Chapters 5-6

Front 1

What is the order of procedures?

Back 1

1) Screening Procedures

2)Bedside evaluation:
a)preparatory examination
b)initial swallow examination

3)Modified Barium Swallow:
a)postural techniques,
b)sensory techniques,
c)swallow maneuvers,
d)food consistency/diet changes,

Front 2

Characteristics that require in-depth evaluation in children and developmentally delayed adults:

Back 2

1. Rejection of food
2. Food selectivity
3. Gagging
4. Open mouth posture

Front 3

Explain the Preperatory Examination

Back 3

no actual swallow, but gathers information about the posture that may result in the best swallowing, the best position for food in the mouth, the potentially best food consistency, and some indication of the nature of the patient’s swallowing disorder

Front 4

What 9 things do you look at in the prepratory examination?

Back 4

a. Patient chart review
b. Observation upon entering the patients room
c. Respiratory status
d. Tracheostemy tubes, intubation, and mechanical ventilation
e. History
f. The examination of oral anatomy
g. oral-motor control
h. laryngral function examination
i. pulmonary function testing

Front 5

Name 5 of the things you look at when examining the oral-motor control

Back 5

• ability to open mouth voluntarily
• identification of optimal oral-sensory stimuli and bolus types
• identification of and compensation for swallowing apraxia
• identification of and compensation for abnormal oral reflexes
• labial function
• lingual function
• posterior tongue function
• chewing function
• soft palate function and oral reflexes
• oral sensitivity examination

Front 6

Discuss the initial swallow examination. When should you do it? NOt do it? What is it for?

Back 6

should look at the risk-benefit ratio in deciding to do it. Should note during feeding the patient’s reaction to food, oral movemens in food manipulation and chewing, any coughing, throat clearing, or struggling behaviors or changes in breathing and their frequency relative to swallowing and their occurrence during meal (beginning, middle, or end), changes in secretion levels throughout the meal, duration of the meal and total intake, and coordination of breathing and swallowing. Prior to initiating swallow, the patient’s preparation is most important. If there are excess secretions, suctioning should be completed both orally and transtracheostomy (and after deflated, do it again orally).

Front 7

Discuss monitoring the tracheostomy tube in swallowing.

Back 7

Best to deflate the tracheostomy cuff prior to attempting any swallow. During each swallow, patient should gently occlude his or her tracheostomy tube with a gloved finger or gauze to establish near normal pressure. Advantages to initiating therapy while tube is in place is that the therapist can observe aspiration more directly by examining the expectoration through the tube. Also coughing eliminates aspirated materials more easily.

Front 8

Of over 2,000 patients with tracheostomy tubes at Northwestern, how many had a swallowing disorder that was related to the tube.

Back 8

1.

Front 9

If you have decided to proceed with a beside swallowing evaluation, what 5 things do you have to decide on before evaluation?

Back 9

a. potentially best posture
b. selection of optimal food position in mouth
c. selection of possible best food consistency
d. selection of optimum swallowing instructions
e. utensils to be used in the initial swallowing evaluation

Front 10

the modified barium swallow in the lateral plane focuses on what anatomical features?

Back 10

Focuses on lips anteriorly, hard palate superiorly, posterior pharyngeal wall posteriorly, bifurcation of the wairway and the esophagus inferiorly.

Front 11

The two purposes of modified barium swallow (viedofluoroscopy)

Back 11

Two purposes: to define the abnormalities in anatomy and physiology causing the patient’s symptoms and to identify and evaluate treatment strategies that may immediately enable the patient to eat safely and/or effectively.

Front 12

generally, food is placed on the mouth using a ____, but if the patient has a strong bite reflex use a _____

Back 12

Generally food is placed on patients mouth in a disposable plastic spoon but if they have a bite reflex a heavier plastic spoon is in order.

Front 13

4 step Order of therapy

Back 13

1-postural techniques- 2-increase oral sensation-3- swallowing maneuvers- 4-diet (food consistency)

Front 14

Inefficient oral transit (reduced posterior propulsion of bolus by tongue). Posture and rationale? sensory stim? Maneuvers?food type?

Back 14

If due to reduced to elevation:
1)head back- utilizes gravity to clear oral cavity
2)position food in oral cavity or syringe 5-10 mil of liquid into oralpahrynx and bypass tongue elevatatio
3) supraglottic swallow if worried about premature spillage
4) initially try thicker liquid so you don't have to worry about premature spillage. Later do thinner liquid so its easier for tongue
If due to reduced anterior-posterior movement:
1) tilt head beack for gravity
2)position food posteriorly in oral cavity or synringe 5 to 10 ml of liquid to byass tongue elevation
3) supraglottic swallow if worried about prematured spillage (extended supraglottic)
4) initially thicker liquids, later thinner liquids
If due to disorganized patterns of anterior-posterior tongue movement (such as parkinson's repeated tongue pumping):
same as others. also:
1) alert patient to pumping and ask him to consciously hold the bolus against hard palate with tongue and to initiate the swallow with a single strong swoop back
If due to reduced tongue strength:
same as ohers
If due to swallowing apraxia-searching motion of lack of response to food in place
1)techniques to improve sensory input by changing bolus characteristics, can try thermal tactile stim, have patient feed himself

Front 15

Delay in triggering the pharyngeal swallow. Posture and rationale? sensory stim? Maneuvers?food type?

Back 15

1) head down-widens valleculae to prevent aspiration
2) thermal tactile stimulation
3)supraglottic swallow. can also try suck swallow
4) thickened liquid

Front 16

Reduced tongue base posterior motion-residue. Posture? sensory stim? maneuver? diet change?

Back 16

1) head down-pushes tongue base backward toward pharyngeal wall
in valleculae
2)Effortful swallow-effort increases posterior tongue base movement
pull-back, yawn, garggle, Masako (Swallow with anterior tongue hold)
3)thin liquids

Front 17

unilateral laryngeal dysfunction- aspiration during swallow
Posture? sensory stim? maneuver? diet change?

Back 17

1)head down - places epiglottis in more posterior protective position, narrows laryngeal entrance
-or- Head rotated to damaged side- increase vocal fold closure by applying extrinsic pressure
2)super-supraglottic swallow- tilts arytnoids forward, closing airway entrance before and during swallow,
supraglottic swallow if at level of true folds, effortful breath hold
3)purees and thick liquids including thickened foods and thickened liquids

Front 18

reduced laryngeal closure aspiration during swallow
Posture? sensory stim? maneuver? diet change?

Back 18

1)head down-places epiglottis in more posterior position, protects and narrows airway
2)super-supraglottic swallow- tilts arytnoids forward, closing airway entrance before and during swallow
-or-
???if due to laryngeal lifting problem try Mendhelson Maneuver, super-supraglottic with masako, (in therapy try shaker, falsetto)???
3)purees and thickened foods and thickened liquids

Front 19

reduced pharyngeal contraction (residue spread throughtout pharynx)
Posture? sensory stim? maneuver? diet change?

Back 19

1) lying down on one side- change direction of gravity on pharyngeal residue
2)Masako Maneuver-the tongue holding technique is designed to exercise the portion of the superior constrictor known as the glossopharyngeus muscle. This muscle is believed to be responsbile for the retraction of the tongue base and anterior bulging of the posterior pharyngeal wall. Needs to be done in conjunction with supraglottic,effortful swallow
follow swallow with repetitive dry swallows
3)thin liquid (also alternating liquid and semisolid so liquids wash smisolids away. limiting diet to liquids or thin paste

Front 20

unilateral pharyngeal paresis-residue on one side of pharynx
Posture? sensory stim? maneuver? diet change?

Back 20

same whether it's due to paralysis or scarred pharyngeal wall:
1)head rotated to damaged side of pharynx- twists pharynx and closes pyriform sinus on the affected side and directs food down the normal side; eliminates damaged side from bolus path; if unilateral paresis is in lingual function as well as pharynx, tilt head toward stronger side keeping materials on the stronger side in oral cavity and through the pharynx
2)supraglottic
3) thin liquids (alternate liquids and solids to wash hicker consistencies)

Front 21

cricohpharyngeal dysfunction- reside in pyriform sinuses
Posture? sensory stim? maneuver? diet change?

Back 21

1)head rotated to weaker side pulls cricoid cartilage away from posterior pharyngeal wall reducing resting pressure in cricopharyngeal sphincter
2) if the problem is reduced laryngeal elevation try Mendhelson Maneuver, super-supraglottic (with masako?), throat clearing(in indirect therapy try shaker and falsetto)
3) thin liquids (so that it can enter esophagus)

Front 22

postural techniues can eliminate aspiration up to ___% of the time

Back 22

80%

Front 23

Sensory techniques include

Back 23

a. increasing downward pressure of the spoon against the tongue in
presenting food in mouth
b. presentation of a sour bolus (50% lemon juice, 50% barium)
c. presentation of a cold blous
d. presentation of a bolus requiring chewing
e. presentation of a larger volume bolus (3 ml or more)
f. thermal-tactile stimulation

Front 24

explain thermal tactile stimulation

Back 24

vertically rubbing the faucial arch (5 times) firmly with laryngeal mirror which has been held in ice, before presenting bolus. Does not trigger the pharyngeal swallow at the time of stimulation but rather hightens the sensitivity for the swallow in the central nervous system and to alert the central nervous system so that when the patient voluntarily attents to swallow, he or she will trigger a pharyngeal response.

Front 25

explain techniques to improve oral sensory stimulation.

Back 25

generally used in patients with swallowing apraxia, delayed onset of the oral swallow, or delayed onset of the pharyngeal swallow. Measures of the effectiveness of these procedures to increase oral sensory input include 1-time between command to swallow and initiation of the oral stage-2-oral transit time-3-pharyngeal delay

Front 26

the supraglottic swallow is designed to?

Back 26

close the airway at the level of the true folds before and during swallow. Voluntary breath hold usually closes the vocal folds before and during the swallow. The maneuver was designed for reduced or late vocal fold closure. Was also designed for delayed pharyngeal swallow because it closes the vocal folds before and during the delay.

Front 27

the steps of the supraglottic swallow:

Back 27

• take deep breath
• keep holding breath and lightly cover tracheostomy tube if present
• keep holding breath as you swallow
• immediately after you swallow, cough

Front 28

what is the extended supraglottic swallow designed for?

Back 28

the extended supraglottic swallow technique is for patients who have severly reduced tongue mobility or bulk due to cancer and have little or no transit time so need to use large boluses to use gravity to dump food down with head tilted back. Start with small amounts (1 or 3 ml) of liquid on spoon and observe as patient tosses head back and dumps the liquid in the pharynx to determine whether (1) the pharyngeal swallow triggers on time and (2) airway closure is sufficient to protect the airway

Front 29

steps of the extended supraglottic swallow:

Back 29

hold breath tightly
• Put entire 5 to 10 ml of liquid in the mouth
• Continue to hold the breath and toss head back, thus dumping the liquid into the pharynx as a whole
• Swallow two to 3 times or as many times as needed to clear the majority while continuing to hold the breath
• Cough to clear any residue from the pharynx

Front 30

explain the super supraglottic swallow

Back 30

designed to close the airway entrance before and during the swallow. Effortful breath hold tilts arytnoid forward, closing airway entrance before and during the swallow. The maneuver was designed for reduced closure of the airway entrance.

Front 31

What was the effortful swallow designed for?

Back 31

designed to increase tongue base posterior motion during the pharyngeal swallow and thus improve bolus clearance from the valleculae. The maneuver was designed for reduced posterior movement of the tongue base.

Front 32

What was the Mendehlson Maneuver designed for?

Back 32

designed to increase the extent and duration of laryngeal elevation and thereby extend the duration and width of cricopharygeal opening- can also improve the overall coordination of the swallow. Was designed for reduced laryngeal movement to keep UES open longer, but also for a discoordinated swallow because it normalizes the timing of the pharyngeal swallow events.

Front 33

What should be the last strategy examined?

Back 33

Generally elimination of certain food consistencies from the diet should be the last strategy examined.

Front 34

If the report does not include _________, and ______ and ________ it is incomplete.

Back 34

If the report does not include the anatomic or physiologic reason for the aspiration or residue, and the interventions attempted to reduce or eliminate these symptoms and their effects, or reasons why they could not be attempted it is incomplete.

Front 35

Clincian should carefully observe the swallowing mechanism by placing outstretched fingers lightly where?

Back 35

on the patient’s neck, with the forefinger under the tip of the mandible on the soft tissue, second finger on the hyoid, the first lingual movement at the initiation of the posterior propulsion of the bolus (which defines the beginning of the oral transit time) can be felt.

Front 36

What did asley et al find on Prevention of Barium Aspiration during Videofluroscopic Swallowing Studies

Back 36

Postural techniques can eliminate aspiration of barium of at least small volumes in most patients.
Recommends changes of posture during MBS procedures.

Front 37

What did Kahrilis find on Volitional augmentation of upper esophageal sphincter opening during swallowing

Back 37

the opening of the UES can be modified using volitional techniques such as the Mendelsohn maneuver that affect hyoid and laryngeal elevation

Front 38

What did Bisch et al find on Pharyngeal Effects of Bolus Volum, Viscosity, and Temperature in Patients with Dysphagia resulting from neurologic Impairment and in normal subjects.

Back 38

Few significant effects of temperature on swallowing disorders or swallow measures (except 1ml cold)
Increase in bolus volume and viscosity decreased pharyngeal delay times in pts with neurologic impairment.

Front 39

What did leder et al find on the relationship between tracheostomy and aspiration in the acute care setting?

Back 39

No causal relationship between trachotomy and aspiration status was exhibited.

Front 40

What did Logemann find on the benefit of head rotation in pharyngoesophogeal dysphagia

Back 40

Head rotation can improve swallowing in patients with unilateral oropharyngeal dysphagia. Beneficial effects include 1) functional exclusion of the relatively flaccid, weakened pharyngeal wall, and 2) reduced UES tone. (operative mechanism depends on dominant mechanism of dysphagia)

Front 41

After Clinical Bedside, what do Langmore and Logemman say is next ?

Back 41

Logemann argues that FEES is necessary because bedside swallow exams fail to detect 38-40% of aspiration and do not allow for observation of the physiology of pharyngeal swallow. Langmore argues that FEES is not always feasible or necessary, and endoscopy is often sufficient. Read the article.

Front 42

What does Welsch say on changes of pharyngeal dimensions due to chin tuck

Back 42

Chin tuck procedures causes a posterior shift of the anterior pharyngeal wall and the laryngeal entrance, while widening the angel of the epiglottis to the anterior tracheal wall, improving airway protection. Widening of the valleculae is not uniform.

Front 43

What does Shannon say about those who benefit from the chind down position for dysphagic patients with delayed swallow or reduced airway closure?

Back 43

Not all patients who aspirate because of a delayed pharyngeal swallow or reduced airway closure benefit from the chin-down procedure. Those who do not benefit show a significantly loarger increase in the epiglottic angle.

Front 44

Whar does de Lama Lazara have to say about the impact of thermal tactile stim on the pharyngeal reflex?

Back 44

The anterior faucial arches are mon of the most sensitive areas for triggering the swallowing reflex. Use of thermal sensitization improved triggering of the swallowing reflex in 23 of 25 neurologically impaired patients. Effects immediate. Longterm effects are unknown. No reflex will be triggered if reflex is absent.

Front 45

What does Martin have to say about normal laryngeal valving patterns during a normal 3 breathhold maneuver?

Back 45

Videofluoroscopy allows visualization of the biomechanics of oropharyngeal and cervical esophagus and to determine if patient is able to maintain laryngeal valving. 3 breath-hold maneuvers were easy, inhale hard, inhale/exhale hard. Arytenoid & TVF produced on all maneuvers; FVF and ant arytenoid tilting only during hard holds.

Front 46

What do Fugi and Logemann say about the effect of a tongue holding maneuver on posterior pharyngeal wall movement

Back 46

Inhibits triggering of pharyngeal swallow, increases pharyngeal residue, shortens airway closure. Does allow pt to actively change the degree of muscular contraction of the PPW (posterior pharyngeal wall)

Front 47

What does Logemann say the potential importance to dysphagic patients and normal individuals of preswallow sensory input is?

Back 47

More research needs to be done on the effects of preswallow sensory input in normal individuals and dysphagics.
Normal swallowers exhibit systematic changes in temporal measures of oropharyngeal swallow as a result of changes in bolus volume and viscosity (effects of taste unknown)

Front 48

What does Davis say the effect of a a maxillary glossectomy prosthesis on articulation and swallowing is?

Back 48

Residue in the oral cavity decreased markedly with the prosthesis (25% with, 90% without) t/d and k/g productions were also more normal

Front 49

if you are interested if te sternocledimastoid muscle is contracting you would use?

Back 49

electromyography (EMG)- hooked wire if deep

Front 50

What is the screening test for the presence of aspiration given at the bedside for a tracheostomy patientthat gives measured amounts of foodand suctions the tracheostomy immediately after for the presense?

Back 50

blue dye test. Note if blue-dyed tinges appear LATER, does not neccessarily mean aspiration occured.

Front 51

The afferent impluses for the gag reflex are carried mainly by what nerve?

Back 51

cranial nerve X but IX may be involved

Front 52

What is difference between gag and swallow?

Back 52

gag reflex is triggered by a noxious stimulus such as vomit or reflux and the motor response is designed to squeeze the material up and out of the pharynx. Swllow is organized set of motor actions designed to take food safely to esophogus.

Front 53

how to elicit palatal reflex? how to elicit gag reflex? how to do thermal tactile stim?

Back 53

palatal-juncture of hard and soft palate; the less table of the reflexes, often requires two strokes
gag- contact with base of tongue or posterior pharyngeal wall
thermal tactile stim- anterior faucial arch

Front 54

The afferent impluses(nerves that carry impulses from the outer body toward the brain or spinal cord)for the palatal reflux are carried by what nerve? what about the efferent (directing outward from brain or spinal cord)portion?

Back 54

glossopharyngeus and possibly the vagus; where the efferent part is carried through the vagus and possibly the glossopharyngeus nerve. The trigeminal nerve which also innervates the part of the palate may also be involved.

Front 55

three questions that need to be answered after evaluation of the patient with an oropharyngeal swallowing problem

Back 55

1) what type of nutritional management is necessary, 2) should therapy be initiated and what type (compensatory or exercises, direct or indirect) 3) what specific therapy strategies should be used.

Front 56

The clinician should consider what 8 things in deciding whether to initiate swallowing therapy with a dysphagic patient and what ype of therapy

Back 56

1) diagnosis
2) prognosis
3) reaction to compensatory strategies
4) severity of patient's dysphagia
5) ability to follow directions
6) respiratory function
7) avaliability of caregiver support
8) patient motivation and interest

Front 57

Reduced Labial Closure

Back 57

Range of motion lip exercises include stretching the lips in the /i/ position as far as possible and holding in extreme extension for 1 second; puckering the lips as tightly as possible and holding for 1 second bringing the lips together and holding for 1 second. Gradual increase in time once lip closure is obtained. Also add pressure (tongue blade) or clinician trying to manually part the lips.

Front 58

Reduced Range of tongue movement laterally during mastication

Back 58

Lateral ROM exercises (indirect therapy) Temporary, use tongue to mash food on roof of mouth if elevation is there or position food on most mobile side and tilt head.

Front 59

Reduced Buccal tension or buccal scarring

Back 59

Facial exercises (indirect therapy)“oh” face, “ee” face rapidly alternate between the two; pull lips as far to one side as possible, then the other side

Front 60

Reduced range of mandibular movement laterally

Back 60

Mandibular ROM exercises (indirect therapy)Opening jaw as widely as possible and holding open for 1 second—particularly important post op oral cancer paitnents and patients undergoing oral radiation, should be continued through radiotherapy and 6-8 weeks after

Front 61

Reduced range of tongue movement vertically

Back 61

More in indirect…. If patient has not achieved tongue-palate contact after several months of repeating these excercises daily at rgular intervals, a palate reshaping prosthesis may be given- lowers palatal arch (designed by SLP and maxillofacial prosthodontist together) may be compromise between speech needs and swallowing needs

Front 62

Reduced tongue movement to form bolus

Back 62

More in indirect…. Temporarily may tilt head slightly forward to keep food in anterior part of the mouth until the patient is ready to initiate the swallow, thus preventing him or her from losing the bolus in one of the lateral sulci, with the start of the swallow the patient may then change head posture

Front 63

Reduced range and coordination of tongue movement to hold bolus

Back 63

More in indirect…. Temporary (interim) measure, clinician may suggest that the patient not attempt to manipulate the bolus once it is in the mouth but to hold the material securely against the front if the roof of the mouth and to initiate the swallow immiediately

Front 64

Reduced ability to hold bolus in normal position

Back 64

Given a bolus of thick paste consistency (about 1/3 teaspoon) and asked to hold it consciously against the anterior to mid-portion of the palate with the tongue. This exercise requires the tongue tip and lateral margins of tongue be contacting the alveolar ridge immediately posterior to the teeth—then bolus can be made thinner and thinner in consistency

Front 65

Reduced oral sensation

Back 65

Should position food on more sensitive side of mouth, use of cold material may help patient localize, use of mild spices or tastes may help localize

Front 66

Tongue thrust (when due to neurologic impairment)

Back 66

Heightening awareness of thrust pattern and asking them to consciously position tongue on the alveolar ride and begin the swallow with an upward-backward push often reduces the thrusting. Applying downward pressure to the middle of the tongue may also reduce the thrust and should be done during feeding. As a compensatory measure the patient may be taught to position food posteriorly on the tongue and thus avoid the thrusting pattern. Titlting the head backward or tiltiing body backward 60 degrees (wheelchair) may also be helpful in keeping food in

Front 67

Reduced tongue elevation

Back 67

More in indirect…. Interim: position food posteriorly in oral cavity or syringe 5 to 10 ml of liquid into oral pharynx and bypass tongue elevation; tilt head back for gravity; if concerned about aspiration can teach supraglottic swallow;

Front 68

Reduced anterior-posterior tongue movement

Back 68

More in indirect…. Frequently this disorder is in conjunction with reduced tongue elevation. Again, in the interim: position food posteriorly in oral cavity or syringe 5 to 10 ml of liquid into oral pharynx and bypass tongue elevation; tilt head back for gravity; if concerned about aspiration can teach supraglottic swallow;

Front 69

Disorganized patterns of anterior-posterior tongue movement

Back 69

Such as parkinson’s rapidly repeating tongue movements- alert patient to pumping and ask him to consciously hold the bolus against the palate with the tongue and to initiate the swallow with a single strong backward movement of the tongue.

Front 70

Reduced tongue strength

Back 70

Resistance exercises include wither a tongue blade or other flat object to push vertically down on the tongue, asking the patient to resist it if possible. Then the tongue blade can be turned vertically and pushed laterally against one side of the tongue with patient resisting. Then can be put down vertically in front of mouth and used to push back against tongue tip with patient applying resistance

Front 71

Swallowing apraxia- searching motions or lack of response to food placed in mouth

Back 71

Techniques to improve sensory input by changing bolus characteristics, thermal-tactile stimulation (indirect)

Front 72

Scarred tongue contour

Back 72

Cannot be improved with exercise, can be compensated for by positioning food posterior to the scarring, and to tilt head backward to use gravity to assist in oral transit. Actual treatment involved surgical release of scar- head and neck surgeon.

Front 73

Delayed or absent triggering of the pharyngeal swallow

Back 73

Thermal tactile stimulation repeated 3 to 4 times a day for 5 to 10 minutes each time, suck-swalow, or using a bolus with a particular sensory characteristic (sour or cold or a particular volume). Compensatory technique- tilt head forward.

Front 74

Bilateral reduction in pharyngeal contraction

Back 74

Masako Maneuver- No direct therapy technique improves pharyngeal contraction at all levels. The tongue holding techinique is called the Masako maneuver and is designed to exercise the portion of the superior constrictor known as the glossopharyngeus muscle. This muscle is believed to be responsible for the retraction of the tongue base and anterior bulging of the posterior pharyngeal wall at tongue base. The maneuver involves holding the tongue between the teeth with the tip extended out ¼ inch. It pulls pharyngeal wall forward while doing the tongue holding. Difficult if there is a pharyngeal delay. Compensatory techniques include:
1. alternating liquid and semisolid or solids so the liquids wash the thicker consistencies
2. limiting the diet to liquids or thin paste
3. following each swallow of food or liquid wih several repetitive dry swallows to clear pharynx

Front 75

Unilateral pharyngeal paralysis

Back 75

No exercise improves pharyngeal paralysis but compensatory strategies:
1. turn head toward the affected side thus closing the pyriform sinus on the affected side and directing food down normal side
2. if unilateral paralysis in lingual function as well as pharynx- tilt head toward stronger side, keeping material on the stronger side in oral cavity and through pharynx
3. supraglottic swallow
4. alternate liquid and solid to wash thicker consistencies

Front 76

Scarred pharyngeal wall

Back 76

No exercise improves scarring, but there are compensatory strategies. Mainly, the supraglottics swallow may help eliminate residue that is in scar on wall. Also:
5. turn head toward the affected side thus closing the pyriform sinus on the affected side and directing food down normal side
6. if unilateral paralysis in lingual function as well as pharynx- tilt head toward stronger side, keeping material on the stronger side in oral cavity and through pharynx
7. supraglottic swallow
8. alternate liquid and solid to wash thicker consistencies

Front 77

Cervical osteophyte

Back 77

A cervical osteophyte or bony overgrowth of one of the cervical vertebrae may be surgically reduced, or the patient may acclimate to it by thinning out the consistency of material swallowed. Changing head posture, particularly to one side or the other may be helpful.

Front 78

Pseudoepiglottis at the base of tongue in total laryngectomees

Back 78

Surgically removed, adjust by only swallowing liquids and thin paste, sometimes head rotation will keep the fold out of the bolus path

Front 79

Cricopharyngeal dysfunction

Back 79

If problem is truly the muscle’s inability to relax, cricopharyngeal myotomy should be considered (after 5 to 6 months of time to recover spontaneously). If it is a laryngeal elevation problem, try mendehlson maneuver, if they can follow directions. These patients tend to be cervical spine injury, cervical anterior or posterior fusion, stroke, radiation therapy, surgery to the pharynx. If bolus pressure is the problem, that means pharyngeal pressure is lacking, so do excercises to improve tongue base. Combo of mendehlson and head rotation to weaker side may be most helpful.

Front 80

Reduced laryngeal elevation

Back 80

Mendhelson Maneuver. Compensatory: sperglottics, super supraglottic, throat clearing, falsetto excercise

Front 81

Reduced laryngeal closure at airway entrance

Back 81

Super supraglottic swallow

Front 82

Reduced laryngeal closure at vocal folds

Back 82

More in indirect….. Supraglottic swallow

Front 83

Therapy for Esophageal Swallowing disorders:

Back 83

Normal handled with medication and surgery

Front 84

3. Patients with oral cancer did not include a particular food consistency in their diet unless combined oral and pharyngeal transit times were approximately ___ seconds or less.

Back 84

10 seconds

Front 85

compensatory treatment procedures include:

Back 85

postural techniques, stimulation, changes in viscocity/amount of bolus, changes in type of bolus, prosthesis

Front 86

There are three types of oral prosthetics that may improve swallowing:

Back 86

a palatal lift prosthetic, reshaping prosthetic, palatal obturator

Front 87

Five swallowing maneuvers include:

Back 87

Mendhelson, Supraglottic, super supraglottic, effortful swallow. Also Masako- lingual control

Front 88

When to use Scintigraphy?

Back 88

• Scintigraphy- camera takes pictures and calculates AMOUNT of residue of aspiration. Only procedure which actually measures amount of aspiration. Used often to look at children and reflux. Nuclear medicine test.

Front 89

The parts of the tracheostomy tube are:

Back 89

the inner cannula, outer cannula, and obturator

Front 90

The difference between the supraglottic swallow and the super-supraglottic swallow

Back 90

is the super supraglottic is an effortful breathhold (bearing down) closes airway entrance and true folds as opposed to just the vocal folds (supraglottic).

Front 91

The difference between the effortful swallow and the super-supraglottic swallow

Back 91

the effortful swallow is a HARD swallow being aware of the backward tongue propulsion and s used to improve tongue base retraction as opposed to the super-supraglottic swallow which is an effortful breathhold and is for closing the airway entrance and has you cough after.

Front 92

why use the minimal leak technique?

Back 92

so no tracheal ischemia which leads to stenosis instead of being fully inflated

Front 93

hole in tube for speech, usually not in cuffed tracheostomy because defeats the point of the cuff

Back 93

Fenestrate tube

Front 94

**** why aren't exercises included in the xray?

Back 94

Exercises are NOT in the x-ray because they don’t have imemediate effects. • Whichever they respond to best should be used in therapy

Front 95

• When to use supraglottic as opposed to super supraglottic?

Back 95

1) use superglottic when the problem is vocal fold adduction; premature spillage or delayed pharyngeal swallow

Front 96

Child with cricopharyngeal problem-

Back 96

• Child with cricopharyngeal problem- SHAKER!! Also try mendehlson maneuver—but child doesn’t have as far to rise, head rotation to UES, and falsetto

Front 97

three therapies you should not use:

Back 97

• Don’t use electrical vital stimulation, DPNS, or myofacial release (myofacial release comes from PT and supposedly massages and breaks up facia where tight)

Front 98

When to use manometry?

Back 98

• Manometry- way to measure pressure during swallow, one kind in esophagus- water manometry little tube 3 mm in diameter has holes all along it, you wouldn’t want to do it in pharynx but when esophagus contracts it shows as pressure goes up. Pharynx- solid state manometry, line for every sensor- generally in pharynx there are 3-5 sensors, one is at the upper sphincter one is at base of tongue, and one is at the esophagus. If what you want to see is pressure, you need manometry, some disagreement about whether you need xray with it.

Front 99

When to use surface EMG

Back 99

• Surface EMG- not really diagnostic procedure because all it shows is electrical activity when muscle contracts, you can use for biofeedback or twaching some clinicians to use it for the mendhelson maneuver.

Front 100

When to use ultra sound?

Back 100

• Ultrasound- high-frequency soundwaves- look up through mandible @ tongue. Lots of little dots you can connect- white blob is hyoid bone, biofeedback for tongue motion- Not invasive and not clearest picture, not good for phaynx.

Front 101

When to use endoscopy

Back 101

• Endoscopy- Endoscopy shows the anatomy the best. the difference between oral and nasal endoscopy is the placement and quality of picture. You would use nasal endoscopy to see if someone could do a supraglottic swallow. Oral endoscopy is good for seeing effortful breathhold.