swallowing 2 Flashcards
indirect treatment involves food (t/f)
false; indirect treatment doesn’t involve food
examples of indirect treatment are
oral-motor control exercises, exercises designed to stimulate the swallow reflex, exercises designed to improve adduction of tissue at the top of the airway, exercises to increase base of tongue strength
what is the benefit of the supraglottic swallow
helps close the airway at the level of the VFs to prevent aspiration
How to do the supraglottic swallow
the pt is asked to hold the food in the mouth, take a deep breath n d hold it soon after initiating a slight exhalation, swallow while holding the breath, and cough soon after the swAllow
super-supraglottic swallow benefits
helps close the airway before and during swallow; also promotes false VF closure
how to do super-supraglottic swallow
The pt is asked to inhale and hold the breath tightly by bearing down (an action that tilts the arytenoids and helps closed the false folds) and swallow while holding the breath and bearing down. The pt coughs soon after the swallow using this technique.
benefits of the effortful swallow
helps increase the posterior motion of the tongue and increase pharyngeal pressure
how to do effortful swallow
the pt is asked to squeeze as hard as possible while swallowing; this may be more effective when combined with infra hyoid motor electrical stimulation
benefits of Mendelssohn maneuver
helps elevate the larynx and thus widens the cricopharyngeal opening
how to Mendelsohn maneuver
pt is first educated about laryngeal elevation, then asked to palpate the laryngeal elevation when swallowing saliva, and finally, taught to hold the laryngeal elevation during swallowing for progressively longer durations
leading cause of non-fatal TBI in the US
falls (35%)
mild TBI rarely results in dysphagia (T/F)
True; mod-severe TBI can result in dysphagia
dysphagia can result in malnutrition, aspiration pneumonia and what else?
- dehydration
- other lung disease processes
- possibly death
incidence of dysphagia is as high as ___% in patients admitted to rehabilitation for TBI
93%
factors that can affect swallowing post-TBI
medications (sedation, pain) ventilation (trach, intubation) injury (head/neck, etc) poor safety awareness motivation issues w/ insight depression/mood
what Is the impact of cognitive-communication and behavioral deficits in swallowing?
inattention - forget to eat, distractable or eat impulsively
low arousal - may cause swallow trigger delay
memory - may forget appropriate consistency or strategies
ex dysfunction- planning/organizing/attn deficits leads to not generalizing strategies to “real life” eating situations
behavior/agitation - outbursts may create higher risk for aspiration/choking or inadequate oral intake
assessment of dysphagia components
- Pt hx
- OME (CN involvement, dentition, oral hygiene)
- cog-comm screen
- observation of fx
- instrumental/non-instrumental
the purpose of rehabilitative/restorative interventions is to restore function (t/f)
true
what is the purpose of compensatory interventions? (i.e., strategies, diet modifications)
not to restore fx, but prevent aspiration or s/s of dysphagia
exercises that impact swallowing physiology and bolus flow are (rehabilitative/compensatory)
rehabilitative
tongue hold exercise is for which pts
for pts w/ decreased contact b/w tongue base and pharyngeal wall
how to do tongue hold
bite your interior tongue and swallow (creates bulkiness in the anterior pharyngeal swallow and allows for increased contact b/w tongue base & pharyngeal wall)
shaker exercise targets
decreased UES opening and weakness of suprahyoid muscles
how to perform shaker exercise
lie on back (supine), perform 3 head lifts, sustain fo 1 minute each, then 1 minute rest, then 30 consecutive head lifts for 2 seconds each
goal of shaker exercise
increase hyo-laryngeal excursion, increase strength in supra hyoid muscles, & shortening the thyroid-hyoid space
tongue is considered compensatory/rehabilitative/both
both
what are the 3 modifications for liquids
thin, nectar, honey
what are the modification levels for solids
puree
mechanical soft (cooked, ground, soft)
mechanically advanced (cooked, chopped, softened)
regular/solid
chin tuck benefits
expands vallecular space and narrows laryngeal vestibule w/ decreases the chance of aspiration
chin tuck is for pts w/
- reduced tongue base retraction
- decreased airway protection due to delayed swallow
head turn is used for
unilateral pharyngeal or laryngeal weakness
how to perform head turn
turn your head to the impaired side
how head turn helps
it closes off the weak side and keeps the bolus going towards the stronger sided
head tilt is used for
unilateral oral weakness
how to perform head tilt
tilt head to stronger side as it redirects the bolus to the stronger side, so you can can chew on the stronger side
supraglottic swallow is used for
reduced airway protection
how to do supraglottic swallow
hold breath, swallow, then cough, inhale
supraglottic swallow benefits
increased airway protection, increased arytenoid approximation, approximation of false VFs, increased opening of UES
how to do super-supraglottic
hold breath, bear down, swallow, cough, swallow again
super-supraglottic swallow is for
reduced airway closure
how to do effortful swallow
squeeze and swallow hard
effortful swallow targets
vallecular and/or pyriform sinus residue and reduced airway closures, also increases hyolaryngeal excursion and improving laryngeal closure
how to do Mendelsohn maneuver
start to swallow until they feel there cricoid cartilage raised, then swallow while it’s raised, and let it go
mendelsohn maneuver targets
decreased hyolaryngeal excursion and/or decreased duration of UES opening
best swallowing treatment is
the act of swallowing itself (functional)
oral motor exercises in dysphagia treatment
very little to no evidence, needs additional research and studies
poor oral hygiene is a risk factor for aspiration pneumonia (T/F)
True
purpose of Frazier free water protocol
a means of increasing hydration and quality of life in pts
Frazier free water protocol based off
based on pt noncompliance w/ thickened liquids as well as research supporting safety of water when aspirated (human body is made up of 60% water and when small ants are aspirated, water is quickly absorbed into the lungs & tissue; water has a neutral pH)
oral hygiene is an important component to Frazier free water protocol (T?F)
true; oral hygiene is a must prior to consuming water in order to decrease bacteria
