Management Flashcards
What do you consider once an evaluation is complete?
1) what type of nutritional mgmt is needed?
2) should therapy be initiated? If so, what kind? Compensatory or exercises? Indirect or direct?
3) what specific strategies need to be used?
Goal of all swallowing therapy programs:
Re-establishment of oral feeding while constantly maintaining adequate hydration and safe swallowing
What to take into account before starting therapy:
Diagnosis, Prognosis, Reaction to compensatory strategies, severity, ability to follow directions, respiratory function, caregiver support, motivation of patient
What does PEG stand for?
Percutaneous endoscopic gastronomy (procedure not device)
Examples of Postural Techniques:
Chin down, chin up, head rotation, chin down & head rotation, head tilt, lying down
Considerations for Feeding Tube
GI history, cost of feeding & insurance coverage, patient’s behavior, preference, & medical Dx, amt. of aspiration
How to increase oral sensory awareness:
downward pressure of spoon on tongue, sour bolus, cold bolus, bolus req. chewing, larger volume bolus, thermal-tactile stimulation
Ways that the UES can be impaired:
narrow (due to edema/fibrosis) OR insufficient opening/closing (inconsistent, closes too early, stays open –> reflux)
Dysphagia Altered Diet:
minced meats, mashable fruits/veggies, no mixed consistency
Mechanical Soft:
meats are chopped & no breads
Dysphagia Advanced:
very chopped meats, no breads, steamed veggies
Difference Between Puree and Pudding Thick
Puree has less moisture
Examples of Intraoral Prosthetics:
palatal lift, palatal obturator, palatal augmentation
Pharyngeal ROM Exercises
Supraglottic swallow, super-supraglottic swallow
What are some vocal fold adduction exercises?
Isometrics/tonics (closes the VF’s by pulling up on a chair/bearing down), Glottal attack
List some tongue base exercises:
Tongue back, gargle, yawn, effortful swallow
What is an exampe of a laryngeal elevation exercise:
Falsetto exercise (hold for 4-5 seconds) go as high as possible
What are the main swallowing maneuvers discussed in class?
Supraglottic & super-supraglottic swallow, effortful swallow, Mendelsohn maneuver
Describe the supraglottic swallow procedure and for what impairments you would use it:
Tell the patient:
- Take a deep breath & hold it
- Keep holding your breath and lightly cover trach tube (if present)
- Keep holding your breath while you swallow.
- Immediately after you swallow, cough.
-Used for reduced or late vocal fold closure
Describe the super-supraglottic swallow procedure and for what impairments you would use it:
“Inhale and hold your breath very tightly, bearing down. Keep holding your breath and bearing down as you swallow. Cough when you are finished.”
-Used for reduced closure of airway entrance & reduced laryngeal elevation
Describe the effortful swallow procedure and for what impairments you would use it:
“As you swallow, squeeze hard with all of your muscles.”
-Used for reduced posterior movement of the tongue base
Describe the Mendelsohn maneuver procedure and for what impairments you would use it:
“Swallow your saliva several times and pay attention to your neck as you swallow. Tell me if you can feel something lifting and lowering as you swallow (Adam’s apple). Now, this time, when you swallow and you feel something lift as you swallow, don’t let it drop. Hold it up with your muscles for several seconds.”
-Used for reduced laryngeal movement and reduced UES opening, as well as discoordinated swallow
