Lecutre 8 Flashcards
List all the basic dysphagia txs
Diet modification Positional Oral sensory Maneuver Exercises Prosthetic Surgery Experimental Other
List some diet modifications
(volume, viscosity, texture, temperature, NPO diet - NG tube, G tube, PEG, J tube, etc.)
List some positional txs
(posture, chin tuck, head rotation, head tilt)
Oral sensory treatments
(tactile/taste/thermal-tactile stimulation
Maneuver
(Supraglottic, Super-supraglottic, Mendelsohn, Effortful)
Exercise
(Shaker, Masako, oral muscle strengthening)
Prosthetic
(Palatal lift or obturator)
Surgery
(CP myotomy, diverticulectomy, dilation, palatopexy, VF medialization-augmentation/thyroplasty)
Experimental
Experimental (Neuromuscular electrical stimulation-NMES: “VitalStim”, Deep pharyngeal neuromuscular stimulation-DPNS, myofascial release-MFR, Botox)
Other
Other (multiple swallows, food presentation, liquid wash, throat clearing, adduction techniques*, EMST)
What are the compensatory techniques designed to do?
eliminate the symtoms
Why are the compensatory techniques therapeutic?
They change the timing of the swallow
List the compensatory techniques
Diet, positional, oral sensory, and prosthetics
T/F diet modification is usually the first things you do.
Falso! its a last resort
When do you do diet modication?
If other compensatory strategies or therapies fail If too cognitively impaired If a “building block” Neurom. control/strength ROM ex’s
what do you change in diet modications?
Bolus volume (size)
Bolus viscosity (consistency)
Temperature
Taste
List the diet consistencies
Liquids -Thin -Nectar -Honey Solids -Pudding -Puree -Mechanical soft -Chopped -Regular
List the positional txs
Sitting upright at 90° Lying on side Chin tuck Head rotation Head tilt Head back
why do you do Sitting upright at 90°
Contributes to gravity to direct bolus down
why do lying on side?
Eliminates gravitational effect on pharyngeal residue
why do chin tuck?
Widens valleculae (to prevent penetration)
Narrows airway entrance & ↑ laryngeal elevation & vf closure
Pushes tongue base backward toward pharyngeal wall
Puts epiglottis in a more protective position
Why do head rotation?
To weaker side: closes off damaged side & directs bolus down stronger side
why do head tilt?
To stronger side: directs bolus down stronger side (by gravity)
why do head back?
use gravity to clear oral cavity
What does EMST do?
strenghtens cough, and respirtory coordination
Give some adduction techniques which would assist with swallowing
coughing, LSVT, Hard glottal attack, sustained phonation, pitch range to falsetto
When it botox used?
motility disorders, CP hypertonicity/dysfunction, achalasia (esophageal/LES dysfunction)
Describe MFR- what is the benefit?
Myofacial release: manual technique, palpation with joint and soft tissue mobilization/release of lips, tongue/face, jaw and neck. Attempts to loosen tight ms and fascial adhesions improve circulation
Why/how is NMES used?
Surface electrodes applied over swallowing muscles
Stimulation attempts to facilitate motor mvmt (via neurom. transmissions) and strengthen muscles for swallow
DPNS - what does it treat?
what do you do? whats the reason to do this?
- treats neuromuscular weakness or incoordination
- Stick a frozen lemon ice stick into 9 sites in mouth and throat (stims bitter taste buds in back) soft palate and S and M constrictors
Why do you do DPNS?
To activate muscles
what may happen if you continue to do DPSN?
-strenghten NM signals and increase ms strenght
What is the goal of the shaker?
Increases UES opening & decreases hypopharyngeal intrabolus pressure
what is the shaker?q
Head life exercise
list the steps of shaker
Lay flat on your back on the floor or a bed
Without lifting your shoulders, hold your head off the floor & look at your feet for 1 minute
Relax your head back down for a 1 minute break
Repeat sequence 2 more times
Raise your head 30 more times & look at your toes (don’t sustain these head lifts)
Repeat entire exercise 3 times per day
Masako
- what does it do?
- anatomical goal
- what kind of swallows do you do this with?
- Goal: strenghtens the pharyngeal constrictors
- deals with anterior position of the tongue
- do only with dry swallows
Oral motor exercises:
- what do you work on?
- How do you work on this?
- you work on ROM, resistance, bolus maintence during prep manipulation and propulsion
2, you work on this through lip seal, jaw strenghtening, and tongue strenghtening (elevation/retraction protrusion and lateral)
Do compensatory techniques change the motor control of the swallow?
NO!
What changes the motor/anatomy/physiology control of the swallow?
Therapies
How do therapies change the control of the swallow?
They increase ROM, Control and strenght
What two types of swallowing therapies exist?
Direct and Indirect
List the Oral Sensory techniques
(5)
- Downward pressure of spoon against tongue
- sour bolus (lemon juice)
- Cold bolus
- Bolus requiring chewing (increase viscosity)
- Suck-swallow
What is using a cold bolus considered?
Thermal/tactile stimulation
Why is thermal/tactile stimulation used?
heightens oral awareness and triggers pharyngeal swallow
What do you do in thermal tactile stimulation?
vertically rub anterior faucial arch 4-5 times with a cold laryngeal mirror or ice sticks
Why do the suck-swallow technique?
It triggers pharyngeal swallow, draws saliva to the back of the mouth
What do you do in the suck swallow technique?
Vertical tongue-jaw sucking with lips closed
When are prosthetics used?
when there are congenital defects or aquired defects
Give some examples of congenital defects that would warrent some prosthetics
disease, cleft lip/palate/mandible, bifid uvula
Give some examples of acquired defects that would warrent some prostetics
disease, trauma and burns
Improvements that result from prostetics are:
Improves speech intelligibility, improves oral prep and oral phase
What can prostetics do for the oral phase of swallowing?
improve chewing, improve bolus formation and control, increases propulsive pressure, Improves the rate of swallow, and decrease tongue-palate distance
what do dentition prosthetics do?
Improve mastication, appearance and denture retention
What do palatal prosthetics do?
(hard palate lowering) - decreases volume of the oral cavity, increases bolus transit and tongue-palate contact
What does soft palate prosthetics do?
Restores contact b/t palate and posterior tongue to maintain bolus control and direct bolus, aid in mastication, avoid pharyngeal spillage (slowing down transit) avoids nasal regurgitation during swallow
What does lingual prosthetics do?
Decreases oral cavity side (which reduces pooling), increases tongue/soft palate contact (increases bolus control) increases eating, and increases artic and resonance
