Management of dysphagia

Question 1

How do we use assessment to inform treatment

Answer 1

• the results of the case history and assessment to make recommendations
• the prognosis
• the nature of the swallowing deficit
• how much time is required

Question 2

Good therapy goals examples

Answer 2

• maximise safety and reduce risk
• return to normal diet and fluids
• increase comfort and satisfaction at mealtimes
• improve QOL

Question 3

Compensatory treatment options

Answer 3

modifying diet and fluid
modifying feeding activity
modifying posture
actively treating the swallow

Question 4

Rehabilitation treatment

Answer 4

Oral motor exercises, sensory stimulation, exercises that alter physiology

Question 5

The standard safe swallow strategies

Answer 5

• Ensure fully upright and alert for all oral intake
• Small mouthfuls & time to chew
• Check mouth clear before next mouthful
• Maintain optimal oral hygiene

Question 6

Frazier Free Water Protocol

Answer 6

Allows patients with dysphagia (including those who aspirate thin fluids) access to water between meals.
Not good for long term as there is a risk of lung scarring

Question 7

Modifying feeding activity (compensatory strategy)

Answer 7

• align to meet medication times
• small frequent meals for patients who fatigue
• reduce environment distractions

Question 8

Bolus control techniques: (5)

Answer 8

Lingual sweep: using tongue to sweep any residue
Cyclic ingestion: food then a bit of water in a cycle
Dry swallows/multiple swallows: effortful swallows
Bolus placement: placing food further back
Modification of bolus size: giving the patient a teaspoon or cutting food smaller

Question 9

Ways to manage the environment (compensatory strategy)

Answer 9

• Family / client education
• Assistance with set-up
• Distraction free, quiet environment
• Appropriate positioning e.g. upright
• Use of dentures, glasses, hearing aid, head / neck supports, devices
• Food preparation - necessary diet / fluid modifications
• Supervision / prompting to use strategies

Question 10

Modifying postures

Answer 10

immediately benefits the patent, need to use the technique every time, improves function but no change in physiology

Question 11

Chin tuck

Answer 11

eliminates aspiration
widens the valleculae
narrows airway entrance
may weaken pharyngeal contraction

Question 12

Head rotation

Answer 12

turn head to the weaker side
redirects the bolus to the stronger side
narrows off the swallowing tract on the side toward the head is turned
used for lateral medullary stroke

Question 13

Head tilt

Answer 13

tilt to the stronger side
for patients with unilateral problems in both the oral and pharyngeal stage of the problem
gravity pulls bolus to the stronger side