oral phase dysphagia: motor-based feeding disorders Flashcards
types of disorders (4)
1) poor bolus lateralization
2) poor bolus mastication
3) poor labial seal
4) weak suck
poor bolus lateralization
inability or difficulty moving the bolus from anterior area laterally to molar area (includes medializing)
-also affects ability to retrieve bolus laterally from buccal cavity and clear oral stasis (residue in mouth)
presentation of poor bolus lat
- does not transfer bolus to molar area
- may fall into anterior sulcus
- typically stays on medial tongue; tongue may “pump” to move bolus back
complications w/ poor bolus lat
- gag response
- loss of bolus over post. tongue
- large solid matter in phar. cavity- possible aspiration or airway blockage
- unable to eat solid matter
conditions assoc. w/ poor bolus lateralization
- hyper/hypotonia
- any dx or condition assoc. w/ abnormal muscle function
- poor sensory awareness
- partial paresis
tx strategies for poor bolus lateralization
- lateral lingual stroking, tapping, or tactile stimulation (vibration, textured teethers, flavored/textured gloves)
- increase sensory input (via taste, temperature, & texture)
poor bolus mastication
inability/difficulty chewing solids or semi-solids
presentation of poor bolus mastication
decreased force- does not exert adequate force during each chew
decreased endurance- does not demonstrate adequate chewing repetitions
complications w/ poor bolus mastication
- gag response
- swallow of large bolus- at risk for aspiration or airway blockage
- downgrade solid diet (less firm or softer solids) or unable to eat solid diet
assoc conditions w/ poor bolus mastication
- hypo/hypertonia
- any dx or condition assoc. w/ abnormal m. function
- sensory processing difficulties
- aversion to textures
tx strategies for poor bolus mastication
- lateral biting stimulation: no teeth: use gloved finger; molar –> tool
- lateral placement of food
- pre-chewing foods- dissolvable crunchy sollids, feeding net- don’t require mastication; safer alternative
- gradual increase of texture - more sensory –> more motor
** never reach across mouth when finger inside; hold finger/tool perpendicular to molars to prevent putting finger in too far; cheek = barrier
possible tools of bolus mastication tx:
gloved finger, Nuk, chewy toy, z-vibe, lil crunchies
poor labial seal
inadequate ant. oral seal during oral and/or pharyngeal phase of swallow
presentation of poor labial seal
- open lips during drinking, shewing, or swallow
- open mouth posture
- Ant bolus loss
- drooling
- jaw weakness and/or instability
complications of poor labial seal
- unfavorable social feedings
- inefficient feedings secondary to bolus loss
- laryngeal penetration or aspiration secondary to poor oral seal
- complications assoc. w/ excessive drooling (social, personal, hygiene)
assoc. conditions w/ poor labial seal
hypo/hypertonia
- any dx or condition assoc. w/ abnormal muscle function/fatigue or decreased endurance
- decreased respiratory status
- cleft lip
- poor sensory awareness, sensory defensiveness, or feeding aversion
tx strategies for poor labial seal
labial tapping (passive)- tap lips in circular motion & follow w/ functional active task
labial stretches (passive)- stretch muscle in direction of muscle fibers; look for opposing m. pull/contraction
labial holding (active)- increases sensory and proprioceptive awareness- have them holding position, like holding pencil above lips
straw drinking (active)- make modifications- viscosity, cut straw, size of straw
spoon presentation
improve jaw stability & posture
spoon presentation for poor labial seal
Those w/o good tone = need flat spoon so they don’t have to do as much
- *Maroon spoons- have a lot of surface area; only contact middle part of lips; the more nerves you contact, the more nerves you stimulate;
- *Lateral/horiz presentation of spoon helps; go up & contact upper lip, as you pull off, activates a bit and helps child pull off food; make it easier to get child to activate to get reward (food)
4 things to do to achieve lip closure for tx
Flatbowl spoon, horz. Placement, contact upper/lower lips simult. & Downward pressure on tongue to get jaw to close more
weak suck
inadequate sucking strength to functionally and efficiently remove liquid from breast/bottle
-most common prob in infants
presentation of weak suck
- high suck/swallow ratio- bc of oral weakness, it takes infant 3-4 sucks to remove enough liquid to form normal-size bolus to swallow
- shortened sucking bursts (<10 sucks/burst)- weak sucking results in decreased ability to demonstrate normal-level sucking bursts
- general oral weakness- results in poor latch to nipple and limited effort exerted for each suck
- anterior loss of liquid
complications w/ weak suck
lengthy feedings (>30 min)- inefficient
- incomplete feedings (doesnt finish full feeding secondary to fatigue)
- poor weight gain
- aspiration secondary to high suck/swallow ratio
assoc. conditions to weak suck
- hypotonia
- any dx/condition assoc. w/ abnormal m. function, neurological dysfunction, fatigue or decreased endurance
- decreased respiratory status
- low birth weight or decreased sucking pads
- cleft palate (sometimes lip)
tx strategies for weak suck
- higher flow nipple (bottle)- to match level of weakness so they don’t have to suck as hard
- cheek support (during feeding)- to decrease size of oral cavity
- resistive sucking on pacifier (active) - good for nasal regurge to clear nasal passages & helps w/ weak suck
- gentle resistance w/ bottle (active)- hand on chest & gently pull on bottle while they pull back
- side-lying position- always increases strength & swallow safety
- monitor/modify behavioral state- swaddle & borders!
Things to remember:
- always wear gloves; use finger when possible
- use firm pressure to access muscle
- for low tone: vibration/tapping
- for high tone: stroking & firm, smooth movements to calm
- give client something to do during week, when you do not see him (homework?)
