Management of acquired adult dysphagia Flashcards
before you use a strategy what must you do?
identify the nature of the dysphagia so you are recommending the most appropriate strategy
how can you confirm a strategy?
videofloroscopy
what two types of strategy can you use?
postural changes
behavioural strategies
what 4 postural changes can you make?
head back
chin down
head turn
head tilt
why would you use a ‘head back’ strategy?
to help oral transit
gravity clears oral residue
what must be intact for a ‘head back’ strategy to work?
pharyngeal swallow
who would a ‘head back’ strategy be most appropriate for?
anyone who has had oral surgery
why would you use the ‘chin down’ strategy?
if there is a delay in the triggering of pharyngeal swallow
the vallecular space widens, allowing the bolus to rest there thus preventing it from going into the airway
the airway is also protected as the epiglottis is pushed posteriorly
why would you use a the head turn method?
turning the head to the weaker side prevents the bolus from travelling down the damaged side
who might use the head turn strategy?
patients with unilateral pharyngeal paresis
why would you use a head tilt strategy?
tilting the head to the stronger side forces the bolus down that side
who would you recommend a head tilt strategy to?
a patient with unilateral oral/pharyngeal weakness
what is an effortful swallow?
the ‘swallowing hard’ manoeuvre increases posterior movement of the tongue base
increased drive of the bolus reduces risk of residue in the vallecula
who would use a supraglottic swallow?
patients who have impaired airway protection
how do you carry out a supraglottic swallow?
- fill lungs with air
- have vocal chords consciously closed
- swallow
- cough to eliminate any aspirated material
who would use a super supraglottic swallow?
patients who additionally have pharyngeal weakness
how do you carry out a super supraglottic swallow?
same as supraglottic but with an effortful swallow
encourage regular throat clearning
what rehab exercise can you recommend?
- shaker exercise for poor UES opening
- manako exercise for BOT to PPW approximation
