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Mahler comps swallow tx > Mahler comps swallow tx > Flashcards

Mahler comps swallow tx Flashcards

To learn specific swallow postures, compensatory maneurvers and treatments by site of lesion

1
Q

consequences of swallow disorders

A

Dehydration
malnutrition
aspiration pneumonia
asphyxia

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2
Q

cough reflex critical points

A
  1. Triggered by penetration of food into larynx
  2. may signal neurogenic dysphagia
  3. No cough m/b silent dysphagia
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3
Q

cough reflex reduction causes

A
  1. disruption of sensation and / or motor response

also TIM: Tracheostomy, Intubataion, Medications

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4
Q

Diseas3e most likely to be associated with dysphagia and why?

A

Brain stem vs cortical or sucortical. Nucleus tratus solitaris in brainstem

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5
Q

common causess of dysphagia? Why

A

STROKE: because stroke interrupts the corticobulbar pathways that connect cortical and brain stem centers for swallowing

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6
Q

brainstem strokes cause dysphagia how?

A

disruption of

  1. corticobulbar tracts
  2. Nucleus tractus solitaris
  3. swallow centers either side of medulla and pons
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7
Q

brain stem stroke dysphagia symptoms: by oral, pharyngeal, laryngeal and VF

A
  1. Oral: reduced strength of lips, tongue, jaw (ipsilataeral)
  2. Pharyngeal swallow: delay, unilateral paresis or reduced contractions
  3. Larynx: reduced elevation, closure and/or CP opening
  4. vocl fold paresis: unilateral
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8
Q

Left CVA dysphagia symptoms

A
  1. Langauge: readingl, writing, understanding symbols
  2. . oral:CONTRALATERAL weakness of lips and tongue, drooling, residue, delayed OTT
  3. delayed pharyngeal swallow
  4. SWALLOW APRAXIA: delay in initiation of swallow, lingual groping, lack of recognition of bolus as to be swallowed
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9
Q

Right CVA dysphagia symptoms

A

LOSS OF INTELLECTUAL CONTROL OVER SWALLOWING.
Frontal: lack of attention, insight, reasoning and judgement, impulsivity
2. IF PARIETAL: perceptual deficits and lack of tontopic orientation, hemineglect: loss of visualiztion of spatial relationships of left-side space
3. contralateral weakness of lips, tongue, delayed OTT, residue
4. delayed pharyngeal swallow

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10
Q

Right CVA patients need feeding oversight why?

A

reduced orientation, percption, attention, impulsivity, errors in judgment, impulsivity, loss of intellectual control over swallow

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11
Q

Wnen do SLP’s evaluate Right CVA patients?

A

as soon as they wake up, first consult

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12
Q

TBI/Head Injury dysphagia symptoms?

A

Cognitive probs of attention, impulsivity, poor memory, reasoning, judgement., and (parietal) orientation

  1. Oral: reduced tongue control, delayed or prolongued OTT
  2. Pharyngeal swallow delay or absent
  3. silent laryngeal penetration and aspiration (w/o cough due to intubation or trecheaostomy)
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13
Q

Dementia deficits and dysphagia

A
  1. Cognition: decreased awareness
  2. Reduced initiation or oral preparatory movements: nonpurposful bolus manipulation and loss of control
  3. Poor BOT retraction
  4. delayed pharyngeal swallow
  5. reduced larngeal elevation
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14
Q

PD and dysphagia key points 2 key points and rationale

A
  1. with PD, deficits in all stages of swallow
  2. 95% of PD have dysphagia and OFten not aware of swallow deficits which show in MBS
    Rationale: basal ganglia influence sensory components in trigeminal system and cause abnormalities in sensorimotor responses throughout swallow
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15
Q

PD and oral stage defictis

A

1, rationale: reduced elevation of middle and posterior tongue during speech and swallow (due to rigifidy not weakness) =
2. limited tongue and mandibular excursion
3. Lingual hesitation, peicemeal deglutition (aka rocking)
4. poor posterior bolus formation
5 = overall excessive mastication and OTT

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16
Q

PD and pharyngeal stage deficitis: rationale and symptoms

A

RAtionale: the pharyngeal contrractions of striated muscle of pharynx are often delayed, therefore laryngeal
1. lowed laryngeal elevation –> slowed laryngeal closure

17
Q

PD and spiration

A

prevalence of aspiration w/o cough in patients w/o dysphagic complaints

18
Q

Oncologic conditions and dysphagia key points

A
  1. cognition and language generally intact

2. tx depends on amt and location of ablative surgery, reconstruction, scar tissue and remaining functional structures

19
Q

Oncologic conditions and pretreatment counseling?

A
  1. Query patient’s understanding of swallow
  2. explain role of SLP
  3. Discuss outcomes of various medical/surgical interventions
20
Q

Oncologic conditions and typical oral phase disorders (3)

A
  1. prolonged OTT
  2. Increased oral residue secondary to decreased tongue strength
  3. Reduced ability to propel bolus into pharyx (BOT)
    3.
21
Q

Oncologic conditions and typical pharyngeal phase disorders

A
  1. reduced BOT retraction
    2 reduced laryngeal elevation and vestibule closure
  2. reduced bolus clearance = residue in valleculae or pyriform sinuses
22
Q

Oncologic conditions and late effects of radio therapy?

A

1, impaired neural transmission

  1. impaired muscled contractions
  2. fewer, smaller muscle fibers
  3. muscle replaced with fibrotic tissue due to reduced blood supply
  4. restricted mouth opening (trismus)
  5. bone loss (necrosis)
  6. altered or reduced taste
23
Q

Oncologic conditions and early effects of radiation?

A

pain, soreness
ulcers and bleeding
mucositis (inflammation)
xerostomia

24
Q

Oncologic conditions and dysphagia symptoms?

A
  1. aspiration after swallow due to reduced pharyngeal contraction
  2. reduced bolus formation and transport
  3. aspiration before the swallow due to delayed phayngeal swallow (residue left in pyriform sinuses and vallecutae inspirated before next phayngeal initiation
25
Q

Oncology and swallow tx after oral

sx?

A
  1. ROM, tongue and jaw
  2. lingual control
  3. tongue strengthening
  4. thermo-tactile stimlation
  5. introral prostehetics
  6. swallow maneuvers
  7. speech treatment
26
Q

Partial laryngectomy: hemilaryngectomy and supraglottic laryngectomy? what ahppens

A

removal of one lateral half of larynx+

reduced laryngeal vestibule and glottis closure especially if resection involves the epiglottis or arytenoid cartilage

27
Q

Supraglottic laryngectomy

A
  1. reduced: closure of airway entrance due to
    arytenoids, epiglottis or VF’s resected
    also
  2. reduced pharyngeal clearance
  3. impaired BOT motion if excised, scarred
28
Q

Xerostomia causes, consequences and tx

A

result of radiation.

discomfort, loss of ability to cleanse teeth, moisten food for mastication and deglutition

29
Q

MBS rationale

A
  1. assessment or anatomy of swallow mechanism
  2. dx physiology of underling cause of dysphagia
  3. assess effectiveness of tx strategies
30
Q

clinical management of dysphagia, rationale and purpose

A
  1. based on understanding of normal bio mechanical and physiology properties of normal swallow
    ID deviations from normal patterns
31
Q

COMPENSATORY STRATEGIES: rationale

A

to eliminate symptoms

32
Q

THERAPY PROCEDURES: rationale

A

to change swallow physiology.

33
Q

Cognition and THERAPY: populations not suitable. Why?

A

requires cognitive participation of patients:

  1. no one under 2 years
  2. no dementia
  3. no severe rt hemi stoke/ syndrome/ tbi
34
Q

Therapy procedures, what’s included?

A
  1. ROM oral and pharyngeal structures
  2. sensory input prior to swallow
  3. Impose voluntary control over timing or co-ordiantion of oropharyngeal movements
35
Q

Indirect management techniques

A
  1. structure of eating environment (utensils, plates with sides)
  2. specifying degree of supervision
  3. diet modification for consistency or calorie count
36
Q

Direct management

A
  1. cognitive stimulation,
  2. compensatory postures/positions
  3. compensatory maneuvers
  4. sensory stimulation
  5. motor control activities and exercises
37
Q

What is the purpose of an assessment?

A

To diagnose type of impairment, severity of impairment,
provide a prognosis,
develop a treatment plan

37
Q

oral pharyngeal exercises and rationale

A

to overload the muscles to increase

  1. ROM
  2. timing
  3. coordination

Mahler comps swallow tx (1 decks)

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