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Dysphasia > Lecutre 8 > Flashcards

Lecutre 8 Flashcards

1
Q

List all the basic dysphagia txs

A

Diet modification Positional Oral sensory Maneuver Exercises Prosthetic Surgery Experimental Other

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2
Q

List some diet modifications

A

(volume, viscosity, texture, temperature, NPO diet - NG tube, G tube, PEG, J tube, etc.)

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3
Q

List some positional txs

A

(posture, chin tuck, head rotation, head tilt)

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4
Q

Oral sensory treatments

A

(tactile/taste/thermal-tactile stimulation

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5
Q

Maneuver

A

(Supraglottic, Super-supraglottic, Mendelsohn, Effortful)

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6
Q

Exercise

A

(Shaker, Masako, oral muscle strengthening)

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7
Q

Prosthetic

A

(Palatal lift or obturator)

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8
Q

Surgery

A

(CP myotomy, diverticulectomy, dilation, palatopexy, VF medialization-augmentation/thyroplasty)

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9
Q

Experimental

A

Experimental (Neuromuscular electrical stimulation-NMES: “VitalStim”, Deep pharyngeal neuromuscular stimulation-DPNS, myofascial release-MFR, Botox)

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10
Q

Other

A

Other (multiple swallows, food presentation, liquid wash, throat clearing, adduction techniques*, EMST)

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11
Q

What are the compensatory techniques designed to do?

A

eliminate the symtoms

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12
Q

Why are the compensatory techniques therapeutic?

A

They change the timing of the swallow

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13
Q

List the compensatory techniques

A

Diet, positional, oral sensory, and prosthetics

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14
Q

T/F diet modification is usually the first things you do.

A

Falso! its a last resort

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15
Q

When do you do diet modication?

A 
If other compensatory strategies or therapies fail
If too cognitively impaired
If a “building block”
Neurom. control/strength
ROM ex’s
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16
Q

what do you change in diet modications?

A

Bolus volume (size)
Bolus viscosity (consistency)
Temperature
Taste

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17
Q

List the diet consistencies

A 
Liquids
-Thin
-Nectar
-Honey
Solids 
-Pudding
-Puree
-Mechanical soft
-Chopped
-Regular
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18
Q

List the positional txs

A 
Sitting upright at 90°
Lying on side
Chin tuck
Head rotation
Head tilt
Head back
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19
Q

why do you do Sitting upright at 90°

A

Contributes to gravity to direct bolus down

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20
Q

why do lying on side?

A

Eliminates gravitational effect on pharyngeal residue

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21
Q

why do chin tuck?

A

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

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22
Q

Why do head rotation?

A

To weaker side: closes off damaged side & directs bolus down stronger side

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23
Q

why do head tilt?

A

To stronger side: directs bolus down stronger side (by gravity)

24
Q

why do head back?

A

use gravity to clear oral cavity

25
Q

What does EMST do?

A

strenghtens cough, and respirtory coordination

26
Q

Give some adduction techniques which would assist with swallowing

A

coughing, LSVT, Hard glottal attack, sustained phonation, pitch range to falsetto

27
Q

When it botox used?

A

motility disorders, CP hypertonicity/dysfunction, achalasia (esophageal/LES dysfunction)

28
Q

Describe MFR- what is the benefit?

A

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

29
Q

Why/how is NMES used?

A

Surface electrodes applied over swallowing muscles

Stimulation attempts to facilitate motor mvmt (via neurom. transmissions) and strengthen muscles for swallow

30
Q

DPNS - what does it treat?

what do you do? whats the reason to do this?

A
  • 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
31
Q

Why do you do DPNS?

A

To activate muscles

32
Q

what may happen if you continue to do DPSN?

A

-strenghten NM signals and increase ms strenght

33
Q

What is the goal of the shaker?

A

Increases UES opening & decreases hypopharyngeal intrabolus pressure

34
Q

what is the shaker?q

A

Head life exercise

35
Q

list the steps of shaker

A

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

36
Q

Masako

  • what does it do?
  • anatomical goal
  • what kind of swallows do you do this with?
A
  • Goal: strenghtens the pharyngeal constrictors
  • deals with anterior position of the tongue
  • do only with dry swallows
37
Q

Oral motor exercises:

  1. what do you work on?
  2. How do you work on this?
A
  1. 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)
38
Q

Do compensatory techniques change the motor control of the swallow?

A

NO!

39
Q

What changes the motor/anatomy/physiology control of the swallow?

A

Therapies

40
Q

How do therapies change the control of the swallow?

A

They increase ROM, Control and strenght

41
Q

What two types of swallowing therapies exist?

A

Direct and Indirect

42
Q

List the Oral Sensory techniques

A

(5)

  1. Downward pressure of spoon against tongue
  2. sour bolus (lemon juice)
  3. Cold bolus
  4. Bolus requiring chewing (increase viscosity)
  5. Suck-swallow
43
Q

What is using a cold bolus considered?

A

Thermal/tactile stimulation

44
Q

Why is thermal/tactile stimulation used?

A

heightens oral awareness and triggers pharyngeal swallow

45
Q

What do you do in thermal tactile stimulation?

A

vertically rub anterior faucial arch 4-5 times with a cold laryngeal mirror or ice sticks

46
Q

Why do the suck-swallow technique?

A

It triggers pharyngeal swallow, draws saliva to the back of the mouth

47
Q

What do you do in the suck swallow technique?

A

Vertical tongue-jaw sucking with lips closed

48
Q

When are prosthetics used?

A

when there are congenital defects or aquired defects

49
Q

Give some examples of congenital defects that would warrent some prosthetics

A

disease, cleft lip/palate/mandible, bifid uvula

50
Q

Give some examples of acquired defects that would warrent some prostetics

A

disease, trauma and burns

51
Q

Improvements that result from prostetics are:

A

Improves speech intelligibility, improves oral prep and oral phase

52
Q

What can prostetics do for the oral phase of swallowing?

A

improve chewing, improve bolus formation and control, increases propulsive pressure, Improves the rate of swallow, and decrease tongue-palate distance

53
Q

what do dentition prosthetics do?

A

Improve mastication, appearance and denture retention

54
Q

What do palatal prosthetics do?

A

(hard palate lowering) - decreases volume of the oral cavity, increases bolus transit and tongue-palate contact

55
Q

What does soft palate prosthetics do?

A

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

56
Q

What does lingual prosthetics do?

A

Decreases oral cavity side (which reduces pooling), increases tongue/soft palate contact (increases bolus control) increases eating, and increases artic and resonance

Dysphasia (12 decks)

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