Treatment Flashcards
1
Q
Head back to 60 degrees
A
Tilt head back after placing bolus in mouth when posterior movement is needed
2
Q
Chin tuck (head flexion)
A
chin tipped down and back w/o neck flexion
3
Q
chin down to 45 degrees (combined bead and neck flexion)
A
head and neck flexed forward 45 degrees with chin as close to the chest as possible prior to swallow attempt
4
Q
head rotation
A
head turned to weaker side parallel w/ shoulder prior to swallow
5
Q
head tilt
A
tilt head towards strong side parallel to shoulder prior to swallow
6
Q
side-lying
A
person eats and drinks while lying on side
7
Q
breath-holding
A
prior to swallow, hold breath and don’t release until after swallow
8
Q
food texture alteration
A
puree, nectar thick, honey-thick
9
Q
sensory heightening
A
manipulate taste (sour, carbonation), temperature (cold), and touch
10
Q
Tactile-thermal stimulation
A
Size 00 laryngeal mirror used to stroke anterior faucial pillars from top to bottom w/ firm touch; repeated 5-10 times w/ instructions to swallow following sets
11
Q
Obturator
A
cutomed designed to fill defect and/or attach to surgically anchored implant
12
Q
palatal lift
A
custom-designed to the size and shape of the oral cavity with the position set to provide partial soft palate elevation
13
Q
Behavioral therapies for drooling
A
use of cueing and self-monitoring to increase awareness of saliva, improve lip closure, and swallow more frequently
14
Q
Medical/surgical therapy for drooling
A
Surgical: salivary gland rerouting/excursion; correction of dental malocclusion in childhood; EMG for biofeedback; pharmacological
15
Q
Behavioral therapies for pocketing of food in lateral sulci
A
introducing food to stronger/more sensitive side of oral cavity; head tilt to stronger side
16
Q
Behavioral therapies for pocketing of food in anterior sulci
A
head back posture
17
Q
behavioral therapies for difficulty maintaining the bolus
A
head back posture
18
Q
medical therapies for difficulty maintaining the bolus
A
intraoral prosthetics
19
Q
behavioral therapy for difficulty chewing
A
change diet to consistency more easily managed (liquids, purees, mechanical softs)
20
Q
behavioral therapies for excessive gagging
A
desensitization through use of applied pressures, vibration, ice
21
Q
behavioral therapies for prolonged oral prep time
A
change diet to consistency more easily managed (liquids, purees, mechanical softs)
22
Q
behavioral therapies for loss of control of bolus
A
tactile thermal application to increase oral sensitivities
23
Q
behavioral therapies for delay in swallow trigger
A
chin tuck; tactile thermal application; cold-textures and/or flavored bolus; thick or pureed diet
24
Q
behavioral therapies for laryngeal penetration
A
chin tuck; head rotation to weak side; (super) thick or pureed diet; breath-hold
25
behavioral therapies for aspiration
chin tuck; head rotation to weak side; thick or pureed diet; breath-hold
26
Medical/surgical intervention for aspiration
if due to unilateral VF paralysis: VF medialization surgically or by injection
27
behavioral therapies for vallecular stasis
chin tuck
28
behavioral therapies for pyriform sinus stasis
head rotation
29
medical/surgical intervention for pyriform sinus stasis
cricopharyngeal dilation; myotomy; botox injection
30
behavioral therapies for pharyngeal stasis
head rotation to weak side; head tilt to strong side; side lying posture; alternating thin and thick viscosity boluses to clear stasis
31
behavioral therapies for nasal regurgitation
avoid chin tuck!; thicken liquids
32
medical/surgical intervention for nasal regurgitation
prosthetics: palatal list prosthesis; surgical: pharyngeal flap surgery or palatoplasty
33
Tongue exercises
push against a tongue depressor held at lips, held to each side, positioned in oral cavity to resist superior and anterior tongue movement; IOPI (or other pressure gauge) used to measure tongue to palate pressure
34
forceful/effortful swallow
swallow hard; push and squeeze all mouth and throat muscles as you swallow
35
Masako exercises
place tongue gently between teeth and bite down, maintaining forward tongue position as you dry swallow
36
Gargling
lift chin slightly, pull tongue to back of mouth and pretend to gargle, focusing on tongue positioned as far to back of mouth as possible
37
Shaker exercises
1. Lay flat on back; w/ shoulders down, raise head and look toward toes; hold position for 60 seconds; rest for 60 seconds; repeat for 3 trials
2. raise and lower head 30 times
38
Mendelsohn Maneuver
As you swallow, squeeze and hold muscles at top of swallow for a count of 3 before relaxing
39
Supraglottic swallow/breath-holding
inhale; hold breath after inhale; keep holding breath while swallowing; immediately cough; swallow again
40
Super-supraglottic swallow
inhale; hold breath very tightly; bear down; keep holding breath while swallowing forcefully; immediately cough; swallow again
41
EMST stands for
Expiratory muscle strength training
42
EMST
Training regimen, patient blows into a spring loaded device that provides resistance
43
NMES stands for
Neuromuscular electrical stimulation
44
NMES
surface electrodes attached to submandibular and laryngeal regions; electrical current delivered while at rest or during swallow
45
rTMS stands for
Repetitive transcranial magnetic stimulation
46
rTMS
1. apply rTMS to damaged hemisphere- increases neuronal excitability
2. apply rTMS to intact hemisphere- affects interhemispheric balance by providing inhibitory stimulation
47
3 exercises for labial musculature
1. Pucker, then smile in exaggerated manner to contract and then stretch; then increase speed
2. Open mouth widely then attempt lip closure with jaw remaining open
3. Diadochokinetic task: /papapa/ /bababa/ /mamama/ targeting accuracy first, then increased speed
48
4 exercises for mandible musculature
1. open mouth as wide as possible and hold for several seconds
2. alternate opening and closing of jaw, focusing on stretch at max opening; then increase speed
3. move jaw from right to left side with max excursion; then increase speed
4. rotate jaw in circular motion
49
7 exercises for tongue musculature
1. open mouth and stick tongue out, holding it steady w/o resting on teeth
2. stick out tongue and elevate tip towards nose
3. stick out tongue and depress towards chin
4. move tongue from corner to corner of mouth; then increase speed
5. move tongue in circular pattern around lips
6. open mouth and pull tongue along hard palate, going back as far as possible
7. manipulate a clinician-controlled object in oral cavity
50
Changing the function, but not the physiology
compensatory strategies
51
restoring lost function
rehabilitation
52
increased bolus cohesion and decreased bolus speed
Nectar Thick
53
compensation to slow oral transit, protect airway, and approximation of BOT to PPW
Chin Down
54
Compensation for poor A>P propulsion
head back
55
Compensation for hemiparetic pharynx
head turn to weak side
56
presence of pharyngeal resudue, reduced BOT retraction, reduced UES, reduced hyolaryngeal excursion
effortful swallow
57
Compensation for reduced oral control/bolus formation/mastication
Soft solids
58
Rehab for poor bolus manipulation/formation/control: _____ exercises against resistance
tongue
59
Reclining rehab for reduced hyolaryngeal excursion and UES opening
shaker
60
Difficult rehab for reduced hyolaryngeal excursion and UES opening
Mendelsohn Meaneuver
61
breathing to increase hyolaryngeal excursion
EMST
62
Tx with device to increase sensory pathways and muscular strength of hyolaryngeal complex
NMES
63
This must be present at some amount during any muscular strengthening task
resistance
64
Name one maneuver that would be good for someone who has had a supraglottic laryngectomy
Supra supraglottic swallow
65
List 3 things that should be included in patient information during an evaluation?
Medical and swallow-related history (physical status, cognition, communication, dental hygiene, cause of dysphagia), family/caregiver level of support, patient motivation/compliance, living/treatment setting, patient/family expectations
66
What 4 things should be included/reviewed during an evaluation?
Patient information, results of swallow evaluation (anatomic/physiological), treatment stimulability (compensatory strategies), factors limiting success (prognosis indicators)
67
Evaluation can lead to either treatment or no treatment. Describe the difference
if they have no treatment they likely don't have a swallow impairment, may be a "wait and see" case, the treatment may be in the hands of another specialist (we should still follow up and advocate for our clients), or due to the fact there is a swallow impairment but the patient doesn't want treatment. If they have treatment they likely have a swallow impairment and a patient interested in therapy
68
Treatment can be compensatory, rehabilitative/restorative, or combined. Describe the difference between compensatory and rehabilitative treatments:
compensatory treatments are meant to meet the client where they're at (use their structures they currently have) to provide helpful tools and improve the swallow, these can be temporary and act like a crutch. Rehabilitative measures are designed to utilize the body's plasticity and alter their physiology to improve the client's swallow. They require some degree of strength, coordination, and endurance
69
Why would you use a postural change:
postural changes are good to change pharyngeal dimension, redirect bolus flow, and they "work well" for both neuro and structural etiologies
70
Types of compensatory Txs
postural changes, sensory input, diet modifications, prosthetics
71
List some of the postural changes:
head back (chin up), chin down/tuck, head rotation, head tilt
72
Why would you use sensory input strategies?
To increase oral-sensory awareness, improve speed in triggering the pharyngeal phase, provide a stimulus prior to a swallow attempt. These are useful when the client has reduced sensation
73
List some examples of sensory input strategies:
sour or cold bolus, chewing, larger volume, self-feed, thermal-tactile stimulation, oral stimulation, VitalStim/NMES
74
T/f: sour or cold bolus strategies are generalized easily?
False
75
t/f: people are at decreased risk for aspiration pneumonia if they self-feed
True
76
t/f: diet modifications decrease dehydration
False, they increase it
77
When implementing diet modifications, you are changing one (or more) of four characteristics of the bolus. List the 4 characteristics:
consistency, texture, size, temperature (I think taste too but these are from the notes)
78
List some examples of diet modifications:
NPO, no liquid by mouth, thin liquid consistency, thick liquid consistency, pureed consistency, crushed medication (if allowed), mechanical soft consistency, regular dietary consistency (what the patient wants)
79
Who are prosthetics good for?
People with oral cancer (tongue or palate), craniofacial anomalies, neurologic (XII involvement)
80
Rehabilitative treatments can be direct or indirect. What does this mean?
Indirect treatments are exercise programs, saliva swallows, they do NOT involve eating. Direct treatments involve introduction of a food or liquid
81
List the direct (swallow-specific) maneuvers
masako, effortful swallow, super-supraglottic swallow, supraglottic swallow, Mendelsohn maneuver
82
List the indirect (not swallow-specific) maneuvers
Lee Silverman Voice Therapy, Expiratory muscle strength training, Shaker, Tongue strengthening exercise
83
T/f: NMES can only be used with direct exercises
False! Can use it w/ both direct and indirect
84
What is the goal of rehabilitative treatments?
Improve range of motion, strength, coordination, and endurance
85
Purpose of Masako
have the base of tongue meet the PPW, hold the tongue out with teeth causing the fast-twitch musculature to work harder.
86
When is the masako useful?
when the base of tongue is weak. When someone has residue in the pharyngeal wall (you see on FEES), valleculae, or pyriform sinuses.
87
When is the super-supraglottic swallow useful:
useful for a patient with a LOT of airway protection problems
88
When is the Mendelsohn maneuver useful:
working on hyolaryngeal muscles (supralaryngeal and suprahyoid muscles), helps with airway protection and UES opening. Use for someone who appears to have adequate tongue-base retraction but still has pharyngeal residue
89
When is Lee Silverman Voice therapy useful:
helps with VF closure, increases glottal pressure, tenses laryngeal musculature, also helps with respiration
90
When is expiratory muscle strength training useful
improves cough function and swallow function, tightens up musculature
91
When is the shaker exercise useful:
when people have UES opening problems, when you need to strengthen the suprahyoid muscles
92
What are some cons to the shaker exercise:
not everyone can lay down/get on the floor/complete this exercise
93
When are tongue strengthening exercises useful:
Dysarthric (slurred speech)
94
t/f: don't recommend a treatment strategy unless you know for sure that it works via instrumental assessment
True
95
t/f: people with slow swallow trigger may benefit from thicker/more viscous foods
True
