Treatment

Question 1

What do swallowing maneuvers do?

Answer 1

Place specific aspects of swallow under volitional control.
Need:
   Intact cognition
   Muscle strength
   Muscle endurance

Question 2

Chin down position effects

Answer 2

Protects airways
Widens vallecula
Narrows airway entrance
Protection mechanism to cover the airway

Question 3

What do you use chin down position for?

Answer 3

Poor BOT control
Delayed pharyngeal swallow
Reduced closure of VF
Reduced laryngeal elevation

Question 4

Change in bolus size and texture effects

Answer 4

Facilitates oral phase and initiates the swallow

Question 5

What do you use change in bolus size and change in texture for

Answer 5

Poor BOT control and pressure
Reduced closure off VF
Mistiming of laryngeal elevation

Question 6

Thermal tactile stimulation effects

Answer 6

Sensory stimulation to brain stem

Question 7

When do you use thermal tactile stimulation, sour bolus, and three second prep for ?

Answer 7

Delayed pharyngeal swallow

Question 8

Super supraglottic swallow effects

Answer 8

Protects before and during swallow
Tilts arytenoid forward
Improved larynx elevation
Improved BOT retraction

Question 9

What to use super supraglottic swallow for

Answer 9

Reduced closure of VF
Mistiming of laryngeal elevation
Reduced laryngeal elevation and BOT pressure

Question 10

Supraglottic swallow effects

Answer 10

Closes and protects airway

Question 11

When to use supraglottic swallow

Answer 11

Reduced closure of the the truer VF

Delayed pharyngeal swallow

Question 12

Head rotation towards WEAKER side effects

Answer 12

Aids in adduction of VF
Twists pharynx so food flows down stronger side
Moves damage to midline

Question 13

When to use head rotation towards weaker side

Answer 13

Reduced VF closure and laryngeal elevation
Reduced BOT pressure and pharyngeal wall movement
Cricopharyngeal dysfunction

Question 14

Mendelsohn maneuver effects

Answer 14

Increases duration of laryngeal elevation and width of CP opening
Increases coordination of swallow

Question 15

When to use Mendelssohn maneuver

Answer 15

Mistiming/reduced laryngeal elevation

Question 16

When to use multiple swallows

Answer 16

Reduced laryngeal elevation and BOT a pressure

Reduced posterior wall movement

Question 17

Effort full swallow effects

Answer 17

Improves tongue pressure
Increases BOT retraction
Clears vallecula residue

Question 18

When to use effortful swallow

Answer 18

Reduced BOT pressure and pharyngeal wall movement

Question 19

Head tilt to STRONGER side effects

Answer 19

Directs bolus down stronger side

Uses gravity to advantage

Question 20

When to use head tilt to stronger side

Answer 20

Oral/pharyngeal weakness on same side

When residue in the mouth/pharynx

Question 21

Head back chin up effects

Answer 21

Drains food from oral cavity
Takes advantage of gravity
Eliminates vallecular space

Question 22

When to use head back chin up

Answer 22

Reduced tongue control/oral transit time

Common with glossectomy

Question 23

Laying down on one side effects

Answer 23

Uses gravity to reside pharyngeal residue

Question 24

When to use laying down on one side

Answer 24

Reduced pharyngeal constriction

Residue in pharynx

Question 25

Neuromuscular electrical stimulation effects

Answer 25

Electrical stimulation on throat, activates muscles of intact peripheral motor nerves Goal is to strengthen muscular system to control swallow

Question 26

When to use neuromuscular electrical stimulation

Answer 26

Decrease risk of penetration and aspiration Reduced CP opening Can lead to cortical reorganization

Question 27

Increases pressure on tongue effects

Answer 27

Helps initiatial chew stimulation

Question 28

Volitional hold and swallow effects

Answer 28

Reduced automaticity and reflexive components | Adds cognitive aspect to swallow

Question 29

When to use volitional hold and swallow

Answer 29

Delayed swallow initiation | Poor bolus control and transfer

Question 30

Food consistency changes

Answer 30

Most effect on quality of life - last option | Thin liquor, nectar thick, honey thick, purée/pudding, soft solid, hard solid, mixed consistencies

Question 31

Masako maneuver (tongue holding)

Answer 31

For decreased super pharyngeal constriction and PPW bulging | Decreases BOT retraction

Question 32

Shaker exercise

Answer 32

For decreased UES opening

Question 33

How does a tracheostomy cannula prevent ability to do some swallowing strategies

Answer 33

Restricted laryngeal elevation and sensitivity Decreased glottal pressure Interrupts cricopharyngeal Causes difficulty in expelling air

Question 34

Limitations of electrical stimulation as a therapeutic approach

Answer 34

Gains made through stimulation must be sustained in functional use or else they can't be maintained If patient unable to participate in swallowing exercises, electrical stimulation will be ineffective

Question 35

The goal of treatment for dysphagia is

Answer 35

To establish the safest, most efficient oral nutrition | Determine if and how to fix the problem