Dysphagia Chapter 5 And 6

Front 1

screenings should be

Back 1

quick, low risk, low cost

Front 2

screening answers ___

Back 2

if the patient has symptoms of dysphagia

Front 3

A diagnositic answers___

Back 3

what the nature of the physiology during swallow

Front 4

indicators for indepth physiologic study in infants, children and developmentally delayed adults

Back 4

rejection of food- MBS

food selectivity- test taste, temp., texture

gagging- radiographic study

open mouth posture- upper airway assessed and dental structure

Front 5

gagging in children could be...

Back 5

oral hypersensitivity/abnormal oral sensation

tactile agnosia

gag is more forward in children

Front 6

two parts of bedside swallow

Back 6

1. preparatory examination
2. initial swallowing examination

Front 7

Preparatory

Back 7

collection of info and exam of vocal tract control

Front 8

Respitory status during preparatory examination; exam the ___ and what 3 things

Back 8

upper aerodigetive tract

respiration, swallowing, speech

Front 9

4 observations to be made during prep (while looking at respiration)

Back 9

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

Front 10

3 Parts of Tracheostomy tubes

Back 10

1. outer cannula- holds site open
2. inner cannula- for cleaning
3. obturator- for placement, or to plug it

Front 11

Cuffed respiration used when ___

Back 11

1. need for respiratory treatment
2. potential for aspiration

Front 12

If patient is on mechanical ventilation with positive pressure the cuff must be ___

Back 12

inflated

Front 13

3 downfalls for swallowing and cuffed trach

Back 13

1. restricted laryngeal elevation
2. reduced laryngeal sensativity
3. pressure on esophogus

Front 14

Fenestrated Trach tube when __

Back 14

pt has difficulty producing voice

hole in outer cannula

Front 15

covering the external end of the trach tube during a swallow and after increases airflow, which stimulates ____ and improves______

Back 15

subglottic sensory receptors and improves vocal fold closure

Front 16

labial assessment alerts the clinician to __

Back 16

facial paralysis, lip closure

Front 17

lingual function identifies ___

Back 17

limitation in tongue function, best positioning

Front 18

gurgly voice warrants ___

Back 18

radiographic exam

Front 19

hoarse voice is suspect of ___ refer to ___ for a ____

Back 19

reduced laryngeal closure during swallow

otolaryngologist

laryngoscopy

Front 20

laryngeal control suggests ___

Back 20

laryngeal function in the swallowing disorder

Front 21

borderline laryngeal function treatment options

Back 21

supraglottic swallow

super-supraglottic swallow

Front 22

Preperatory examination tells us what?

Back 22

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

Front 23

delayed pharyngeal swallow;. try

Back 23

chin duck

Front 24

tilting head back is okay if

Back 24

pharyngeal and laryngeal control are good

Front 25

turn head toward

Back 25

affected side

Front 26

head tilt

Back 26

towards better side

like in lingual hemiparesis or reduction in oral function on one side in addition to pharynx involvement

Front 27

poor oral control

Back 27

thickened liquid first

Front 28

delayed pharyngeal swallow

Back 28

thicker consistency

Front 29

reduced tongue base or pharyngeal wall contraction

Back 29

liquids

Front 30

reduced laryngeal elevation or reduced ues opening

Back 30

liquids

Front 31

reduced closure of laryngeal entrance

Back 31

thicker consistency

Front 32

hand position for swallow

Back 32

index behind mandible anteriorly

middle at hyoid bone

third top of thyroid cartilage

fourth bottom of thyroid cartilage

Front 33

sensory awareness used for

Back 33

swallow apraxia, delayed onset of oral swallow, delayed triggering of pharyngeal swallow

Front 34

supraglottic swallow

Back 34

closes airway at the level of true vocal folds before and during swallow

Front 35

super-supraglottic swallow

Back 35

closes airway entrance before and during swallow

Front 36

effortful swallow

Back 36

increase tongue base posterior motion during pharyngeal swallow and improves bolus clearance from valleculae

Front 37

Mendelsohn maneuver

Back 37

increase the extent and duration of laryngeal elevation and increases the duration and width of cricopharyngeal opening

Front 38

Questions to ask after evaluation

Back 38

1. what type of nutritional management is necessary?
2. should therapy be initiated and what type?

Front 39

continuous goal of a tx program

Back 39

is to reestablish oral feeding while maintaining adequate hydration and nutrition and safe swallowing

Front 40

a patient who aspirates more than ___ of food ______ be on oral feeding

Back 40

10%

should not

Front 41

compensatory strategies

Back 41

control the flow of food and eliminate the pt's symptoms but do not change the physiology of the swallow

Front 42

5 compensatory strategies

Back 42

1. postural changes
2. increasing sensory input
3. modify volume and speed of food
4. change good consistency or viscosity
5. introduce intraoral prosthetic

Front 43

chin-down

Back 43

pushes anterior pharyngeal wall posteriorly

tongue base and epiglottis push closer to posterior pharyngeal wall

airway entrance narrowed

vallecular space widened

Front 44

chin-down helpful for

Back 44

delay in triggering pharyngeal swallow

reduced tongue base retraction

reduced airway entrance closure

Front 45

chin-up

Back 45

drain food from oral cavity

Front 46

chin-up helpful for

Back 46

reduced tongue control

Front 47

head rotation

Back 47

rotate to damaged side

closes damaged side of pharynx

pushes damaged side toward midline increase adduction of vf

Front 48

head rotation helpful for

Back 48

unilateral pharyngeal impairment

unilateral vocal fold weakness

Front 49

chin down and head rotation

Back 49

best protection

Front 50

head tilt used when

Back 50

both a unilateral oral impairement and unilateral pharyngeal impairment on the same side

Front 51

head tilt

Back 51

towards better side

Front 52

lying down used for

Back 52

bilateral reduction in pharyngeal wall contraction or reduced laryngeal elevation

residue in pharynx aspirated after swallow

Front 53

oral sensory awareness tech used for

Back 53

swallow apraxia
tactile agnosia for food
delayed onset of oral swallow
reduced oral sensation
delayed triggering of the pharyngeal swallow

Front 54

types of sensory enhancements

Back 54

increase downward pressure of spoon
present sour bolus
present cold bolus
bolus requiring chewing
larger bolus
thermal-tacile stimulation

Front 55

thermal tactile most used for

Back 55

stimulating pharyngeal swallow

Front 56

larger bolus may ____ pharyngeal swallow

Back 56

facilitate

Front 57

thin liquids for

Back 57

oral tongue dysfunction
reduced tongue base retraction
"" pharyngeal wall contraction
"" laryngeal elevation
"" cricpharyngeal opening

Front 58

thickened liquids for

Back 58

oral tongue dysfunction
delayed pharyngeal swallow

Front 59

purees and thick/thickened foods for

Back 59

delayed pharyngeal swallow
reduced laryngeal closure at entrance
reduced laryngeal closure throughout

Front 60

therapy procedures do what

Back 60

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

Front 61

direct therapy

Back 61

introduce food into the mouth and attempt to reinforce apporpriate behaviors

Front 62

indirect therapy (for those who aspirate on all food/liquid)

Back 62

use exercises to improve neuromotor controls or practice with saliva only

Front 63

range of motion exercises can improve

Back 63

lips, jaw, oral tongue, base of tongue, larynx, vocal folds

Front 64

manuever for airway closure at vocal folds

Back 64

supraglottic swallow

Front 65

manuever for entrance to airway closure

Back 65

super-supraglottic swallow

Front 66

purpose of heightening sensativity

Back 66

to alert the central nervous system

Front 67

swallowing maneuvers (see previous slides as well)

Back 67

supraglottic swallow
super-supraglottic swallow
effortfull swallow
the Mendelsohn maneuver

Front 68

effortful swallow will

Back 68

increase posterior motion of tongue base during pharyngeal swallow and improve bollus clearance in valleculae

Front 69

supraglottic how to

Back 69

deep breath and hold
(cover tracheostomy)
hold breath while swallow
cough immediately after swallow

Front 70

super-supraglottic does what

Back 70

increases anterior tilt of the arytenoid and the false vocal cord closure to close entrance to airway

Front 71

super-supraglottic how to

Back 71

inahle and hold breath
bear down
hold breath and bear down as swallow
cough

Front 72

effortful swallow how to

Back 72

as you swallow squeeze hard with all your muscles

Front 73

Mendelsohn maneuver how to

Back 73

swallow saliva several times
to feel laryngeal lift

when swallow don't let your adams apple drop, hold it with your muscles

Front 74

mendelsohn

Back 74

imprves coordination
increases extent and duration of laryngeal elevation
increaes duration and width of cricopharyngeal opening

Front 75

cricopharyngeal dysfunction causes

Back 75

1. failure of CP muscular portion to relax
2. reduced laryngeal motion up and forward
3. poor pressure to drive bolus through sphincter