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75 Cards in this Set

  • Front
  • Back
screenings should be
quick, low risk, low cost
screening answers ___
if the patient has symptoms of dysphagia
A diagnositic answers___
what the nature of the physiology during swallow
indicators for indepth physiologic study in infants, children and developmentally delayed adults
rejection of food- MBS

food selectivity- test taste, temp., texture

gagging- radiographic study

open mouth posture- upper airway assessed and dental structure
gagging in children could be...
oral hypersensitivity/abnormal oral sensation

tactile agnosia

gag is more forward in children
two parts of bedside swallow
1. preparatory examination
2. initial swallowing examination
collection of info and exam of vocal tract control
Respitory status during preparatory examination; exam the ___ and what 3 things
upper aerodigetive tract

respiration, swallowing, speech
4 observations to be made during prep (while looking at respiration)
1. timing of saliva swallows in relation to phase of respiratory cycle

2. timing of coughing in relation to respiration-swallow coordination

3. duration of comfortable breath hold (1, 3, 5 sec)

4. oral or nasal breathing pattern
3 Parts of Tracheostomy tubes
1. outer cannula- holds site open
2. inner cannula- for cleaning
3. obturator- for placement, or to plug it
Cuffed respiration used when ___
1. need for respiratory treatment
2. potential for aspiration
If patient is on mechanical ventilation with positive pressure the cuff must be ___
3 downfalls for swallowing and cuffed trach
1. restricted laryngeal elevation
2. reduced laryngeal sensativity
3. pressure on esophogus
Fenestrated Trach tube when __
pt has difficulty producing voice

hole in outer cannula
covering the external end of the trach tube during a swallow and after increases airflow, which stimulates ____ and improves______
subglottic sensory receptors and improves vocal fold closure
labial assessment alerts the clinician to __
facial paralysis, lip closure
lingual function identifies ___
limitation in tongue function, best positioning
gurgly voice warrants ___
radiographic exam
hoarse voice is suspect of ___ refer to ___ for a ____
reduced laryngeal closure during swallow


laryngeal control suggests ___
laryngeal function in the swallowing disorder
borderline laryngeal function treatment options
supraglottic swallow

super-supraglottic swallow
Preperatory examination tells us what?
1. posture that may be best swallow
2. best position for food in mouth
3. potentially best food consistency
4. indication of nature of swallow disorder
delayed pharyngeal swallow;. try
chin duck
tilting head back is okay if
pharyngeal and laryngeal control are good
turn head toward
affected side
head tilt
towards better side

like in lingual hemiparesis or reduction in oral function on one side in addition to pharynx involvement
poor oral control
thickened liquid first
delayed pharyngeal swallow
thicker consistency
reduced tongue base or pharyngeal wall contraction
reduced laryngeal elevation or reduced ues opening
reduced closure of laryngeal entrance
thicker consistency
hand position for swallow
index behind mandible anteriorly

middle at hyoid bone

third top of thyroid cartilage

fourth bottom of thyroid cartilage
sensory awareness used for
swallow apraxia, delayed onset of oral swallow, delayed triggering of pharyngeal swallow
supraglottic swallow
closes airway at the level of true vocal folds before and during swallow
super-supraglottic swallow
closes airway entrance before and during swallow
effortful swallow
increase tongue base posterior motion during pharyngeal swallow and improves bolus clearance from valleculae
Mendelsohn maneuver
increase the extent and duration of laryngeal elevation and increases the duration and width of cricopharyngeal opening
Questions to ask after evaluation
1. what type of nutritional management is necessary?
2. should therapy be initiated and what type?
continuous goal of a tx program
is to reestablish oral feeding while maintaining adequate hydration and nutrition and safe swallowing
a patient who aspirates more than ___ of food ______ be on oral feeding

should not
compensatory strategies
control the flow of food and eliminate the pt's symptoms but do not change the physiology of the swallow
5 compensatory strategies
1. postural changes
2. increasing sensory input
3. modify volume and speed of food
4. change good consistency or viscosity
5. introduce intraoral prosthetic
pushes anterior pharyngeal wall posteriorly

tongue base and epiglottis push closer to posterior pharyngeal wall

airway entrance narrowed

vallecular space widened
chin-down helpful for
delay in triggering pharyngeal swallow

reduced tongue base retraction

reduced airway entrance closure
drain food from oral cavity
chin-up helpful for
reduced tongue control
head rotation
rotate to damaged side

closes damaged side of pharynx

pushes damaged side toward midline increase adduction of vf
head rotation helpful for
unilateral pharyngeal impairment

unilateral vocal fold weakness
chin down and head rotation
best protection
head tilt used when
both a unilateral oral impairement and unilateral pharyngeal impairment on the same side
head tilt
towards better side
lying down used for
bilateral reduction in pharyngeal wall contraction or reduced laryngeal elevation

residue in pharynx aspirated after swallow
oral sensory awareness tech used for
swallow apraxia
tactile agnosia for food
delayed onset of oral swallow
reduced oral sensation
delayed triggering of the pharyngeal swallow
types of sensory enhancements
increase downward pressure of spoon
present sour bolus
present cold bolus
bolus requiring chewing
larger bolus
thermal-tacile stimulation
thermal tactile most used for
stimulating pharyngeal swallow
larger bolus may ____ pharyngeal swallow
thin liquids for
oral tongue dysfunction
reduced tongue base retraction
"" pharyngeal wall contraction
"" laryngeal elevation
"" cricpharyngeal opening
thickened liquids for
oral tongue dysfunction
delayed pharyngeal swallow
purees and thick/thickened foods for
delayed pharyngeal swallow
reduced laryngeal closure at entrance
reduced laryngeal closure throughout
therapy procedures do what
change swallow physiology. May improve oral or pharyngeal structure range of motion, improve sensory input prior to swallow, take voluntary control over timing or coordination
direct therapy
introduce food into the mouth and attempt to reinforce apporpriate behaviors
indirect therapy (for those who aspirate on all food/liquid)
use exercises to improve neuromotor controls or practice with saliva only
range of motion exercises can improve
lips, jaw, oral tongue, base of tongue, larynx, vocal folds
manuever for airway closure at vocal folds
supraglottic swallow
manuever for entrance to airway closure
super-supraglottic swallow
purpose of heightening sensativity
to alert the central nervous system
swallowing maneuvers (see previous slides as well)
supraglottic swallow
super-supraglottic swallow
effortfull swallow
the Mendelsohn maneuver
effortful swallow will
increase posterior motion of tongue base during pharyngeal swallow and improve bollus clearance in valleculae
supraglottic how to
deep breath and hold
(cover tracheostomy)
hold breath while swallow
cough immediately after swallow
super-supraglottic does what
increases anterior tilt of the arytenoid and the false vocal cord closure to close entrance to airway
super-supraglottic how to
inahle and hold breath
bear down
hold breath and bear down as swallow
effortful swallow how to
as you swallow squeeze hard with all your muscles
Mendelsohn maneuver how to
swallow saliva several times
to feel laryngeal lift

when swallow don't let your adams apple drop, hold it with your muscles
imprves coordination
increases extent and duration of laryngeal elevation
increaes duration and width of cricopharyngeal opening
cricopharyngeal dysfunction causes
1. failure of CP muscular portion to relax
2. reduced laryngeal motion up and forward
3. poor pressure to drive bolus through sphincter