Management

Question 1

What do you consider once an evaluation is complete?

Answer 1

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?

Question 2

Goal of all swallowing therapy programs:

Answer 2

Re-establishment of oral feeding while constantly maintaining adequate hydration and safe swallowing

Question 3

What to take into account before starting therapy:

Answer 3

Diagnosis, Prognosis, Reaction to compensatory strategies, severity, ability to follow directions, respiratory function, caregiver support, motivation of patient

Question 4

What does PEG stand for?

Answer 4

Percutaneous endoscopic gastronomy (procedure not device)

Question 5

Examples of Postural Techniques:

Answer 5

Chin down, chin up, head rotation, chin down & head rotation, head tilt, lying down

Question 6

Considerations for Feeding Tube

Answer 6

GI history, cost of feeding & insurance coverage, patient’s behavior, preference, & medical Dx, amt. of aspiration

Question 7

How to increase oral sensory awareness:

Answer 7

downward pressure of spoon on tongue, sour bolus, cold bolus, bolus req. chewing, larger volume bolus, thermal-tactile stimulation

Question 8

Ways that the UES can be impaired:

Answer 8

narrow (due to edema/fibrosis) OR insufficient opening/closing (inconsistent, closes too early, stays open –> reflux)

Question 9

Dysphagia Altered Diet:

Answer 9

minced meats, mashable fruits/veggies, no mixed consistency

Question 10

Mechanical Soft:

Answer 10

meats are chopped & no breads

Question 11

Dysphagia Advanced:

Answer 11

very chopped meats, no breads, steamed veggies

Question 12

Difference Between Puree and Pudding Thick

Answer 12

Puree has less moisture

Question 13

Examples of Intraoral Prosthetics:

Answer 13

palatal lift, palatal obturator, palatal augmentation

Question 14

Pharyngeal ROM Exercises

Answer 14

Supraglottic swallow, super-supraglottic swallow

Question 15

What are some vocal fold adduction exercises?

Answer 15

Isometrics/tonics (closes the VF’s by pulling up on a chair/bearing down), Glottal attack

Question 16

List some tongue base exercises:

Answer 16

Tongue back, gargle, yawn, effortful swallow

Question 17

What is an exampe of a laryngeal elevation exercise:

Answer 17

Falsetto exercise (hold for 4-5 seconds) go as high as possible

Question 18

What are the main swallowing maneuvers discussed in class?

Answer 18

Supraglottic & super-supraglottic swallow, effortful swallow, Mendelsohn maneuver

Question 19

Describe the supraglottic swallow procedure and for what impairments you would use it:

Answer 19

Tell the patient:

1. Take a deep breath & hold it
2. Keep holding your breath and lightly cover trach tube (if present)
3. Keep holding your breath while you swallow.
4. Immediately after you swallow, cough.

-Used for reduced or late vocal fold closure

Question 20

Describe the super-supraglottic swallow procedure and for what impairments you would use it:

Answer 20

“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

Question 21

Describe the effortful swallow procedure and for what impairments you would use it:

Answer 21

“As you swallow, squeeze hard with all of your muscles.”

-Used for reduced posterior movement of the tongue base

Question 22

Describe the Mendelsohn maneuver procedure and for what impairments you would use it:

Answer 22

“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