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Dysphagia > Treatment > Flashcards

Treatment Flashcards

1
Q

Head back to 60 degrees

A

Tilt head back after placing bolus in mouth when posterior movement is needed

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2
Q

Chin tuck (head flexion)

A

chin tipped down and back w/o neck flexion

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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

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4
Q

head rotation

A

head turned to weaker side parallel w/ shoulder prior to swallow

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5
Q

head tilt

A

tilt head towards strong side parallel to shoulder prior to swallow

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6
Q

side-lying

A

person eats and drinks while lying on side

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7
Q

breath-holding

A

prior to swallow, hold breath and don’t release until after swallow

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8
Q

food texture alteration

A

puree, nectar thick, honey-thick

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9
Q

sensory heightening

A

manipulate taste (sour, carbonation), temperature (cold), and touch

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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

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11
Q

Obturator

A

cutomed designed to fill defect and/or attach to surgically anchored implant

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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

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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

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14
Q

Medical/surgical therapy for drooling

A

Surgical: salivary gland rerouting/excursion; correction of dental malocclusion in childhood; EMG for biofeedback; pharmacological

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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

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16
Q

Behavioral therapies for pocketing of food in anterior sulci

A

head back posture

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17
Q

behavioral therapies for difficulty maintaining the bolus

A

head back posture

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18
Q

medical therapies for difficulty maintaining the bolus

A

intraoral prosthetics

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19
Q

behavioral therapy for difficulty chewing

A

change diet to consistency more easily managed (liquids, purees, mechanical softs)

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20
Q

behavioral therapies for excessive gagging

A

desensitization through use of applied pressures, vibration, ice

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21
Q

behavioral therapies for prolonged oral prep time

A

change diet to consistency more easily managed (liquids, purees, mechanical softs)

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22
Q

behavioral therapies for loss of control of bolus

A

tactile thermal application to increase oral sensitivities

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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

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24
Q

behavioral therapies for laryngeal penetration

A

chin tuck; head rotation to weak side; (super) thick or pureed diet; breath-hold

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25
Q

behavioral therapies for aspiration

A

chin tuck; head rotation to weak side; thick or pureed diet; breath-hold

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26
Q

Medical/surgical intervention for aspiration

A

if due to unilateral VF paralysis: VF medialization surgically or by injection

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27
Q

behavioral therapies for vallecular stasis

A

chin tuck

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28
Q

behavioral therapies for pyriform sinus stasis

A

head rotation

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29
Q

medical/surgical intervention for pyriform sinus stasis

A

cricopharyngeal dilation; myotomy; botox injection

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30
Q

behavioral therapies for pharyngeal stasis

A

head rotation to weak side; head tilt to strong side; side lying posture; alternating thin and thick viscosity boluses to clear stasis

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31
Q

behavioral therapies for nasal regurgitation

A

avoid chin tuck!; thicken liquids

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32
Q

medical/surgical intervention for nasal regurgitation

A

prosthetics: palatal list prosthesis; surgical: pharyngeal flap surgery or palatoplasty

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33
Q

Tongue exercises

A

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

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34
Q

forceful/effortful swallow

A

swallow hard; push and squeeze all mouth and throat muscles as you swallow

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35
Q

Masako exercises

A

place tongue gently between teeth and bite down, maintaining forward tongue position as you dry swallow

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36
Q

Gargling

A

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

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37
Q

Shaker exercises

A
  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
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38
Q

Mendelsohn Maneuver

A

As you swallow, squeeze and hold muscles at top of swallow for a count of 3 before relaxing

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39
Q

Supraglottic swallow/breath-holding

A

inhale; hold breath after inhale; keep holding breath while swallowing; immediately cough; swallow again

40
Q

Super-supraglottic swallow

A

inhale; hold breath very tightly; bear down; keep holding breath while swallowing forcefully; immediately cough; swallow again

41
Q

EMST stands for

A

Expiratory muscle strength training

42
Q

EMST

A

Training regimen, patient blows into a spring loaded device that provides resistance

43
Q

NMES stands for

A

Neuromuscular electrical stimulation

44
Q

NMES

A

surface electrodes attached to submandibular and laryngeal regions; electrical current delivered while at rest or during swallow

45
Q

rTMS stands for

A

Repetitive transcranial magnetic stimulation

46
Q

rTMS

A
  1. apply rTMS to damaged hemisphere- increases neuronal excitability
  2. apply rTMS to intact hemisphere- affects interhemispheric balance by providing inhibitory stimulation
47
Q

3 exercises for labial musculature

A
  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
Q

4 exercises for mandible musculature

A
  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
Q

7 exercises for tongue musculature

A
  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
Q

Changing the function, but not the physiology

A

compensatory strategies

51
Q

restoring lost function

A

rehabilitation

52
Q

increased bolus cohesion and decreased bolus speed

A

Nectar Thick

53
Q

compensation to slow oral transit, protect airway, and approximation of BOT to PPW

A

Chin Down

54
Q

Compensation for poor A>P propulsion

A

head back

55
Q

Compensation for hemiparetic pharynx

A

head turn to weak side

56
Q

presence of pharyngeal resudue, reduced BOT retraction, reduced UES, reduced hyolaryngeal excursion

A

effortful swallow

57
Q

Compensation for reduced oral control/bolus formation/mastication

A

Soft solids

58
Q

Rehab for poor bolus manipulation/formation/control: _____ exercises against resistance

A

tongue

59
Q

Reclining rehab for reduced hyolaryngeal excursion and UES opening

A

shaker

60
Q

Difficult rehab for reduced hyolaryngeal excursion and UES opening

A

Mendelsohn Meaneuver

61
Q

breathing to increase hyolaryngeal excursion

A

EMST

62
Q

Tx with device to increase sensory pathways and muscular strength of hyolaryngeal complex

A

NMES

63
Q

This must be present at some amount during any muscular strengthening task

A

resistance

64
Q

Name one maneuver that would be good for someone who has had a supraglottic laryngectomy

A

Supra supraglottic swallow

65
Q

List 3 things that should be included in patient information during an evaluation?

A

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
Q

What 4 things should be included/reviewed during an evaluation?

A

Patient information, results of swallow evaluation (anatomic/physiological), treatment stimulability (compensatory strategies), factors limiting success (prognosis indicators)

67
Q

Evaluation can lead to either treatment or no treatment. Describe the difference

A

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
Q

Treatment can be compensatory, rehabilitative/restorative, or combined. Describe the difference between compensatory and rehabilitative treatments:

A

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
Q

Why would you use a postural change:

A

postural changes are good to change pharyngeal dimension, redirect bolus flow, and they “work well” for both neuro and structural etiologies

70
Q

Types of compensatory Txs

A

postural changes, sensory input, diet modifications, prosthetics

71
Q

List some of the postural changes:

A

head back (chin up), chin down/tuck, head rotation, head tilt

72
Q

Why would you use sensory input strategies?

A

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
Q

List some examples of sensory input strategies:

A

sour or cold bolus, chewing, larger volume, self-feed, thermal-tactile stimulation, oral stimulation, VitalStim/NMES

74
Q

T/f: sour or cold bolus strategies are generalized easily?

A

False

75
Q

t/f: people are at decreased risk for aspiration pneumonia if they self-feed

A

True

76
Q

t/f: diet modifications decrease dehydration

A

False, they increase it

77
Q

When implementing diet modifications, you are changing one (or more) of four characteristics of the bolus. List the 4 characteristics:

A

consistency, texture, size, temperature (I think taste too but these are from the notes)

78
Q

List some examples of diet modifications:

A

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
Q

Who are prosthetics good for?

A

People with oral cancer (tongue or palate), craniofacial anomalies, neurologic (XII involvement)

80
Q

Rehabilitative treatments can be direct or indirect. What does this mean?

A

Indirect treatments are exercise programs, saliva swallows, they do NOT involve eating. Direct treatments involve introduction of a food or liquid

81
Q

List the direct (swallow-specific) maneuvers

A

masako, effortful swallow, super-supraglottic swallow, supraglottic swallow, Mendelsohn maneuver

82
Q

List the indirect (not swallow-specific) maneuvers

A

Lee Silverman Voice Therapy, Expiratory muscle strength training, Shaker, Tongue strengthening exercise

83
Q

T/f: NMES can only be used with direct exercises

A

False! Can use it w/ both direct and indirect

84
Q

What is the goal of rehabilitative treatments?

A

Improve range of motion, strength, coordination, and endurance

85
Q

Purpose of Masako

A

have the base of tongue meet the PPW, hold the tongue out with teeth causing the fast-twitch musculature to work harder.

86
Q

When is the masako useful?

A

when the base of tongue is weak. When someone has residue in the pharyngeal wall (you see on FEES), valleculae, or pyriform sinuses.

87
Q

When is the super-supraglottic swallow useful:

A

useful for a patient with a LOT of airway protection problems

88
Q

When is the Mendelsohn maneuver useful:

A

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
Q

When is Lee Silverman Voice therapy useful:

A

helps with VF closure, increases glottal pressure, tenses laryngeal musculature, also helps with respiration

90
Q

When is expiratory muscle strength training useful

A

improves cough function and swallow function, tightens up musculature

91
Q

When is the shaker exercise useful:

A

when people have UES opening problems, when you need to strengthen the suprahyoid muscles

92
Q

What are some cons to the shaker exercise:

A

not everyone can lay down/get on the floor/complete this exercise

93
Q

When are tongue strengthening exercises useful:

A

Dysarthric (slurred speech)

94
Q

t/f: don’t recommend a treatment strategy unless you know for sure that it works via instrumental assessment

A

True

95
Q

t/f: people with slow swallow trigger may benefit from thicker/more viscous foods

A

True

Dysphagia (9 decks)

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