Swallow Quizzes Flashcards
What are the main objectives of the IDDSI Framework in the context of dysphagia management?
to standardize the classification of food and drink textures for individuals with dysphagia
What is the purpose of the IDDSI Flow Test?
to assess the viscosity of liquids
In the IDDSI Framework, IDDSI Level 7 is intended for individuals who:
have no swallowing difficulties
Which IDDSI level describes liquids that are “mildly thick” and can flow off a spoon but at a slower pace than water?
Level 2
What does the acronym “IDDSI” stand for in the context of dysphagia management?
International Dysphagia Diet Standardisation Initiative
Which testing method in the IDDSI Framework assesses the flow characteristics of fluids by observing their behavior when poured from a spoon?
Spoon Tilt Test
Using the IDDSI Flow Test, how many milliliters of liquid should be left after 10 seconds for Level 1 “slightly thick liquids”?
1-4 mL
Which group of foods can be categorized as transitional foods?
Wafers, Cheeto Puffs, ice cream
What level would it be appropriate to use the fork drip to test thickness?
Level 4
What size syringe should be used for the flow test?
10 mL
What are some causes of dysphagia
stroke, Parkinson’s disease, Alzheimer’s disease, brain injury, ALS, CP, MS, associated with head and neck cancer, and other surgeries involving head and neck.
What are the components of IOPI?
handheld pressure transducer, air-filled bulb, connecting tube, LED display for objective measurement in kPa.
What population can we use IOPI on?
All age ranges
What are three ways IOPI can be used for diagnostic evaluation?
Can help decide whether tongue strength is involved in oral-stage swallowing problems and/or dysarthria. Can help document the patient’s tongue weakness to justify strength exercises. Assess the results of tongue strength therapy and compare them to/or establish a baseline.
What are three ways IOPI can be used in therapy?
Exercise the patient’s tongue with specific targets/pressures, set exercise parameters using the principles of exercise science, and provide biofeedback during oral motor exercises.
What are the limitations of IOPI?
Lack of research with normative data, lack of information on sex differences, lack of information on children, variability among research (decreases pressure in various studies as compared to earlier studies), and lack of consistency in investigation procedures.
What can decreased tongue pressure present as?
Penetration and aspiration of foods; food remaining in the mouth after a swallow; and residue in the throat.
Where can the IOPI be utilized?
private practice, hospital, SNF, rehab, and patients can practice at home
Would using visual stimuli (such as a game) be an innovative idea for enhancing IOPI and establishing better therapy outcomes?
yes, it can help with patient motivation and show them visual feedback of their success.
The VFSS revealed significant swallowing impairments, including delayed swallow initiation, poor bolus control, and penetration of liquid into the airway. next step in therapy?
Education and counseling; IOPI device usage; and diet modification.
What muscles are responsible for expiration?
Internal intercostals, abdominal muscles, and accessory muscles.
What muscles are responsible for inspiration?
Diaphragm, external intercostal muscles, and some accessory muscles
True/false: The responsibility of the diaphragm is to expand the thoracic activity for inspiration and relax to reduce the thoracic cavity for expiration.
True
What does EMST stand for?
Expiratory Muscle Strength Training
What does IMST stand for?
Inspiratory Muscle Strength Training
What two values do you get from a Peak Flow Meter?
Peak Expiratory Flow (PEF) and Forced Expiratory VOlume 1 seconds (FEV1)
List 2 benefits of EMST
increase cough strength, improve protection, and increase vocal intensity
For EMST, training should start at what percentage of your total muscle strength?
75%
Should you blow into a Peak Flow Meter fast or slow?
fast
Who is a good candidate for IMST?
Someone with decreased maximum inspiratory pressure.
What does sEMG stand for?
Surface, Electro, Myo, Graphy
What is the purpose of sEMG?
provide visual biofeedback, used on swallow rehabilitation, and assess muscle activity in swallow
What disorder can sEMG be used for?
dysphagia
Why is biofeedback NOT important in swallow rehabilitation?
Biofeedback is only for the clinician to use.
True/false: Many swallow exercises and maneuvers can be done using the sEMG device?
True
List one maneuver that can be used with sEMG.
Mendelsohn’s and Effortful Swallow
Why should you place the electrodes in the same area each time?
consistent data in the same spot gives similar feedback, but you can’t compare data from one session to the next session. Compare the scores from the beginning of the session to the end of the session.
How do you calculate the Swallow Effort Ratio (SER)?
divide the peak amp of an effortful swallow by typical swallowing.
Explain how you would verbally cue a patient using Mendelsohn’s maneuver in the therapy.
Swallow your saliva and feel your Adam’s apple move up and down. Place your tongue tip against the ridge that’s behind your front teeth. Swallow your saliva again, but halfway through the swallow, hold your Adam’s apple up using the muscles under your chin. Hold it for 1-3 seconds. Repeat 10 times.
True/false: It does not matter if the sEMG bluetooth cables cross, information will still be accurately recorded.
False
Define the Family Systems Theory:
Considers the role of family/caregivers in the problems faced by an individual.
Define approach: This theory is based on a tension b/t individual freedom of choice and aspects of existence, such as responsibility, death, loneliness, and meaninglessness of the universe
existential approach
How could denial of impairments be dangerous for some patients?
This can lead to prolonged difficulties, poorer QOL, malnutrition, less motivation to eat/engage with others, etc.
What are some of the underlying feelings of angry patients?
it is important to consider the sources of a patient’s anger due to surface response to underlying feelings of fear or dread.
Name 3 counseling tips.
tone of voice, active listening, empathy, respect, perspective-taking, non-verbal communication, consistent communication, non-blaming language, clear statements, and appropriate question types.
Which of the following is not a social-emotional impact associated with dysphagia?
increased enjoyment eating food
True/false: When your client is feeling anxious, you should ask leading questions as a counseling technique.
false, asking leading questions can be perceived as manipulative and may give the clinician inaccurate impressions of how the person is feeling and thinking. For example, asking clients if they have been feeling anxious since their voice disorder began or asking a family member if they have been depressed since their husband’s stroke would be considered a leading question.
Which of the following is not a way clinicians can support families?
having interprofessional skills
True/false: Counseling is a broad term that refers to assistance provided interactively to individuals and their families/caregivers dealing with challenging emotions to facilitate realistic and clearly understood goals and improve QOL.
True
Treu/false: Transference is the clinician’s perceptions, beliefs, wishes, and responses to a client which are influenced by the client’s characteristics from past experiences.
False
True/false: The four basic elements of informed consent are purpose, benefits, risks, and alternatives.
True
What does the SMART goals acronym stand for?
Specific, measurable, attainable, relevant, timely
What is Shared Decision Making (SDM) and why is it important?
Facilitates patient-centered standard of informed consent and ensures decisions are integrated with the best available evidence and patient values.
Which of the following are the three most common barriers to informed consent?
capacity, limited English proficiency, and refusal
Consider how you would give informed consent before administering an MBSS evaluation.
Purpose: assess swallow efficiency and airway protection, and recommend treatment.
Benefits: considered the “gold standard”, assesses all stages of swallowing.
Risks: radiation exposure, aspiration, discomfort, unnatural due to positioning and foods.
Alternatives: CES, FEES
How would you proceed with proposing a modified diet? Discuss the risks, benefits, and alternatives. Consider the quality of existing evidence.
- information provisions are particularly important, make sure pt understand this is not an end all be all
- Purpose: reduce risk of aspiration/choking
- Benefits: possibly reduce choking and pneumonia, easier to control swallow
- Risks: increase in pharyngeal residue, effects on medications, malnutrition, dehydration, disruptions to eating and lifestyle
- need to consider and disclose overall lack of supporting evidence
- Alternatives: normal diet, feeding tube, trial therapy
How many key parameters does the APEKT method assess?
8
The main purpose of the ASPEKT-C method is to:
Assist clinicians in identifying mechanisms leading to impaired swallowing safety and efficiency on videofluoroscopic swallow studies.
What is the main difference between the ASPEKT method and the ASPEKT-C method?
ASPEKT-C is a shorter process for regular use by clinicians.
True/false: The ASPEKT- method assesses both foods and drinks from the IDDSI scale.
False
True/false: Swallowing safety is defined as the ability to protect the airway and swallowing efficiency as the ability to clear material through the esophagus.
False
The swallowing safety section of the ASPEKT method includes all of the following except:
Total pharyngeal residue
What PAS scores are considered to be impaired?
3, 5-8
What is the correct formula for PhAMP?
(pharyngeal area) (c2-c4)^2 x 100
What vertebrae are used to calculate cervical?
C2-C4
PhAMP is defined as?
The area of un-obliterated visible airspace and/or bolus at maximum constriction during the first swallow of the bolus.
The SOS Approach is?
A transdisciplinary program for assessing and treating children with feeding and weight/growth difficulties.
Circle all tenets of the SOS program.
Myths about eating, systematic desensitization, normal development, and food hierarchies/choices.
What are some special populations to consider in pediatric dysphagia management?
Autism and CP
Compare and contrast picky eaters vs. problem feeders.
- Picky eaters: decreased variety; typically 30 /more food in their food range. Eats at least one food from most nutrition or texture groups. Can tolerate new foods on their plate (can touch/taste food).
- Problem feeders: restricted variety; usually eats less than 20 foods. refuses entire categories of food textures or nutrition groups. Cries, screams, tantrums, falls apart when new foods are present (complete refusal).
- Picky: decreased variety of food (30+), burn out from food jagging and will eat again after break, eats at least one food from most nutrition/texture groups, eat new foods in 20-25 steps, can tolerate new foods on plate, eats different sets of food at meal at same time/table as family
- Problem: restricted variety (20-), burn out from food jagging and won’t eat again after break, refuses entire categories of food textures or nutrition groups, eat new foods in more than 25 steps, refusal of new foods, eats different set of foods at different time/table as family
List one example for each food in the developmental food continuum.
Hard munchable: Slim Jim/ bell pepper
Meltable hard solid: graham cracker
Soft cubes: banana/avocado
Soft mechanical (single texture): eggs / plain muffin
Soft mechanical (mixed texture): spaghetti with sauce / mac n cheese
Hard mechanical: hard cookies / tortilla chips
What is NOT a discharge criteria for the SOS program?
Child will be able to take in adequate amounts of nutrition via an age-appropriate container, to sustain hydration and to support growth.
What is NOT part of the assessment phase?
Assessment at home in the child’s natural setting
What is true about peer-feeding groups?
Access to a wider variety of therapeutic foods that can be specifically prepared to meet therapy needs.
Positive social reinforcement is used to support mastery of each step in the eating hierarchy.
True
Food/eating hierarchies include which requirements?
Nutrition, texture, sensory, structure
What is NMES an abbreviation for:
Neuromuscular Electrical Stimulation
E-Stim may be used in various types of therapy for:
Muscle rehabilitation
What are the types of neuromuscular electrical stimulation (NMES)?
VitalStim, Guardian, AmpCare, eSwallow, and PENS
Neuromuscular Electrical Stimulation (NMES) is a method for stimulating muscles with long electrical pulses.
False
What is VitalStim?
NMES device that administers small, electrical impulses to the swallowing muscles in the throat through electrodes attached to the skin overlaying the musculature.
E-Stim is safe to use for everyone, no matter what.
False
ASHA’s stance on E-Stim:
ASHA does not have an official position on the use of E-Stim
Guardian Way electrical stimulation has research to show it is reliable for muscle rehabilitation therapy.
False
What does AmpCare claim to do?
Resulting in significant and functional improvements in swallow safety.
Circle all contraindications for E-Stim:
Do not use if the patient has a cardiac pacemaker or implanted defibrillator.
Do not use if connected to lead wires.
