Dysphagia: Ch. 4

Front 1

Most pediatric dysphagia therapy techniques can not be applied to adults.

True or False?

Back 1

False: Many can be, but not all

Front 2

Important step in treatment.

Back 2

extinguishing undesirable behaviors

Front 3

Treatment strategies that help ensure successful feeding in the presence of an underlying disorder. Used for more severe deficits.

Back 3

Compensatory Strategies

Front 4

Treatment strategies that promote or develop normal feeding skills.

Back 4

Facilitative Strategies

Front 5

Facilitative strategy that is best used to promote awareness. Not proven to be effective as a direct technique.

Back 5

Oral-Motor Therapy

Front 6

Establishing Optimal Infant Stage/Feeding Readiness, Altering the Environment, Positioning, Altering Consistency/Temp/Volume/Taste, and Changing Utensils

are examples of what kind of strategies?

Back 6

compensatory

Front 7

Establishing Nonnutritive Suck, External Pacing, Oral Stimulation, Reducing Oral Aversions, Developing Chewing Skills, and Intervention for Behavioral Feeding Disorders

are examples of what kind of strategies?

Back 7

facilitative

Front 8

For a weak suckle, why do we change nipples, establish NNS, provide support, establish negative pressure, and use lingual stroking?

Back 8

To increase liquid extraction from the nipple

Front 9

For a suckle lag, why establish optimal state, establish NNS, organize the infant, provide support, and externally pace?

Back 9

to increase initiation of nutritive suck(l)ing when nipple is present

Front 10

For disorganized suck(l)ing, why alter the nipple to slow flow rate, establish NNS, and organize infant for oral feedings?

Back 10

to establish sustained rhythmical nutritive suck(l)ing

Front 11

For antertior spillage, why tap jaw and provide external lip/jaw support?

Back 11

to increase muscle tone and external support and facilitate oral retention of food

Front 12

for jaw thrusting, why slightly recline head, support jaw, sensory stimulate, and have child hold objects between teeth?

Back 12

to reduce jaw thrust during feeding and improve oral prep of food

Front 13

for jaw retraction, why provide jaw support while manually pulling jaw forward, and slightly incline head/trunk?

Back 13

to facilitate jaw extension during feeding to improve oral prep of food

Front 14

for jaw clenching, why apply firm pressure to face/cheeks, hold mandible with palm for support,and incline head and trunk?

Back 14

to facilitate graded jaw movements for food acceptance

Front 15

for tonic bite reflex, why apply pressure to face/cheeks/gums, sensory stim cheeks/lips/chin, release bite w/ pressure to TMJ, and use a flat (maroon) spoon?

Back 15

to reduce and manage the occurrence of the tonic bite reflex during feeding

Front 16

for jaw instability, why provide jaw support, sensory stimulate (cheek tapping), have child hold objects btwn teeth, alter position to determine best for jaw stability?

Back 16

to facilitated graded jaw movements for food acceptance

Front 17

for lip retraction, why use facial molding, tap cheeks starting and nose to upper lip, tilt spoon up, position slightly flexed head with loose chin-down?

Back 17

to promote lip closure during feeding

Front 18

When do you use VFSS in the treatment of pediatric dysphagia?

Back 18

to test for effectiveness of a new technique, not throughout therapy

Front 19

Name one effective calming cue

Back 19

Swaddling

Front 20

Rhythmical rocking (older), avoidance of motion (preemies), pressure to arms/legs/trunk, quiet, dim lights, quiet or white noise, smooth/bland/neutral smelling food

are examples of what?

Back 20

calming cues

Front 21

tickling soles of feet/palms, changing diaper, cold cloth, arrhythmical movement, visual changes, fluctuating pitch/loudness, and bold foods

are examples of what

Back 21

alerting cues

Front 22

What are the 4 steps to establishing a nonnutritive suck?

Back 22

1. place gloved finger or pacifier in mouth

2. press middle of tongue firmly 4-6 times (1-2 times/sec)

3. pause to see if infant continues unassisted sucking

4. repeat as tolerated

Front 23

Which is preferable for stimulating a NNS: Finger or Pacifier?

Back 23

Finger

Front 24

Why use a pulse oximeter when feeding?

Back 24

Reads blood oxygen levels, indication of a problem if levels are low..

95+ is optimal

Front 25

How is VFSS used in external pacing?

Back 25

determine number of suck-swallow-breathe cycles to administer in therapy. Assessment only to avoid overexposure!

Front 26

List some standard optimal feeding positions

Back 26

chin-tuck, 90 degree angle, head forward, neck elongated, symmetrical shoulders slightly depressed, secured position, provide foot support, hands at midline, flex hips and knees, loosen diaper for belly breathing

Front 27

Optimal feeding position for poor head control or tongue thrust

Back 27

slightly reclined (watch for reduced bolus control as a result!)

Front 28

Name an important program for tube-fed infants

Back 28

Oral Stimulation. Do during feeding to establish association between oral stim and eating.

Front 29

List three considerations in reducing oral aversions

Back 29

1. least to most noxious

2. use gloves rather than utensils if kid doesn't have teeth (less noxious)

3. give kid time to swallow

Front 30

When do you use increased versus decreased bite sizes?

Back 30

increased: heighten sensory awareness

decreased: oral stage deficiencies

Front 31

Considerations for temperature and taste

Back 31

hot/cold or spicy/sour

avoid room temp or bland. may cause aspiration because of low stimulation

Front 32

is a milkshake a thickened liquid?

Back 32

no!

Front 33

3 keys in stim. for developing chewing skills

Back 33

Chewable, Retrievable, Safe

(wrap food in gauze)

Front 34

What's one way to separate behavioral choice from inability in cases of food refusal?

Back 34

present food in a modified form

Front 35

Which do kids prefer: food on a spoon or finger food?

Back 35

finger food

Front 36

What's the general rule for optimal flow rate?

Back 36

highest safe rate. Careful of fatigue in preemies!

Front 37

Variables in bottles

Back 37

number of holes

stiffness of nipple

nipple size

nipple shape

bottle shape

cup?

Front 38

Modified cup good for establishing upright head position

Back 38

cut-out or "nosy" cup

Front 39

two considerations for spoon selection

Back 39

shallow curve

avoid metal

Front 40

Spoon feeding considerations

Back 40

lips closed around spoon, slight neck flexion for max lingual control, tip up slightly to facilitate lip closure

Front 41

What size nipple should you use for preemies?

Back 41

Regular (not preemie) because takes up space in mouth since they don't have fat pads

Front 42

nipple shape for creating negative pressure

Back 42

broad-based

Front 43

most breast-like nipple shape

Back 43

flat

Front 44

nipple shape for retracted tongue

Back 44

long and thin

Front 45

Name some rules for treating children with behavioral feeding disorders

Back 45

Don't use food as a reward, Liquids at end of meal, Remove food immediately if they angrily throw it, Start with small portions of solids

Front 46

Name some ways to start in feeding a child with a behavioral feeding disorder

Back 46

don't start with dessert (use Mrs. Dash to spice it up)

dip toy in jello

make it pleasurable!

Front 47

True or false: Oral-Motor Treatment may facilitate feeding skills

Back 47

True: key word is MAY

Front 48

Best way to use oral-motor treatment

Back 48

adopt and adapt

Front 49

True or false: putting ice on the back of the neck is an effective stimulation method.

Back 49

False: may trigger siezures

Front 50

make a bowl shape with entire hand and place it under jaw with thumb under lower lip

Back 50

chin cupping

Front 51

place index finger directly below bottom lip and put middle finger under mandible. place thumb vertically along side of face

Back 51

chin support with 2 fingers

Front 52

place thumb directly below bottom lip with middle and index fingers on chin

Back 52

chin support with 3 fingers

Front 53

To improve jaw/lip stability

Back 53

Chin and Lip support: chin cup, chin support (2 or 3 fingers)

Front 54

To improve jaw/cheek stability

Back 54

Jaw and Cheek support: thumb under chin with index and middle finger on either side of mouth, middle finger on cheeks with pressure during bottle feed

Front 55

to increase tongue strength

Back 55

Lingual Stroking: finger at midline, stroke toward front with downward pressure, quick unpredictable movements, tap to increase tone, deep pressure to decrease tone

Front 56

To relax cheek muscles prior to feeding

Back 56

Facial Molding: use fingers or a warm washcloth, begin at periphery of face, work toward chin and cheek with firm pressure toward lip, obtain closed mouth position, continue to mouth

Front 57

To improve tone

Back 57

Cheek Tapping: tap both sides of cheeks with firm and gentile pressure, simultaneous or alternate sides, 10-20 reps, use index and middle finger

Front 58

To improve muscle tone

Back 58

Quick Stretch: firm pressure with fingers over corner of lips, move toward cheeks, pressure to masseter and buccinator muscles, move toward ears

Front 59

Increase Sensitivity

Back 59

Thermal Stimulation:
Older kids: chill laryngeal mirror or small metal spoon, stroke soft palate and anterior faucial pillars, go slowly, allow child to place spoon, 10-15 times, instruct child to swallow

Younger kids: drill a hole in back of pacifier, fill with water and freeze, place in baby's mouth

Front 60

To promote stronger lip/tongue seal for sucking

Back 60

Negative Pressure: allow baby to begin sucking bottle, gently pull bottle anteriorly while in mouth