Strategies & Therapies Flashcards by Gabriela Senior

Dysphagia treatments are divided in two main groups: ________________ & __________________

Compensatory Strategies

Therapies

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What are the COMPENSATORY strategies?

Diet modification
Positional
Oral Sensory
Prosthetics

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What are the types of THERAPIES?

Maneuvers
Exercises
Surgeries

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Which compensatory strategy is done as a LAST RESORT?

Diet modification !!!

Why? Because this affects QOL
this is done only if other comp. strategies fail or if the pt. is severely cognitively impaired.

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T or F: Compensatory strategies are designed to ELIMINATE SYMPTOMS.

TRUE!

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T or F: Compensatory strategies are NOT dependent of the caregiver and increases motor control of swallow.

FALSE!
Caregiver is in CONTROL!
DOES NOT INCREASE motor control of swallow.

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T or F: Therapies INCREASE the swallow anatomy & physiology and INCREASE ROM , control and strength

TRUE

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What is the difference b/w DIRECT vs. INDIRECT therapy?

Direct = use of swallow to perform therapy. 
Indirect= swallowing is not involved to perform therapy.

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Diet modification involves changes in bolus ______?

consistency
size
volume
viscosity 
taste
temperature

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What are the consistencies of LIQUIDS?

THIN -(water)
NECTAR- (v8)
HONEY

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What are the consistencies of SOLIDS?

PUDDING
PUREE - (apple sauce) 
MECHANICAL SOFT - (scrambled eggs) 
CHOPPED - (corn hash) 
REGULAR - (cracker)

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Mention all of the POSITIONAL (6) strategies:

1) Sitting at 90 degrees
2) Head Rotation
3) Head Tilt
4) Head Back
5) Chin Tuck
6) Lying on side

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Mention all of the ORAL SENSORY strategies:

1) Thermal tactile stimulation
2) Sour bolus
3) Cold bolus
4) Pressure with spoon against tongue
5) Bolus requiring chewing
6) Suck-swallow

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What does a person do with the thermal tactile stim?

Vertically rubs anterior facial pillars 4-5 times with a lemon swab or a cold laryngeal mirror
**helps w/ oral awareness and triggers pharyngeal swallow

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What is the suck-swallow?

Vertical JAW-TONGUE SUCKING with LIPS CLOSED

**triggers pharyngeal swallow and draws saliva back

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Sitting up at 90 degrees

Directs bolus down (w/ gravity)

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Lying on side

Lie on STRONG SIDE!
Eliminates residues (no gravity)

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Chin Tuck

Places EPIGLOTTIS IN PROTECTIVE position
NARROWS AIRWAY entrance 
INCREASES LARYNGEAL ELEVATION & VF CLOSURE
WIDENS VALLECULAE (avoid penetration)
PUSHES TONGUE BASE BACK

Head rotation

Rotate to WEAK SIDE! (close off damaged area)

Directs bolus to strong side.

Head tilt

Tilt to STRONG SIDE!

Directs bolus to strong side (w/gravity)

Head back

CLEARS ORAL CAVITY (w/gravity)

What are the types of PROSTHETICS that can be done?

Dentition
Soft palate
Palatal lowering (hard palate)
Lingual

What is the purpose of the prosthetics?

Improve speech intelligibility & oral prep/phase (chewing, bolus formation, bolus transport, bolus control etc)

Who can get a PROSTHETIC?

CONGENITAL DEFECTS (cleft lip/palate, disease, bifid uvula) 
ACQUIRED DEFECTS (disease, trauma, burns)

What are the 4 types of MANEUVERS?

1) Effortful 2) Supraglottic 3) Super-supraglottic 4) Mendelsohn

Steps: EFFORTFUL SWALLOW

1) SQUEEZE hard all of your throat/pharyngeal muscles BEFORE SWALLOW 2) SWALLOW while SQUEEZING

Steps: SUPRAGLOTTIC

1) Inhale and HOLD BREATH before swallow 2) Place BOLUS IN BACK OF TONGUE 3) Swallow 4) Cough before inhaling 5) Swallow & breath

Steps: SUPER-SUPRAGLOTTIC

(effortful + supraglottic) 1) Inhale and HOLD BREATH before swallow 2) Place BOLUS IN BACK OF TONGUE 3) SQUEEZE while swallowing (bear down) 4) Cough 5) Swallow

Steps: Mendelsohn (hardest to teach!)

1) PUSH TONGUE AGAINST ROOF OF MOUTH 2) HOLD SWALLOW - THRYOID CARTILAGE UP for at least 3 seconds * Should have pt. practice with dry swallows to feel their thyroid lift up.

What are the EXERCISES?

1) Shaker 2) Masako 3) Oral Motor

Steps: SHAKER (head lift exercise)

1) LAY FLAT ON BACK (bed or floor) 2) LIFT HEAD and LOOK AT FEET for 1 minute! (do not raise shoulders!!!) 3) TAKE 1 minute BREAK 4) REPEAT SEQUENCE TWICE 5) RAISE HEAD 30times & LOOK AT TOES (don't sustain) 6) REPEAT ENTIRE THING 3 TIMES per day!

Steps: MASAKO

1) STICK TONGUE OUT 2) GRIP w/ LIPS 3) DRY SWALLOW!

Oral motor exercises increase _______, ________, and ___________.

ROM Resistance Bolus maintenance

What are the types of surgeries (5)

1) CP MYOTOMY 2) DIVERTICULECTOMY 3) VF MEDIALIZATION 4) PALATOPEXY 5) DILATION

What are the types of EXPERIMENTAL treatments available for dysphagia?

1) DPNS - (Deep Pharyngeal Neuromuscular Stimulation) 2) NMES - (Neuromuscular Electrical Stimulation) 3) Myofascial release 4) Botox

Which of the experimental treatments is a MANUAL TECHNIQUE?

Myofascial release!

Which experimental treatment is mainly used for achalasia, CP dysfunction, & motility issues?

BOTOX!

Which experimental treatment places frozen lemon ice sticks in 9 sites in mouth and throat?

DPNS!!!

Which experimental treatment uses surface electrodes applied over swallowing muscles?

NMES

Which NMES company is more efficacious (Dr. C's opinion) a. Vital Stim b. E-Swallow c. Ampcare

C- AMPCARE | why? b/c it involves only one channel of electrodes (suprahyoid muscles)

What is the main PURPOSE of DPNS?

- TREAT neuromuscular weakness or incoordination - ACTIVATE MUSCLES - STRENGHTEN neuro m. signals - INCREASE m. strength

What is the main PURPOSE of NMES?

- INCREASE m. strength | - FACILITATE MOTOR MVMT

What is the main PURPOSE of MYOFASCIAL release?

- LOOSEN TIGHT MUSCLES and fascial adhesions | - IMPROVE CIRCULATION

What is the main PURPOSE of BOTOX?

- DEADENS TRANSMISSION OF NERVE TO M. | - RELAX muscle