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Dysphagia > Techniques > Flashcards

Techniques Flashcards

0
Q

Name the compensatory posture techniques

A 
Chin tuck
Head rotation
Heat tilt
Side lying
Neck extension
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1
Q

What does the patient need to understand?

A

What should be happening in their swallow
What isn’t happening
Why this is an issue for them
What they can do to change it

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2
Q

Name the two compensatory delivery options

A

Rate of delivery

Mode of delivery

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3
Q

Name the compensatory sensory techniques

A

Taste/flavour
Temperature
Size and texture

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4
Q

Name compensatory bolus modifications

A

Consistency

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5
Q

Name compensatory bolus control and clearance techniques

A

Pharyngeal expectoration
Lingual sweep
Double swallow

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6
Q

Name the rehabilitatory voluntary control/swallow manoeuvres…

A 
Controlled swallow
Effortful swallow
Supraglottic swallow
Super supraglottic swallow
Mendelssohn's manoeuvre
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7
Q

Name the rehabilitatory exercise/stimulation programs

A 
Masako manoeuvre 
Shaker (head lift) exercise
Orofacial exercise
Vocal adduction exercises
Breathing exercises
Pharyngeal strengthening exercises
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8
Q

Describe the chin tuck technique

A

Tuck chin to chest and look at knees during swallow

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9
Q

When do you use the chin tuck technique

A

For delayed onset pharyngeal swallow in isolation, or reduced posterior movement of the tongue
Also worth a try to see if it helps with premature spill

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10
Q

How does the chin tuck work

A

Moves epiglottis forward and narrows entrance to larynx - improved protective closure of larynx under base of tongue
Reduces anterior-posterior dimensions of the pharynx bringing base of tongue and posterior pharyngeal wall closer

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11
Q

Describe the head rotation…

A

Torso remains forward

Turn head to weak side to full extent of comfort

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12
Q

How does head rotation work?

A

Closes weaker pharyngeal side and directs bolus down stronger side
Aids upper oesophageal sphincter opening due to mechanical action

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13
Q

Who do you use head rotation on?

A

Patients who show unilateral weakness

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14
Q

Describe head tilt

A

Patient instructed to tilt head towards stronger, non-damaged side during oral intake

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15
Q

How does the head tilt work

A

Tilting head to the stronger side may direct bolus does the stronger side

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16
Q

Who do you use head tilt with

A

Impaired oral motor control
Unilateral pharyngeal weakness
Asymmetric altered anatomy

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17
Q

Describe neck extension

A

Patient to extend neck with back erect when preparing to transfer the bolus out of the oral cavity into the pharynx

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18
Q

How does the neck extension work?

A

Uses gravity to move the bolus into the pharynx (but inhibits UES opening)

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19
Q

Who do you use neck extension with?

A

Patients with profound oral phase impairment who do have good airway protection abilities

Those with excellent cognition

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20
Q

What are the Different modes of delivery?

A

Self-feeding vs fed

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21
Q

What are the benefits of self-feeding

A

Can assist orientation and awareness. Facilitate improved oral stage

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22
Q

Who can’t be asked to self-feed

A

Patients with poor cognition, bad positioning, physical capacity

23
Q

How can you alter rate of intake?

A

Slow it down by using…
Teaspoon vs standard spoon
Small cup vs standard cup
Put fork/spoon down between mouthfuls

24
Q

Who benefits from a change in rate of intake?

A

Patients with poor oral control

Or patients with dementia/TBI - impulsive

25
Q

What are different routes of intale

A

Oral - cup, straw, fork/spoon

Non-oral - NGT, PEG, TPN

26
Q

What are some problems with the straw?

A

Harder to control bolus size

Can be dangerous as negative suction action can cause fluids to be pulled quickly into pharynx and aspirated

27
Q

Who is the straw beneficial for?

A

Patients with poor oral control

28
Q

How does thermotactile stimulation work?

A

Clinician uses small, ice cold mirror to stroke and stimulate the base of the anterior faucial arch to enhance sensory awareness, which can help trigger swallow

29
Q

How does orofacial brushing work?

A

Clinician uses brushes/fingers/cold swabs to stroke the facial muscles and oral structures to either enhance awareness, or reduce hypersensitivity
It enhances sensory awareness of oral and facial structures to help encourage oral movement to help stimulate swallowing

30
Q

How does cold bolus, sour bolus, carbonated bolus and textured bolus work?

A

Enhances sensory awareness and therefore can help trigger swallow and speed up total swallow duration

31
Q

Who are cold/sour/carbonated/textured bolus used with

A

Patients with slow oral transit and delayed swallow trigger

32
Q

How does changing the size of bolus help?

A

By altering the volume in the mouth, it either provides the patient with more sensory feedback - OR - by reducing size, assists ability to control bolus

33
Q

What are the benefits of thickened fluids

A

Reduces aspiration risk for some patients

Slows the flow of bolus, increases the cohesion of the bolus

34
Q

What is a problem with thick fluids?

A

Can be hard for patients to propel

35
Q

How does the lingual sweep work?

A

Use tongue (or finger) to clear residue from buccal, sublingual, intra-oral areas

36
Q

How does second swallow/clearing swallow work?

A

After each bolus swallow, the patient has a dry swallow to clear residue

37
Q

What are other techniques that can be used to control the bolus?

A

Patients need to concentrate on food and not get distracted
Discourage laughing and talking while eating
Go slowly
Give small mouthfuls
Make sure each mouthful has been swallowed before giving next bite

38
Q

Describe a controlled swallow

A

Teach patient to control bolus in mouth and then train commencing swallow at will, then combine

39
Q

What is involved in an effortful swallow?

A

As you swallow, squeeze hard with all your muscles (should get increased lingual effort)

Used for problems with base of tongue and bolus clearance

40
Q

When do you teach a controlled swallow?

A

For patients with issues with bolus containment and initiation of swallow

41
Q

What is a supraglottic swallow?

A

Take a breath and hold it while swallowing bolus.

Post swallow expel air forcefully with cough prior to inhalation

42
Q

What is the point if supraglottic swallow?

A

Provides conscious, volitional airway protection

43
Q

Who do we use supraglottic swallow with?

A

Patients with inadequate airway protection particularly silent aspiration

44
Q

Describe the super-supraglottic swallow

A

Take a deep breath and bear down while swallowing the bolus. After the swallow, exhale forcefully or cough

45
Q

What is the point of the super-supraglottic swallow?

A

Designed to close entrance (not just the folds) of the the airway before and during the swallow

46
Q

Who do you use the super-supraglottic swallow with?

A

Patients with problems with airway protection

47
Q

Describe the Mendelssohn manoeuvre.

A

Become familiar with movement of larynx when swallowing and then try to hold the larynx up for a few seconds during a dry swallow. Then try with bolus swallow

48
Q

Who do we use the Mendelssohn manoeuvre withL

A

People with problems with airway protection, and poor Cricopharyngeal opening

49
Q

What does the Mendelssohn manoeuvre do?

A

Designed to increase the extent and duration of laryngeal elevation and thereby increase duration and width of Cricopharyngeal opening

50
Q

What are the benefits of oromotor therapy?

A 
Improved jaw strength and range of movement
Buccal  tension
Lip  closure
Improve  lingual manipulation
Improve tongue  strength
51
Q

How do we improve base of tongue to posterior pharyngeal wall?

A

Masako technique - hold tongue tip between teeth and swallwo

52
Q

What is a way to improve pharyngeal contractions

A

Dry gargle

53
Q

What is the aim of the head lift (Shaker) technique

A

Strengthening the supra hyoid muscles - including geniohyoid, thyrohyoid, digastric muscles

54
Q

How do we determine fluid consistency?

A

Line spread test

Dysphagia (5 decks)

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