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Dysphagia > Week 11 > Flashcards

Week 11 Flashcards

1
Q

What are the different behavioral therapies for improving the components of swallowing?

A 
Shaker exercise
Tongue strengthening
Masako maneuver
EMST
Transcutaneous e-stim
Effortful pitch glide

Intramuscular stimulation
Neural stimulation

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2
Q

Shaker maneuver

A

Head raising exercise to target improved UES muscle function

Pt lies on their back and raised head to look at toes without shoulders lifting

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3
Q

What are the physiological targets of shaker manuever

A

Poor UES opening (extent and/or duration) resulting in post-swallow residue

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4
Q

What are the desired outcomes of the shaker manuever?

A

Improved UES function

decrease pharyngeal residue

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5
Q

Tongue strengthening

A

Lingual resistance exercises for weak tongue muscles to improve strength for swallowing. Resistance provided bt pressure sensitive bulb or tongue depressor

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6
Q

What are the physiological targets of tongue strengthening?

A 
Poor bolus formation
Premature spill
oral residue
poor base of tongue to posterior pharyngeal wall
pharyngeal residue
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7
Q

What are the desired outcomes of tongue strengthening?

A

Improve tongue strength to functional levels
impacting bolus formation, spill
Bolus driving forces and post swallow residue

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8
Q

Masako maneuver

A

Swallow initiated with tongue held firmly bt teeth to improve posterior pharyngeal wall contraction

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9
Q

What are the physiological targets of masako?

A

Poor tongue to posterior pharyngeal wall contact
Poor pharyngeal constriction
pharyngeal residue

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10
Q

What are the desired outcomes of masako?

A

Improve bolus driving forces and post-swallow residue

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11
Q

Expiratory muscle strength training (EMST)

A

Calibrated, one way, spring loaded valve
Valve blocks the flow of air until enough pressure is produced
Exercises the expiratory and submental muscles
Treatment lasts 4 5o 5 weeks with 25 breaths a day 5 days a week

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12
Q

What are the physiological targets of EMST?

A 
Weak cough
Poor respiratory support
Disrupted exhale-swallow-exhale pattern
? poor hyolaryngeal elevation
penetration/aspiration caused by respiratory issue listed above
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13
Q

What are the desired outcomes of EMST?

A

Improve airway protection and respiratory support

Possibly improve hyolaryngeal elevation

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14
Q

Transcutaneous electical stim

A

or e-stim, VitalStim, NMES

Use of electical current to stimulate the nerves or nerve endings that innervate the muscles beneath the skin

Controversial
Must be assessed under VFSS

causes depression of the hyolaryngeal structure at rest

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15
Q

Effortful pitch glide

A

Pt phonated on a low to high gliding pitch with effort. Causes elevation of the arytenoids/larynx and constriction of the pharynx

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16
Q

What are the physiological targets of effortful pitch glides?

A

Poor pharyngeal constriction

Poor laryngeal elevation

17
Q

What are the desired outcomes of effortful pitch glide?

A

Improve pharyngeal constriction (and reduce residue)

Improved laryngeal elevation (and improve safety)

18
Q

Muscle stimulation

A

Ongoing research to look at utility of intramuscular electrical stimulation

Most precise but more invasive

Early research phases, no clinical application available

19
Q

Facilitative maneuvers

A
  • postures or gestures demonstrated to improve swallowing safety or efficiency
  • need to confirm function on instrumental exam
  • some naturally occurring or easier to teach such as increased effort, jaw thrust (may pull open UES) or expectoration of pharyngeal residue
  • should be taught before instrumental for ALARA principle
20
Q

Effortful swallow

A

“swallow as hard as you can. squeeze your throat muscles harder”
“Pretend you are swallowing a big grape or pill”

Can be used on initial swallow or as a secondary clearing swallow for residue
Requires strength and endurance over meal
Some SLPs consider it an exercise/treatment

21
Q

What are the physiological targets of effortful swallow?

A

Significant post-swallow residue
Poor pharyngeal constriction
Poor base of tongue to posterior pharyngeal wall

22
Q

What are the desired outcomes of effortful swallow?

A

Improve pharyngeal efficiency

Decrease pharyngeal residue

23
Q

Mendelsohn maneuver

A

Prolonged elevation of the larynx during swallowing to increase both displacement and duration of hyolaryngeal excursion. Prolong UES opening

MUST BE assessed instrumentally

24
Q

What are the physiological targets of mendolsohn maneuver?

A

Early UES closure
Incomplete UES opening
Poor pharyngeal constriction
(post-swallow residue)

25
Q

What are the desired outcomes of mendolsohn maneuver?

A

Improve and prolong UES opening to decrease pharyngeal residue

26
Q

Supraglottic swallow

A

close airway prior to bolus entry into the pharynx and to keep the airway closed for the duration of bolus transport

“Put the bolus in mouth, hold breath, and keep holding it as you swallow. Then do and audible breath or cough to clear your airway.”

Best tested under endoscopy or AP view of VF

  1. Hold
  2. Swallow
  3. Cough
27
Q

What are the physiological targets of supraglottic swallow?

A

Premature spill
delayed swallow initiation
delayed/poor laryngeal closure

28
Q

What are the desired outcomes of supraglottic swallow?

A

Ensure airway protection before and during the swallow

29
Q

Super supraglottic swallow

A

Supraglottic + increased effort of airway closure (bear down)

“Put the bolus in your mouth, hold your breath and bear down like you are lifting something heavy, keep holding as you swallow. Then cough”

30
Q

What are the physiological targets of super supraglottic swallow

A

Premature spill
delayed swallow initiation
Delayed/poor laryngeal closure
difficulty with VF closure

31
Q

What are the desired outcomes of supraglottic swallow?

A

Ensure airway protection before and during the swallow

32
Q

What are surgical treatments for dysphagia?

A

Reconstruction of structures (lips, tongue, palate, VF augmentation or medialization)

Cricopharyngeal (CP) bar - failure of the cricopharyngeus muscle to relax during swallowing as a result of fibrosis, GERD, neuromuscular disease. Causing dificulty with increased texture viscosity
Myotomy (surgical) - cut the CP muscle
Dialation (non-surgical) - physically expand the UES
Botox (non-surgical) - inject botox into CP muscle temporarily

33
Q

Zenker’s diverticulum

A

Ballooning out of the pharyngeal wall due to high pressure

Globus sensation, regurgitation, penetration/aspiration of regurgitated material, halitosis, infection

If small with no discomfort - no intervention warranted
Large and symptomatic - surgically manages with endoscopic stapling or fiberoptic laser

Dysphagia (13 decks)

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