Treatment of Dysphagia Flashcards
What is cervical auscultation?
Cervical auscultation is the use of a listening device, typically a stethoscope in clinical practice, to assess swallow sounds and by some definitions airway sounds
When can cervical auscultation be used?
During an evaluation and/or treatment!
What is the relationship between cervical auscultation and silent aspiration?
In instances of silent aspiration, you may hear changes in their breath sounds that you couldn’t hear unless completing cervical auscultation
(Stridor or wet breath sounds)
How do you know which exercises you should have the patient do?
Base the treatment off of what symptoms you observed during the swallow assessment/MBSS? e.g. Poor bolus control/cohesion? Anterior loss of the bolus? Oral residue? Pre-swallow spillage? Pharyngeal residue? Aspiration before the swallow? Aspiration after the swallow?
Once you know what the symptom is, what’s the next step?
Figure out the physiological cause of the symptoms you observed.
e.g.
Poor bolus control BECAUSE of impaired Lingual/labial strength?
Impaired oral sensation?
Decreased tongue base retraction?
Decreased hyolaryngeal excursion?
Decreased pharyngeal constriction/peristalsis?
Decreased opening of the UES?
Once you’ve identified the symptoms through a swallow assessment and identified a physiological cause of those symptoms, what’s next?
TREATMENT!
i.e Compensation (diet modification, postural changes), Facilitation (exercises), or both!
Describe compenstion as a treatment strategy.
Techniques designed to compensate for lost function
Compensatory treatment procedures are those that control the follow of food and eliminate the patient’s symptoms without necessarily changing the physiology of the swallow.
- Logemann (1998)
Describe facilitation as a treatement strategy.
Improve function or change the swallow physiology.
These are the EXERCISES designed to produce a change in the way someone swallows.
Is there a time when you would ONLY use one approach? (Only facilitation or only compensation)
ONLY Compensation: If it’s a progressive disease, compensation might be the best option so they aren’t more fatigued than necessary.
ONLY Compensation: Laryngectomy or other surgeries that prevent the patient from accomplishing a facilitating strategy.
ONLY Facilitation: this is a bit rarer because even if the patient isn’t using a compensatory strategy, the SLP might be compensating in therapy. e.g. Reducing the size of the bolus, the texture of the bolus, etc.
What specific strategies are presented in compensation treatment?
Includes changes in:
Posture
Head turn, chin tuck, changes in seating
Food/liquid texture
Thickened liquids, pureed foods
Food placement
Placing bolus on the stronger side of the mouth
Food presentation
Special utensils/cups
What does ‘facilitation’ consist of? Which exercies?
“Traditional Dysphagia Therapy”
Consists of various exercises to improve the impaired physiologic function.
Lingual/labial strengthening and range of motion exercises
Hyolaryngeal exercises
Mendelsohn maneuver, Shaker, Chin-tuck against resistance
Tongue base strengthening exercises
Masako, effortful swallow
Pharyngeal strengthening exercises
Supraglottic swallow
What are some hyolaryngeal exercises mentioned in class?
Hyolaryngeal exercises:
Mendelsohn maneuver, Shaker, Chin-tuck against resistance
Which co-existing impairments can impact your dysphagia treatment?
Aphasia Apraxia Cognition Stroke ALS Parkinsons Dimentia
When working with a patient who has a co-existing impairment with dysphagia, what is your first question?
What is the extent of the cognitive/language impairment?
e.g.
Can the patient attend to a bolus in their mouth?
Can the patient attend to a task for >2 minutes?
Can the patient follow verbal/visual directions?
What is neuromuscular electrical stimulation/vital stim?
An electrical current is used to stimulate the nerves either superficially via the skin or directly into the muscle in order to stimulate the peripheral nerve.
