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82 Cards in this Set

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What three questions should be answered after eval of an oropharyngeal swallowing prob?
1. what type of nutritional management is necessary?
2. Should tx be initiated and what type (compensatory or exercizes, direct or indirect)?
3. what specific tx strategies should be used?`
191
A decision to prove tx for a pt w/dysphagia should be based on: (3)
1. pt's potential for improvement
2. recovery of swallowing ability
3. longer maintenance of oral intake because of exercise
192
What pt characteristics should be considered when deciding whether or not to initiate swallowing tx?(8)
1. diagnosis
2. prognosis
3. reaction to compensatory strategies
4. severity of the pt's dysphagia
5. ability to follow directions
6. respiratory function
7. availability of caregiver support
8. patient motivation and interest
193
Name the 5 factors used to determine the type of nonoral feeding
1. pt's gastrointestinal hx
2. cost of feedings and insurance
3. pt's behavior
4. pt's preference
5. pt's medical dx
195
A pt who is aspirating _% of every bolus should not be fed orally.
10
196
Compensatory treatment procedures are those that:
control the flow of food and eliminate the pt's symptoms, such as aspiration, but do not necessarily change the physiology of the pt's swallow
196
Name 5 compensatory strategies
1. postural changes (changes dimension of pharynx and direction of food flow
2. increasing sensory input
3. modifying volume and speed of food presentation
4. changing food consistency or viscosity
5. introducing intraoral prosthetics
197
Postural techniques redirect food flow and change _ dimensions in systematic ways.
pharyngeal
197
The chin-down posture (anatomic)
pushes anterior pharyngeal wall posteriorly

tongue base and epiglottis are pushed closer to the posterior pharyngeal wall

the airway entrance is narrowed

the vallecular space is widened
199
The chin-down posture is useful in what type of disorders?
delay in triggering the pharyngeal swallow

reduced tongue base retraction

reduced airway entrance closure
199
The chin-up posture (what it is for)
drains food from the oral cavity using gravity
199
the chin-up posture is useful for what type of disorder?
reduced tongue control
199
Head rotation is toward the:
damaged side
199
What does the head rotation do?
closes the damaged side of the pharynx
199
When is the head rotation used?
When there is a unilateral pharyngeal wall impairment

a unilateral vocal fold weakness
199
Head tilt - tilted toward the:
better or stronger side
199
Lying down is for which disorders?
reduction in bilateral pharyngeal wall contraction

reduced laryngeal elevation
200
Before advising a pt to eat lying down, observe _ _ first.
straw drinking ( to see if they are sucking or inhaling)
200
The best exercise for swallowing is _
Swallowing
200
inefficient oral transit (reduced posterior propulsion of bolus by tongue):
posture to apply and why
head back

uses gravity to clear oral cavity
198
delay in triggering phayrngeal swallow:
posture to apply and why
chin down

widens valleculae
narrows airway entrance
pushes epiglottis posteriorly
198
reduced posterior motion of tongue base:
posture to apply and why
chin down

pushes tongue base back to pharyngeal wall
198
unilateral laryngeal dysfunction
head rotated and/or chin down

places extrinsic pressure on thyroid cartilage which increases adduction
198
reduced laryngeal closure:
posture to apply and why
chin down; head rotated

puts epiglottis in more protective position
narrows laryngeal entrance
increases vocal fold closure
198
reduced pharyngeal contraction:
posture to apply and why
lying down on one side

eliminates gravitational effect on pharyngeal residue
198
unilateral pharyngeal paresis:
posture to apply and why
head rotated

eliminates damaged side from bolus path
198
unilateral oral and pharyngeal weakness on the same side:
posture to apply and why
head tilt

directs bolus down stronger side
198
cricopharyngeal dysfunction:
posture to apply and why
head rotated

pulls cricoid cartilage away from posterior pharyngeal wall, reducing resting pressure in cricopharyngeal sphincter
198
Techniques to improve oral sensory awareness prior to swallow are generally utilized in pts wit:
swallow apraxia
tactile agnosia
delayed onset of oral swallow
reduced oral sensation
delayed triggering of pharyngeal swallow
201
Sensory enhancement techniques include: (6)
1. increasing downward pressure of the spoon against tongue when presenting food in mouth

2. presenting a sour bolus

3. presenting a cold bolus

4. presenting a bolus that requires chewing

5. presenting a larger volume bolus (3ml+)

6. thermal-tactile stimulation
201
thermal-tactile stimulation involves:
rubbing the anterior faucial arch firmly four or five times with a size 00 laryngeal mirror before presentation of a bolus
201
exaggerated suck-swallow
increased vertical tongue-jaw sucking movements with the lips closed - helps trigger pharyngeal swallow

good for pt w/poor saliva control
202
measures of the effectiveness of sensory enhancement procedures include:3)
1. duration of time from command to swallo until initiation of the oral stage

2. oral transit time

3. pharyngeal delay time
202
what food consistency is best:
oral tongue dysfunction
red. tongue base retraction
red. pharyngeal wall contraction
red. laryngeal elevation
red. cricopharyngeal opening
thin liquids
203
Which food consistency is best:
oral tongue dysfunction
delayed pharyngeal swallow
thickened liquids
203
Which food consistency is best:
delayed pharyngeal swallow
red. laryng closure @ entrance
red. laryng closure throughout
purees and thick foods; including thickened liquids
203
% considered significant loss of oral tongue tisuse
25%
203
Four types of prosthetics:
1. palatal lift
2. palatal obturator
3. palatal augmentation or reshaping prosthesis
4. palatal reshaping prosthesis
203
Compare and contrast therapy procedures and compensatory strategies.
tx procedures are designed to change swallow physiology.

comp strat are designed to eliminate symptoms
203
therapy procedures are designed to (3things)
improve ROM of oral or pharyngeal structures

improve sensory input prior to swallow

take voluntary control over the timing and coordintion of selected oropharyngeal movts during swallow
203
Indirect therapy involves exercise programs or swallows of saliva, but no:
food or liquid is given
205
Indirect therapy is used in pt's who aspirate on:
all food viscosities and volumes
205
Direct therapy involves presetning food or liquid to the pt and asking:
them to swallow it while following specified instructions
206
In direct therapy, the pt should always be given _ instructions.
written
206
The pt should be encouraged to _ whenever needed.
cough
206
Name four types of therapy procedures:
1. oral motor control
2. range of motion exercises
3. heighten sensory input
4. swallow maneuvers
206
_ control and _ exercises can be used to improve fine motor control of the tongue.
bolus
chewing
206
Exercises to increase range of tongue motion, including tongue elevation and lateralization, should improve:
oral transit
206
ROM exercises have been found to improve _ understandability and _ swallow efficiency in oral cancer pt.
speech
oropharyngeal
207
Name 2 bolus control exercises
those to improve gorss manipulation of material

exercises to hold a cohesive bolus
207-208
Name 5 sensory stimulation techniques:
1. increasing downward pressure of the spoon against the tongue as the bolus is delivered to the mouth

2. introducing a bolus w/increased sesnory characteristics

3. providing a bolus requiring chewing

4. thermal-tactile stimulation

5. providing a larger volume bolus
211
thermal-tactile stimulation is designed to improve:
the speed of triggering the pharyngeal swallow
211
T or F
Thermal-tactile stimulation triggers the pharyngeal swallow at the time of the stimulation.
False - the purpose is to heighten the sensitivity for the swallow in the CNS and to alert the CNS so when the pt attempts to voluntarily swallow, the trigger is more rapid
213
W/sensory stimulation, once the pharyngeal swallow begins to trigger, tx can be expanded by (2 things)
1. increasing the amount of material presented (still using a pipette @ base of faucial arches)

2. changed the consistency of the food presented
214
Swallow maneuvers are desgined to:
place specific aspects of pharyngeal swallow physiology under voluntary control.
214
Name the 4 swallow maneuvers
supraglottic
super-supraglottic
effortful
Mendelsohn
214
Swallow manevuers are not feasible in pts w/
cognitive or significant language impairment

or who fatigue easily
215
Supraglottic swallow:
problem it is designed for and the rationale
reduced or late vocal fold closure: rationale-voluntary breath hold usually closes vocal folds before and during swallow

OR delayed pharyngeal swallow: rationale - closes vocal folds before and during delay
215
Super-supraglottic swallow:
problem it is designed for and the rationale
reduced closure of airway entrance: effortful breath hold tilts arytenoid forward, closing airway entrance before and during swallow
215
Effortful swallow:
problem it is designed for and the rationale
reduced posterior movt of tongue base: effort increases posterior tongue base movt
215
Mendelsohn maneuver:
problem it is designed for and the rationale
reduced laryngeal movt: larngeal movt opens the UES

disocordinated swallow: normalizes timing of pharyngeal swallow events
215
The supraglottic swallow is:
to close the vf before and during swallow to prevent aspiration
216
Voluntary airway closure technique
another name for supraglottic swallow
216
4 directions to pt doing a supraglottic swallow:
1. take a deep breath and hold
2. keep holding your breath and lightly cover your trach
3. keep holding your breath while you swallow
4. immediately after you swallow, cough
217
dump and swallow technique (aka extended supraglottic swallow)
for those w/ no oral transit

first give small vol of liquid to see if: trigger present and if there is sufficient airway closure

then give 5 directions (see other flashcard)
218
extended supraglottic swallow or dump and swallow technique instructions
give 5 to 10 ml in a cup and say
1. hold breath tightly
2. put the entire 5 to 10 ml liquid in the mouth
3. continue to hold the breat and toss the head back = dumping liquid into the pharynx
4. swallow 2 or 3 timesto clear the liquid while STILL holding the breath
5. cough to clear any residue from the pharynx
218
the dump and swallow allows the pt to take:
a significant amount of caloris in a short period of time
219
The super-supraglottic swallow is disigned to close the _ to the airway voluntarily by tilting the _ _ anteriolry to the base of the _ before and during the swallow and closing the _ cords tightly.
entrance
arytenoid
epiglottis
false
219
The super-supraglottic improves the _ of laryngeal elevation
rate
220
The effortful swallow is designed to increase posterior motion of the _ _ during the pharyngeal swallow.
tongue base
221
What instructions do you give a pt trying to do an effortful swallow.
"As you swallow, squeeze hard w/all your muscles."
221
The Mendelsohn maneuver is designed to increase the _ and _ of laryngeal elevation and thereby increase the duration and width of cricopharyngeal opening.
extent
duration
221
Instructions for the Mendelsohn maneuver
"swallow your saliva several times and pay attention to your neck as you swallow. Tell me if you can feel that something lifts and lowers as you swallow. Now when you swallow and you feel something lift as you swallow, don't let your Adam's apple drop. Hold it up with your muscles for several seconds."
221
3 exercises to improve labiral closure
1. stretching the lips in the /i/ position for 1 second

2. puckering the lips as tightly as possible and holding for 1 sec

3. bringing the lips together and holding tightly for 1 second
223
The design of a prosthesis depends on: (2)
speech needs
swallowing patterns
225
Can a scarred tongue contour cannot be improved with exercise.

True or False
True
229
Techniques to improve _ input work best for apraxics.
sensory
229
Masako
a tongue holding maneuver designed to exercise the glossopharyngeus muscle (swallowing with tongue 3/4 out b/t teeth)
231
Glossopharyngeus
responsible for the retraction of the tongue base and anterior bulging of the posterior pharyngeal wall at the level of the tongue base
231
compensatory techniques for bilateral reduction in phayrngeal contraction
1. alternating liquid and semisolid or solid swallows so the liquid washes the material of thicker consistency through the pharynx

2. limiting the diet to liquids or thin paste materials requiring less pressure to clear the pharynx

3. following each swallow of food or liquid with several repetitive dry swallows
231
Name the exercise that improves pharyngeal paralysis.
There is no exercise that can do this.
232
Name the compensatory techniques for phayrngeal paralysis
turn head toward affected side

tilt head to better side

supraglottic swallow
232