Management Overall

Question 1

What are the considerations for treatment planning?

Answer 1

• Diagnosis
• Prognosis**
• Reaction to compensatory strategies
• Severity of the patient’s dysphagia
• Ability to follow directions
• Respiratory function**
• Availability of caregiver support
• Patient motivation and interest
• (culture)

Question 2

What are the 2 types of NG tubes?

What is the consideration for using one over the other?

Answer 2

1. Rigid: Stays in for a longer time; doesn’t allow for collection of bacteria
2. Dobhoff: soft; thin silicone; not meant to be used for long periods of time; bacteria risk

Question 3

What is a gastrostomy?

Answer 3

A feeding tube into the stomach

Question 4

What are the considerations for oral versus non-oral feeding?

Answer 4

If a radiographic study indicates that it takes the patient more than 10 seconds for oral and phayngeal transit time combined to swallow every consistency of food attempted, but there is no aspiration, the patient may feed by mouth but will need non-oral feeding to supplement oral feeds

Question 5

What does PEG stand for and what is it?

Answer 5

Percutaneous Endoscopic Gastrotomy; this is long-term fix for chronic swallowing disorders.

Question 6

What is a PEJ tube?

Answer 6

Percutaneous Endoscopic Jejunostomy. A jujunostomy is done when there is a problem with the gut. This is a last resort. It causes chronic diarrhea. The jejunum is below the stomach- in the intestine.

Question 7

What are the considerations for the type of non-oral nutrition?

Answer 7

i. Gastrointestinal history
ii. Cost of feeding & insurance coverage
iii. Patient’s behavior
iv. Patient’s preference
v. Patient’s medical diagnosis
- -Amount of aspiration?

Question 8

Name the techniques to increase oral sensory awareness.

Answer 8

1. Downward pressure of spoon on tongue
2. Sour bolus
3. Cold bolus
4. Bolus requiring chewing
5. Larger volume bolus
6. Thermal-tactile stimulation

Question 9

What is the difference between direct and indirect therapy procedures?

Answer 9

Direct: With food
Indirect: Exercises / saliva swallows

Question 10

What are some exercises for oral control and oral ROM?

Answer 10

1. Oral Motor Control Exercises
2. ROM exercises
3. Resistance
4. Bolus Control Exercises
   - Gross manipulation
   - Cohesive bolus
   - Propulsion

Question 11

What are some pharyngeal ROM exercises?

Answer 11

1. Airway entrance (Supraglottic swallow, Super-supraglottic swallow, Repeated glottal attack)
2. Vocal fold adduction exercises (Isometrics and isotonics –> Glottal attack)
3. Tongue base exercises (gargle, yawn)
4. Laryngeal elevation exercises (Falsetto Exercise)

Question 12

Piecemeal deglutition

Answer 12

a physiological phenomenon occurring when a bolus of a large volume is divided into two or more parts which are swallowed successively

Question 13

Xerostomia

Answer 13

Dry mouth

Question 14

Trismus

Answer 14

Inability to open the mouth

Question 15

DOSS

Answer 15

The Dysphagia Outcome Severity Scale (DOSS)
Level 1: Severe dysphagia: NPO: Unable to tolerate and PO
safely
Level 2: Moderately severe dysphagia: Maximum assistance or
use of strategies with partial PO only (tolerates at least
one consistency safely with total use of strategies)
Level 3: Moderate dysphagia: Total assist, supervision, or
strategies, two or more diet consistencies restricted
Level 4: Mild-moderate dysphagia: Intermittent
supervision/cueing, one or two consistencies
restricted
Level 5: Mild dysphagia: Distant supervision, may need one
diet consistency restricted
Level 6: Within functional limits/modified independence
Level 7: Normal in all situations

Question 16

PAS

Answer 16

PA SCALE on FINA
1- no penetration no aspiration
2- penetration without residue in the vestiblue, no aspiration
3- penetration with residue in the vestibule
4- penetration to the level of VF no residue
5- penetration to the level of VF with residue
6- apsiration with residue
7- aspiration no residue
8- aspiration

Question 17

Functional Assessment or Oral Intake for Dysphagia Patients

Answer 17

Functional Assessment or Oral Intake for Dysphagia Patients
1 NPO (e.g., Consumes nothing by mouth)
2 Tube fed with minimal PO (e.g., Nutrition through tube with some occasional sips of water of coffee)
3 Limited PO diet requiring tube supplements (e.g., Uses tube as supplement to oral intake, may include a diet of any consistency that is supplemented with tube feeds to meet nutritional requirements)
4 Total PO diet limited to single consistency (e.g., Thick liquids and puree diet; Blenderized food and thick liquids are essentially one consistency)
5 Total PO diet with multiple consistencies. Unable to ingest certain categories of food without special preparation. (e.g., restrictions such as no thin liquids; mechanical soft with thick liquids or regular diet with thick liquids; puree with thin liquids)
6 Total PO diet without special preparation. Limitations on specific food items due to swallowing difficulty. (e.g., takes thin liquids but can’t handle carbonated drinks; does not eat stringy/grainy foods)
7 Total PO, no restrictions on oral intake

Question 18

Palutive care

Answer 18

Goal is to control the cancer; not kill the cancer

Question 19

Neo-adjuvant chemotherapy

Answer 19

before surgery

Question 20

Adjuvant chemotherapy

Answer 20

after surgery/radiation

Question 21

Concurrent/concomitant chemotherapy means that ____

Answer 21

With radiation

Question 22

osteoradionecrosis

Answer 22

Radiated bone death

Question 23

How do you use the TNM scale?

Answer 23

T (tumor) can be 0-4
- unknown primary tumor (0)

N (nodes) can be 0-3
-no positive lymph nodes
-when N is higher, chemotherapy needs to come in
-1, positive lymph node
-2, 2 positive lymph nodes
–N2a: on one side (unilateral, same side)
–N2b: the other side or bilateral lymph node involvement
-3, three or more positive nodes
M (methasis) 0-1

Question 24

Dysgeusia

Answer 24

Loss of taste

Question 25

Obynophagia

Answer 25

Pain on swallowing