compensatory techniques; facilitates vocal adduction and airway protection training (supraglottic swallow); facilitates training of velopharyngeal closure

47
Q

describe vital stim

A

sends an electrical current to help stimulate muscles involved in swallowing

48
Q

describe sEMG

A

surface electromyography; measures effort and strength of a swallow; electrical activity is easily influenced (oils, shaven / unshaven hair); simply measures electrical activity

49
Q

the basis of EMG signal ___

A

concerns the activity of the muscle motor units located under or near the electrodes

50
Q

describe motor unit

A

found inside a muscle; the motor neuron, its axon, and the muscle fiber innervated by the neuron; smallest functional unit of a muscle

51
Q

sEMG biofeedback provides ___

A

real time visual representation of the swallow (making involuntary function a conscious deliberate process); objective tx expectations, goal delineation, and measurement; accelerated tx process; framework pt driven tx

52
Q

Adams’ (1971) closed loop theory of motor learning

A

closed loop type of learning in which accuracy and repetition are important for refinement of a skill

53
Q

what sEMG doesn’t tell us

A

what the pharynx is doing; when to proceed with PO intake; when to re-evaluate (diagnostics); when the pt is aspirating

54
Q

___ is NOT a diagnostic tool

A

sEMG

55
Q

current approach to rehab (Huckabee)

A

muscle function recovers by addressing muscle weakness; three categories: flaccidity or hypofuntion, spasticity or hyper function, muscle dyscoordination or apraxia

56
Q

sEMG treatment (Huckabee)

A

prep the skin and place electrodes correctly; pt population (cortical-brainstem infarct, cancers, atrophy pts, CP); use caution with pts with unstable cardiac conditions; transient dysphonia is not uncommon; discourage biting / teeth-grinding

57
Q

sEMG treatment protocol (Huckabee)

A

education; relaxation; patterning of a motor response; muscle recruitment

58
Q

describe tracheostomy

A

surgical opening in the anterior neck into the trachea; purpose: bypass airway obstruction, long-term easy access to the airway for mechanical ventilation and / or pulmonary toilet

59
Q

effects of trach tubes on swallowing

A

if cuff is inflated, may compress the esophagus; MAY decrease laryngeal elevation; MAY result in a decrease in sensitivity of the cough reflex

60
Q

describe ethics

A

the study of human conduct-character focusing on decisions and actions that are right / wrong, good / bad, better / worse

61
Q

compare ethical principals

A

autonomy : the right to decide for oneself about one’s own life :: beneficence : actions done for the benefit of others and actions that produce good :: nonmaleficence : actions that avoid harm or evil

62
Q

describe virtue

A

a habitual disposition to act well; a habit under the guidance of reason

63
Q

briefly describe informed consent

A

the right to consent and the right to refuse

64
Q

components of informed consent

A

adequate disclosure of info; capacity of the pt to understand the information and make an informed decision; voluntary choice without coercion; appreciation of consequences of the choice made

65
Q

describe legal competence

A

the law’s presumption that all adults are competent to decide for themselves what will be done with their person or property; competence to: stand trail, manage property, for medical decision making; this is determined by a court

66
Q

describe decision-making capacity

A

of comprehension; of choices; of consequences

67
Q

how decisions are made for people without decision making capacity

A

let others decide; substituted judgement (what would the pt want); best interest (what is best for the ct)

68
Q

describe advance directives

A

a document enabling people to express their wishes about their health care that will tell others how to care for them and / or make decisions for them if they are unable to; two types: the living will, the durable power of attorney

69
Q

potential benefits of feeding tubes

A

increased: life span, recovery, return to useful functioning, resistance to infection; improved: QOL, psychological and physiological state, healing of skin and wounds

70
Q

overall burdens of feeding tubes

A

cannot be absorbed from the gut; does not abstate failure to thrive; physical pain; underlying condition is hopeless; uncomfortable; prolongs dying; spiritual-emotional pain and suffering; indignity; emotional and financial burden on family

71
Q

describe palliative care

A

improving the QOL of pts and families facing the problems associated with life-threatening illnesses; enrollment in hospice is not required

72
Q

SLP role for NPO and PO

A

NPO : secretion management, oral care, small PO feeds for oral gratification :: PO : intervention by increasing activity and participation and not restoration of function

73
Q

describe blue dye swallowing test

A

only for pts with tracheostomy tubes; takes place of a typical clinical / bedside eval; administer food / liq after feeding water with blue veg dye, then suction

74
Q

blue dye swallowing test procedures

A

start with 1 tsp water with blue veg dye, administer food / liq, then suction; if there are any signs of aspiration / penetration you must suction; if no aspiration / penetration, suction after 2 - 3 tsp to rule out silent aspiration; suction 10 - 15 min after completing the eval to clear out the cuff

75
Q

blue dye swallowing test: if the pt passes the formal exam and is made PO, ___

A

their food is often tinged blue for a few days to verify safety

76
Q

advantages of FEES

A

observe structure; able to see pts bedside; no radiation; biofeedback; test sensation using the scope; pts more tolerant of FEES

77
Q

disadvantages of FEES

A 
no oral phase assessment, no observation during the
pharyngeal swallow (because of squeezing)
78
Q

disadvantages of MBSS

A

radiation; you have to move the pt from their room

663 Midterm 2 (2 decks)

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