quiz 7 Flashcards
what are the basic areas of evaluation in an oromotor exam?
- anatomic structure (symmetry, scar tissue)
- oral secretions (pooling or dried)
- strength
- range of motions
- coordination of lips, tongue, and palate for speech & nonspeech tasks
- lip closure and lingual function during spontaneous swallows
- frequency of spontaneous swallowing
SCROAL
- strength
- coordination
- oral secretions
- anatomic structure
- lip closure/lingual function (during ss, and freq of ss)
how might the SLP examine the swallow at bedside without risking aspiration of food or liquid?
using cloth dipped in different taste stimuli wrapped around a disposable straw
- gauze, satin, burlap: to represent different food textures
why examine the breath-hold?
determine if the patient can tolerate swallow maneuvers, or other therapy procedures that increase duration of the apneic (airway closure period) during swallow
need to hold breath for 5 seconds to use swallow maneuvers comfortably
why examine coordination of swallow and respiration?
it is safer to interrupt the exhalatory phase of the respiratory cycles because interrupting or returning to inhalation after the swallow could encourage inhalation of residue
prolonged phonation - how to evaluate?
- on the vowel /o/ in terms of vocal quality and respiratory control
- can they take an easy inahlation then a slow drop of the chest and inward motion of abdomen to produce a prolonged vowel on sustained phonation of at least 10 seconds
why should a gag reflex be evaluated?
to examine the pharyngeal wall motion as part of the motor response for the gag
- the pharyngeal wall motion should be symmetric (assymetry may indicate a unilateral pharyngeal wall paresis)
does the gag reflex and the swallow predict each other
there is NO evidence of the relationship between the presence and normalcy of a gag and the presence and. normalcy of a swallow
how is the blue dye test given and to whom?
presenting blue-dyed foods to patient with tracheostomy and suctioning after each swallow attempt to identify the presence of any food in the airway below the larynx
- given to those with a tracheostomy
cervical auscultation: what is the test and why is it not a definitive diagnostic test?
placing a stethoscope against their neck and listening to the sounds of swallow and respiration
- inhalation and exhalation phases of respiratory cycles can be identified and so can the phase during with the patient swallows
not definitive diagnostic test because:
- we don’t know if clinicians can detect normal from abnormal sounds
fiberoptic endoscopic examination of swallow (FEES)
methodology and what is/isn’t visualized
- nasal placement of a fiberoptic laryngoscope so the tip is positioned posterior to the uvula — so it visualizes the pharynx from above
- the oral stages are not visible
- bolus becomes visible as it comes over the base of the tongue and into the pharynx
- laryngeal/pharyngeal elevation is partially seen
- residual food in the pharynx after swallow
white out period: nothing can be seen as the pharynx closes around the endoscopic tube
can pharyngeal dysphagia be definitively diagnosed with a bedside evaluation?
NO — can’t identify the actual anatomical or physiologic abnormality causing the patient’s symptoms
modified barium swallow examination
& how do the findings influence treatment?
they are given thin liquids, pudding-type material, and something requiring mastication with barium and x-rayed while swallowing
-use postural strategies to see if they help
findings allow the patient’s swallowing therapy and recovery to be uninterrupted
6 outcomes sought in conducting an MBS
- identification of specific anatomical or physiologic dysfunction in patient’s oropharyngeal swallow
- relationship of physiology to patient’s symptoms (cause of residue or aspiration)
- identification of treatment strategies to improve pharyngeal swallow and conditions under which patient can eat safely, if possible
- need for any non oral supplement or non oral nutrition if patient aspirates and it cannot be stopped
- type of swallowing therapy needed to improve patient’s swallow
- need for, and timing of, reassessment of patietn’s swallow
- anatomical/physiologic dysfunctions in oropharyngeal swallow
- physiologic cause of residue/aspiration
- treatment strategies to eat safely
- non oral supplement/nutrition
- type of swallowing Tx
- timing of reassessment
explain differences between direct and indirect treatment for dysphagia
indirect: exercising msucle groups used in swallowing or practicing specific neuromuscular elements of the swallow without actually using food
direct: designed to actually change swallow physiology and the procedures are practied using food or liquied
- not provided if patient is aspirating
know the basic procedure associated with the shaker exercise
- they lie on their back and elevate their head just enough to see thie feet/toes while keeping shoulders on the bed
- head is elevated for 1 min, followed by 1 min of rest
- procedure is done 3 times with rest in between each head elevation
- after 3rd minute of rest they lift their head to see their toes and rest it back 30 times
