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CD 663 > Midterm II > Flashcards

Midterm II Flashcards

1
Q

FEES allows you to view:

A

the swallow immediately before and after triggering the swallow

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2
Q

What can you observe when using a FEES?

A
  • VP closure
  • structural integrity of larynx/pharynx
  • excess secretions
  • sensation via touching epiglottis / arytenoid cartilage
  • and TVC adduction/abduction
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3
Q

The FEES can also allow you to see what important instrumental information?

A

Premature spillage/pooling

Pentration/aspiration

Pharyngeal residue

Effectiveness of cough

Effectiveness of dry swallow
*as well as the effectiveness of various postures and compensatory measures

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4
Q

What is the order of consistencies given when conducting an MBSS?

A

Thin liquids
thick liquids if needed
Puree
soft solid
regular solid

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5
Q

What are some of the downsides to conducting an MBSS?

A

Exposure to radiation

takes time to take patient to radiology

not enough time can be spent on swallow study

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6
Q

When observing an MBSS in the Oral Stage, what are you looking for?

A

bolus formation - gathering on tongue blade

bolus maintenance - spreading or spillage of bolus anteriorly or onto sulci

bolus transit - is it smooth, tongue pumping, able to push against hard palate

oral residue

premature spillage - normal in solids

ability to chew/masticate

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7
Q

During the pharyngeal stage of MBSS what are you looking for?

A

adequacy/ timing of VP closure

BOT retraction

epiglottic inversion/retroflexion

hyoid movement/laryngeal elevation

contraction of pharyngeal constrictors

CP/UES relaxation/opening
*laryngeal penetration: how deep, cough, clear
*aspiration: can person clear it thru cough

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8
Q

During the Esophageal Stage what are you looking for when conducting an MBSS?

A

backflow food/liquid from esophagus

food/liquid sticking or clearing slowly through cervical esophagus

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9
Q

What are some other additional observations when conducting an MBSS?

A

Zencker’s Diverticulum

Cervical Osteophytes

Head and Neck Cancer Pts:
resected structures
lymph edema
fistulas
pseudovallelae

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10
Q

True or False:

One of the ways you can help with swallow is first change the diet and then compensatory technique

A

True

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11
Q

Chin Tuck helps with

A

reduced premature spillage by letting gravity help keep bolus in cavity

widens vallecular space in order to hold more food/liquid before swallow

promotes better base of tongue to posterior Pharyngeal wall contact

decreases opening to the laryngeal aditus/vestibule

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12
Q

Head Turn helps with:

A

increased TVC closure via extrinsic pressure

promote passage of bolus through stronger side of pharynx

promotes reduced resting pressure of the CP segment by pulling cricoid cartilage further away from posterior pharyngeal wall

used when pyriform sinus and pharyngeal wall residue
*can be combined with chin tuck for increased clearance and improved airway protection

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13
Q

Effortful Swallow allows for:

A

stronger tongue to palate contact and stronger BOT to posterior pharyngeal wall contact

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14
Q

Supraglottic Swallow you must:

A

voluntarily hold one’s breath prior to and during swallowing, then coughing immediately after swallow, then dry swallow

*protects airway during swallow

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15
Q

Super Supraglottic Swallow is:

A

effortfull swallow + supraglottic swallow

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16
Q

Mendelsohn Maneuver is:

A

where the individual voluntarily prolongs duration of laryngeal elevation resulting in increased duration/extent of laryngeal elevation and therefore increased duration of CP opening

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17
Q

When making decisions in regards to diet after conducting an MBSS you should consider:

A

kind of diet
level of supervision during feeding
will SLP continue or will patient be discharged
is a repeat MBSS needed
patient candidate for dysphagia therapy
did aspiration occur (how much, silent, effectiveness of cough)
postures/procedures help reduce aspiration

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18
Q

Frazier Free Water Protocol should be used:

A

between meals

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19
Q

When writing an MBSS report it should include the following:

A

Medical History
Diet History
Consistencies given during eval
Oral Stage observations
Pharyngeal Stage observations
Overall impressions
prognosis
diet recommendations
recommended precautions

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20
Q

Name some of the medical treatments for Dysphagia:

A

Feeding tube - NGT/PEG
*paralyzed vocal fold due to open heart surgery
Cricopharyngeal Dilation: stick a tube and expand tube and expand cricopharyngeus
Inject botox and paralyze muscle (done every 3-6 months)

Cricopharyngeal Myotomy - muscle cutting (last choice)
*gastric juices and lung juices never meant to come into contact

GERD meds
Appetite stimulants for elderly

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21
Q

What are the behavioral treatments for Dysphagia?

A

Diet modifications
Oral-Facial Exercises
Compensatory Postures
Thermal Gustatory Stimulation
Biofeedback

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22
Q

Bolus Maintenance and Lip Seal is meant to help which phase of swallowing?

A

Oral Phase

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23
Q

For whom is the Bolus Maintenance/Lip Seal exercise meant for?

A

for patients who drool

*alternate puckering/spreading lips with and without resistance

opening mouth wide and then puckering slowly

pressing lips tightly together for a few seconds

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24
Q

For those who have trouble with mastication/formation of bolus, maintenance of bolus, posterior bolus propulsion, premature spillage, and oral residue: you should

A

increase tongue strength, ROM, and coordination:

*tongue lateralization with/without resistance

tongue tip elevation/de-elevation into the anterior Sulci/Buccal Sulci

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25
Q

Thermal Tactile Stimulation is good for:

A

delayed trigger in swallow

*cold laryngeal mirror brushes anterior faucial pillars

26
Q

Chin Tuck helps with:

A

premature spillage
*by having gravity move bolus to the front

*widens the vallecular space allowing for more food/liquid to be held safely until a swallow is triggered

27
Q

When patient has tongue pumping with premature spillage:

A

instruct patient to consciously try to reduce pumping action and initiate a hard deliberate post tongue movement
*can use sEMG for biofeedback and see electrical activity spike when there is improvement

28
Q

If you see delayed pharyngeal swallow and pooling of food into hypopharynx befor swallow you can:

A

Present cold and sour boluses: may heighten sensory input and result in less delay
*stroking of faucial pillars with cold laryngeal mirror: less delayed swallows following afterwards

29
Q

If someone has Vallecular Residue (Pharyngeal Phase) due to BOT weakness; you can do the following

A

Effortful swallow
*chin tuck (widens vallecular space)
Masako Maneuver: holding tip of tongue gently between front teeth while swallowing

30
Q

If there is pharyngeal wall residue and pyriform sinus residue (due to weak pharyngeal contraction); you can:

A 
do effortful swallow
Masako Maneuver may strengthen superior constrictor
sEMG Feedback (demonstrate the strength necessary to swallow)
Head turn to weak side
31
Q

If you see Laryngeal Penetration/Aspiration you could:

A

chin tuck
effortful swallow
repeat dry swallow
head turn posture
thermal gustatory - thermal tactile stim during meals
supraglottic and super supraglottic swallow

32
Q

When there is cricopharyngeal dysfunction (problems with UES) you can:

A

botox injections or surgical myotomy
head turn may help pull UES
exercises to increase laryngeal elevation: Shaker Exercise
*lay supine and lift head & look at toes

33
Q

True or False:

Occupational Therapists are sometimes in charge of doing bedside evaluations and MBSSs

A

True

34
Q

What is biofeedback?

A

the technique of making unconscious or involuntary bodily processes perceptible to the senses in order to manipulate them by concsious mental control

35
Q

Choose some of the applications that Biofeedback is used for:

A) Migraine headaches

B) Tension headaches

C) Chronic pain

D) ADD

E) All of the above

A

all of the above

as well as: digestive system disorders

incontinence

high blood pressure

cardiac arrhythmia

Raynaud’s Disease

Epilepsy

Paralysis, etc

36
Q

What are biofeedback applications in Speech Pathology?

A

Stuttering

Voice

Dysarthria

Aphasia

Dysphagia

37
Q

What is sEMG?

A

it is a measure of electrical activity given off by the muscle

*interpret it as a measure of effort and strength

*when muscles contract they give off a burst of bio-electrical energy that can be recorded by skin sensors

38
Q

What does Biofeedback from sEMG provide?

A

real time visual representation of swallow, allowing for conversion of involuntary function into a conscious deliberate process

*concrete objective treatment

39
Q

True or False:

Biofeedback is a form of treatment

A

False

40
Q

What does the Biofeedback NOT tell us?

A

what the pharynx is doing

when to proceed with PO intake

when to re-evaluate with diagnostic examination

when patient is aspirating

41
Q

Neuromuscular deficits can be classified into what 3 categories?

A

Flaccidity or hypofunction

Spasticity or hyperfunction

Muscle dyscoordination or Apraxia

42
Q

What are some of the precautions you should take when using sEMG?

A

check if patient has unstable cardiac conditions - check with MD

transient dysphonia

discourage biting/grinding of teeth

use care in removing electrodes

43
Q

True or False:

Trach Tube can occasionally be recommended to reduce aspiration

A

True

44
Q

What is a tracheotomy?

A

surgical opening in the anterior neck into the trachea

45
Q

What are the primary purposes for the use of a trach tube?

A

bypass an obstruction in airway

long term easy access to the airway for mechanical ventilation and/or pulmonary toilet

46
Q

Label the parts of the trach tube:

A

A - Neck Plate

B - Tracheostomy Tube

C - Fully inflated cuff

D - Pilot line

E - Pilot Balloon

47
Q

What is the inner canula used for?

A

clean out excess liquids

48
Q

What is the obturator used for?

A

when you want to block the tube

49
Q

An inflated cuff is meant for:

A

create perfect sealed pressure - no air leakage

50
Q

What are some of the effects of trach tube on swallowing?

A

may decrease laryngeal elevation

if cuff is inflated - can compress esophagus

may result - in decrease in sensitivity of cough reflex

51
Q

In the world of ethics what does Autonomy mean?

A

the right to decide for oneself about one’s own life

52
Q

In the world of ethics what does beneficence mean?

A

actions done for the benefit of others, actions that produce good

53
Q

What is the hippocratic oath?

A

I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them

54
Q

What is Informed Consent?

A

capacity of the patient or client to understand the information and make an informed decision, a voluntary choice without coercion

55
Q

What are some issues the patient may need to consider?

A

how does patient feel about preserving the ability to eat over the ability to speak

want to try to master swallowing techniques that still leave him/her at risk for aspiration

does patient who is advised from eating or drinking understand the possible consequences of aspiration

56
Q

What is Legal Competence?

A

the law presumes that all adults are competent to decide for themselves what will be done with their person and property

*competence to stand trial

*competence to manage property

*competence for medical decision making

57
Q

What is Decision-Making Capacity?

A

ability to understand whether or not to accept or reject treatment

58
Q

How are decisions made for patients who lack DMC?

A

others decide for them

states vary with regard to both the standards of surrogate decision making and the standard of proof
*main principles: what would the patient want

what is best for patient

59
Q

What is Advanced Directives?

A

a document that enables people to express their wishes about their health care in a form that will tell others how to care for them and to make decisions for them if and when the time comes that they are unable

60
Q

What are the two types of Advanced Directives?

A

The Living Will - what you want

Power of Attorney - who will make decisions for you

61
Q

What are some of the potential benefits of Feeding Tubes?

A

increased life span

ability to recover

possiblity of returning to useful functioning

improved quality of life

improved physiological and psychological state

increased resistance to infection

improved healing of skin and wounds

62
Q

What are burdens of feeding tubes?

A

cannot be absorbed from gut; does not abate failure to thrive

physical pain

cannot help because underlying condition is hopeless

causes discomfort and prolongs dying

spiritual and emotional pain and suffering

indignity

emotional and financial burden

CD 663 (3 decks)

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