modifications/positions/maneuvers

Question 1

diets (3)

Answer 1

pureed, soft mechanical, regular

Question 2

liquids (2)

Answer 2

thin, thickened

Question 3

thickening agents (3)

Answer 3

powder, gel, pre-thickened

Question 4

examples of natural thickeners

Answer 4

ice cream, yogurt, pureed fruit, creamed soups

Question 5

levels of thickness (3)

Answer 5

nectar, honey, pudding

Question 6

level of thickness that is not used often

Answer 6

pudding. if they’re on pudding it will be hard to get daily hydration levels

Question 7

hierarchy of changing someones diet

Answer 7

positions, maneuvers, modify viscosity

Question 8

who benefits from chin tuck

Answer 8

for delayed swallow and reduced tongue base retraction and have significant amounts of residue.

Question 9

what does chin tuck do

Answer 9

narrows airway entrance and widens vallecular spaces

Question 10

head rotation

Answer 10

for L or R. when you rotate head to the L, bolus is being forced down R side

Question 11

head tilt

Answer 11

tilts head to stronger side. bolus will go down side that they tilt towards

Question 12

who benefits from head extension

Answer 12

apraxic pts who hold food (propels it back), head/neck cancer, tongue resections

Question 13

who benefits from lying down/side lying

Answer 13

tongue resections, hemilaryngectomy

Question 14

supraglottic swallow is for what

Answer 14

reduced or late VF closure

Question 15

what does supraglottic swallow do

Answer 15

closes VF before and during swallow which protects the airways

Question 16

steps of supraglottic swallow (4)

Answer 16

1. Take a deep breath and hold it “like you’re going under water”
2. Keep holding your breath
3. Keep holding your breath while you swallow
4. Immediately after you swallow, cough

Question 17

exceptions of supraglottic swallow

Answer 17

oral cancer pts because they’ll aspirate before the swallow due to reduced tongue mobility, respiratory pts

Question 18

oral cancer pts can use what maneuver

Answer 18

extended supraglottic swallow “dump and swallow”

Question 19

steps of extended supraglottic swallow (5)

Answer 19

1. hold breath tightly
2. put entire 5cc/10cc in your mouth
3. hold your breath and toss your head back
4. swallow 2-3 times or as many times as needed to clear liquid but continue to hold breath
5. cough after

Question 20

what does super-supraglottic maneuver do

Answer 20

closes entrance to airway by tilting arytenoid cartilages anteriorly to base of epiglottis before/during swallow. improves laryngeal elevation rate at beginning of swallow

Question 21

what pts use super-supraglottic swallow

Answer 21

reduced VF closure, supraglottic, laryngectomy, neck radiation pts

Question 22

super-supraglottic swallow steps (3)

Answer 22

1. inhale and hold your breath tightly, bearing down
2. keep holding your breath and bearing down as you swallow
3. cough when you are finished (like having a bowel mvmt while holding breath)

Question 23

what does mendehlson maneuver do

Answer 23

improves swallow coordination, epiglottic inversion, extent of laryngeal elevation, increases width and duration of UES opening

Question 24

mendehlson maneuver steps (3)

Answer 24

1. swallow your saliva several times and pay attention to your neck as you swallow
2. tell me if you feel your Adams apple lift and lower
3. now, when you swallow and you feel something lift as you swallow, don’t let your Adams apple drop, hold it up for several seconds

Question 25

what does effortful swallow do

Answer 25

increases lingual force (posterior motion of tongue base), improves bolus clearance from valleculae

Question 26

who would benefit from effortful swallow

Answer 26

pt with reduced tongue based retraction

Question 27

effortful swallow steps

Answer 27

swallow hard but swallow like youre swallowing a grape whole

Question 28

pharyngeal wall contraction maneuvers (2)

Answer 28

masako maneuver, showa maneuver

Question 29

masako maneuver

Answer 29

tongue held between teeth and swallow (foster doesn’t do this one a lot because its awkward)

Question 30

showa maneuver

Answer 30

tongue to roof of mouth and swallow hard