Swallowing Intervention

Question 1

Oral care rationale

Answer 1

• Studies have linked poor oral hygiene to development of aspiration pneumonia
• Oral care is often not a priority
• Reduces Pneumonia and death rates

What is considered ‘best practice’?
• Use of lip balms and mouth gels when needed
• Best practice would be oral care at least twice
per day

Question 2

What does an impaired cough reflex mean?

Answer 2

Increase risk of aspiration

Question 3

Oral care strategies

Answer 3

Use simple language to communicate what is happening
(use communication aides such as a picture board if
needed)
• Ensure oral care is undertaken in a calm environment
• Make oral care part of the routine
• Allow the individual to assist whenever possible
• Allow them to hold something if they can not assist
• Ensure they are comfortable and relaxed

Question 4

Chin tuck against resistance

Answer 4

Strengthens suprahyoid muscles

Question 5

Shaker/head lift exercises

Answer 5

• Targets reduced opeening of cricopharyngeal sphinecter, decreased laryngeal elevation or pharyngeal contraction
• Good for strokes
  Performed in supine position (laid down), lift heaad x3 for 10 sec, 30 times

Question 6

Masako exercise

Answer 6

• Base of tongue to posterior pharyngeal wall contact
• Targets decreased strength of pharyngeal swallow
  
  • NOT WITH FOOD
  • Poke out tongue and swallow
  • Further out harder it is
  • Comes in reps
    Videofluroscopy necessary before deciding on this technique

Question 7

Effortful swallow

Answer 7

• Both a restorative and compensatory technique
• Swallow hard
• Targets decreeased laryngeal elevation and reduced pharyngeal contraction
• Increasing BOT to postererior pharyngeal wall contact
  Limited evidence available

Question 8

Mendehlson Manouvre

Answer 8

• Can be difficult to teach
  
  • Targets reduced opeening of cricopharyngeal sphinecter, decreased laryngeal elevation or pharyngeal contraction
    Aims to keep UES open for longer to decrease pooling in pyriforms

Question 9

Swallowing: Postures

Answer 9

• Chin tuck

Aims:
 Change flow of bolus (route and rate)
 Reduce signs and symptoms of dysphagia
 Reduce risk of development of complications of dysphagia

Question 10

Swallowing: Postures

Answer 10

Chin tuck
○ Treat delays in swallow, tongue control, reduce post tounge moevment
○ How? Widens valleular space, narrows airway entrance pushes Base OTongue to Posterior Wall, puts epiglottis in protective position.
○ If approariate use straw to assist
○ Don’t use with poor oral closure
Wary if poor laryngeal closure

Head Rotation
○ Direct bolus to stronger side of pharynx through rotation to weaker side
○ Can use in conjunction with chin tuck
○ Less obvious - reluctant to use inpublic
○ Unilateral vocial fold paresis

Body posturing
Improves ability to self-feed, aid in airway protection and maximise comfort

Question 11

Bolus Control

Answer 11

3 second Prep
		○ "1, 2, 3, swallow"
		○ Manage delayed pharyngeal swallow or eating too fast
		○ Useful for parkinson's or ataxia
Moves from autonomous to conscious task

Lingual sweep
○ Clear oral residue
Finger if tongue is too weak

Dry swallows (multiple swallows)
○ Post-swallow residue
○ Twice the work -> fatigue effect
○ Trial with VF

Question 12

dysphagia clients: What to look for

Answer 12

Teach what to listen for:

- Clearing throat - Voice quality check

Question 13

Pre and post intervention measure for quality of life?

Answer 13

SWAL-QOL

Question 14

ICF measurement?

Answer 14

AUSTOMS