Lesson 6- Management of Swallowing Disorders Flashcards
Characteristics of Indirect Therapy
improving oral motor control
stimulating the swallow reflex
increasing VF adduction (w/o food or liquid)
Characteristics of Direct Therapy
use of food/liquid with specified instruction
4 Types of Indirect Therapy
- range of motion exercises
- resistance exercises (IOPI)–Iowa Oral Performance Instrument
- bolus control exercises
- bolus propulsion exercises
Bolus Control Exercises Hierarchy
- manipulating licorice whip
- chewing gum
- paste-expectorated
- liquid-expectorated
- gauze soaked in juice
Stimulating the Swallow Response
- thermal tactile stimulation (not compelling support of efficacy via research)
- sour bolus may be more effective
Increasing Adduction of VFs
Step 1 (5-10x daily) push-pull-phonation w/ 1 hand hold breath 'ah' with hard glottal attack Step 2 push-pull phonation with two hands add supraglottic swallow *improvement may take 2 wks- 6 months
Electrical Stimulation
vital stim (research not peer reviewed)
Direct Therapy Considerations
- presenting food/liquid w/ specific instruction
- need MD clearance
- SMALL amts
- Provide pt w/ written instructions and rationale
- practice dry swallows first
- consider cognition and pt ability to do independently
Swallowing Postures
chin tuck supraglottic swallow super supraglottic swallow effortful swallow Mendelsohn Shaker (isokinetic/ isometric) Masako
Supraglottic Swallow
Take a deep breath and hold it
Keep holding your breath while you swallow
Cough after the swallow
Can be done with head straight, chin tucked or head turned rt. or lft.
Super Supraglottic Swallow
Hold breath tightly and bear down
Keep holding your breath while you swallow
Cough after you swallow
Can be done with head straight, chin tucked or head turned rt. or lft.
Effortful Swallow
Lips are tightly closed
As you swallow squeeze hard
Think swallow and push!
Imagine swallowing a grape whole
Mendelsohn Maneuver
Have the pt feel the ‘Adam’s apple’ during a normal swallow
Now when you swallow don’t let your Adam’s apple drop. Squeeze and hold the squeeze.
Shaker Isokinetic (dynamic)
Lying flat, lift the head, look at the feet 30x
Do not hold
Shoulders remain on the bed
Shaker Isometric (static)
Isometric (static)
Lying flat, lift the head, look at the toes and hold for 60 secs
Shoulders remain on the bed
Strengthens superior hyoid muscles, P-E opening
Masako
Stick your tongue out of your mouth and hold with your front teeth
Swallow while keeping your tongue gently between your teeth
Let go of your tongue between swallows
The tongue-hold maneuver is intended to aid in the transport of the bolus during the pharyngeal phase of swallowing by increasing pharyngeal pressure.
Mastication Disorder Therapy for Reduced Range of lateral tongue movement
Functional movement practice
Position food
Mash food on palate with tongue
Mastication Disorder Therapy for Reduced buccal tension/scarring
Pressure on affected cheek to close sulcus
Straw sucking
Place food on unaffected side
Tilt head to unaffected side
Mastication Disorder Therapy for Reduced range of lateral mandibular movement
Open/close mouth
Hand assist
Mash food against the palate
Mastication Disorder Therapy Reduced range of vertical tongue movement
Functional movement practice
Prosthesis to lower palate
preparatory disorder Therapy for Reduced labial closure
Press lips together
Lips together on spoon or tongue blade
Consistency with consecutive trials
Tug of war?????
preparatory disorder Therapy Reduced tongue movement to form a bolus
Practice with paste/liquid expectorated
Inspect oral cavity for residue
Tilt head anteriorly to prevent loss, tilt head back to swallow
preparatory disorder Therapy for Reduced range and coordination of tongue movement
Licorice whip/lollipop Any exercise for bolus control with expectoration Anterior head tilt Gum chewing Functional movement practice
preparatory disorder Therapy for Reduced oral sensitivity
Position food on more sensitive side
cold/sour bolus
spices
Oral disorder therapy for Tongue thrust
Position food posteriorly
Oral disorder therapy for tongue elevation
Functional movement practice
Position food posteriorly
Syringe or straw with liquid
Tilt head backward
Oral disorder therapy for Reduced anterior to posterior tongue movement
Functional movement practice
Gauze soaked in juice
Oral disorder therapy for Disorganized anterior to posterior tongue movement
Increase pt awareness
Practice holding food to palate and initiating swallow
placement
Oral disorder therapy for Scarred tongue
Position food posterior to the scarring
Tilt head back to assist with oral transit
Surgical release of the scar
Pharyngeal disorder therapy for Delayed/absent swallow response
Thermal tactile stim???????
Chin tuck
Slow rate
Small bites
Pharyngeal disorder therapy for Reduced pharyngeal wave contraction
Alternate liquids/solids Limit consistencies to liquid or puree Dry swallows Effortful swallow Supraglottic swallow Lying down
Unilateral pharyngeal paralysis
therapy
Turn head to affected side
Alternate liquids/solids
Supraglottic swallow
