modifications/positions/maneuvers Flashcards
diets (3)
pureed, soft mechanical, regular
liquids (2)
thin, thickened
thickening agents (3)
powder, gel, pre-thickened
examples of natural thickeners
ice cream, yogurt, pureed fruit, creamed soups
levels of thickness (3)
nectar, honey, pudding
level of thickness that is not used often
pudding. if they’re on pudding it will be hard to get daily hydration levels
hierarchy of changing someones diet
positions, maneuvers, modify viscosity
who benefits from chin tuck
for delayed swallow and reduced tongue base retraction and have significant amounts of residue.
what does chin tuck do
narrows airway entrance and widens vallecular spaces
head rotation
for L or R. when you rotate head to the L, bolus is being forced down R side
head tilt
tilts head to stronger side. bolus will go down side that they tilt towards
who benefits from head extension
apraxic pts who hold food (propels it back), head/neck cancer, tongue resections
who benefits from lying down/side lying
tongue resections, hemilaryngectomy
supraglottic swallow is for what
reduced or late VF closure
what does supraglottic swallow do
closes VF before and during swallow which protects the airways
steps of supraglottic swallow (4)
- Take a deep breath and hold it “like you’re going under water”
- Keep holding your breath
- Keep holding your breath while you swallow
- Immediately after you swallow, cough
exceptions of supraglottic swallow
oral cancer pts because they’ll aspirate before the swallow due to reduced tongue mobility, respiratory pts
oral cancer pts can use what maneuver
extended supraglottic swallow “dump and swallow”
steps of extended supraglottic swallow (5)
- hold breath tightly
- put entire 5cc/10cc in your mouth
- hold your breath and toss your head back
- swallow 2-3 times or as many times as needed to clear liquid but continue to hold breath
- cough after
what does super-supraglottic maneuver do
closes entrance to airway by tilting arytenoid cartilages anteriorly to base of epiglottis before/during swallow. improves laryngeal elevation rate at beginning of swallow
what pts use super-supraglottic swallow
reduced VF closure, supraglottic, laryngectomy, neck radiation pts
super-supraglottic swallow steps (3)
- inhale and hold your breath tightly, bearing down
- keep holding your breath and bearing down as you swallow
- cough when you are finished (like having a bowel mvmt while holding breath)
what does mendehlson maneuver do
improves swallow coordination, epiglottic inversion, extent of laryngeal elevation, increases width and duration of UES opening
mendehlson maneuver steps (3)
- swallow your saliva several times and pay attention to your neck as you swallow
- tell me if you feel your Adams apple lift and lower
- 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
