Therapy Procedures Flashcards
Goal
- Designed to change the physiology of the swallow
- Improve range of motion or oral and pharyngeal structures to:
improve sensory input, voluntarily control timing of swallow, improve coordination of some oropharyngeal movements
Indirect Therapy
- For those who can’t have food; aspirate on all food viscosities and volumes
- Exercise programs or swallows of saliva
- Tx focuses on improve control of muscles for swallowing
Direct Therapy
- Present food/liquid to Pt to swallow with specific instructions
- Present small amounts at a time to protect airway
- Encourage Pts to cough intermittently to clear any debris
Oral Motor Control Exercises
Pts with tongue control difficulties such as:
- tongue lateralization
- elevation to hard palate
- cupping of the tongue around the bolus to hold it with the sides of the tongue sealed to the lateral alveolar ridge
- A-P movement of the midline of the tongue in the initiation of the voluntary or oral stage of the swallow
Range of Motion Tongue Exercises
Tongue Elevation:
- to alveolar ridge and hold
- elevate back of tongue as high as possible
- lateralize tongue as if to clear debris from lateral sulcus
- protrude tongue out of mouth
- retract tongue as far as possible
Bolus Control Exercises
To improve gross manipulation of material
Technique: Use a rolled 4”X4” gauze pad or licorice stick for Pt to manipulate one end while the clinician/patient can assist to prevent loss of control/choking
Range of Motion Exercises for Pharyngeal Structures -Airway Closure
Effortful closure task:
- Pt take in breath and hold it while bearing down
- Should NOT be used for Pts with high blood pressure and/or cardiac issues - can use frequent hard glottal attack upon phonation of a vowel
Vocal Fold Adduction Exercises:
- Pt bear down against a chair with only one hand and to produce clear voice simultaneously
- Pt then lift or push simultaneously with voicing– sit and pull up on seat with both hands with a prolonged phonation
OR
- Pt begin phonation of “ah” using an initial hard glottal attack followed by sustained phonation with a clear and smooth vocal
Range of Motion Exercises for Pharyngeal Structures - Tongue Base exercises
- Pull back tongue as far as possible and hold
- Pretend to gargle
- Pretend to yawn
Swallowing Maneuvers
Designed to place specific aspects of pharyngeal swallow physiology under voluntary control - Supraglottic Swallow - Super-Supraglottic Swallow - Effortful Swallow - Mendelsohn Maneuver
Supraglottic Swallow
Designed to close airway at level of vocal folds before and during swallow
Goal: protect the trachea from aspiration
Super-Supraglottic Swallow
Designed to close airway at false vocal folds before and during swallow
Used for:
- Pts with reduced airway closure
- Pts with poor tongue base retraction
- Pts with supraglottic laryngectomy
- Pts with radiotherapy to neck
Effortful Swallow
Designed to increase posterior motion of the tongue base during pharyngeal swallow to improve bolus clearance from valleculae
Directions:
As you swallow squeeze hard with all of your muscles to improve pressure exerted by the oral tongue at all points along the palate, tongue base, increase tongue base movement
Mendelsohn Maneuver
Designed to increase extent and duration of laryngeal elevation to increase duration and width of cricopharyngeal opening (UES)
Used for:
- Pts with reduce laryngeal movement
- Pts with discoordinated swallow
Swallowing Maneuver Prerequisites
- Ability to follow directions – NOT used in cognitively impaired or SLI Pts
- Require increased muscle efforts – NOT used in Pts easily fatigued
- Used only temporarily – NOT used long term, only until normal swallow recovers
