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57 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Usually, bedside exmination precedes what?
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Videofluoroscopy
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Most common imaging technique in swallowing
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Screening should always be...
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quick, low cost, low risk
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3 things
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What are two important characteristics of screening procedures?
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Specificity (ID true negatives) and
Sensitivity (ID true positives) |
What should screening ID?
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At this time, clinicians should use a screening procedure that is
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low-risk and non-invasive
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n/a
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In infants, children, and developmentally delayed adults, which behaviors should lead to an in-depth diagnostic?
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Food rejection, food selectivity, gagging, open-mouth posture
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n/a
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Gagging as food is placed in the mouth indicates what?
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Oral hypersensitivity or tactile agnosia
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n/a
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Bedside/clinical exam provides which information?
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1) current medical diagnosis, medical hisory, swallowing history; 2) patient's medical status (nutritional and respiratory); 3) patient's oral anatomy; 4) respiratory function 5) labial control 6) lingual control 7)palatal function 8) pharyngeal wall contraction 9) laryngeal control 10) ability to follow directions 11) reaction to oral sensory stimulation 12) reactions, symptoms during swallowing
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There's 12 items on this list...
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Bedside/clinical exam can be divided into ...
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Two parts: preparatory examination and innitial swallowing examination
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Two parts
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As a result of the preparatory exam, we should have information on
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1) posture that may result in best swallowing, 2) best position for food in the mouth, 3) potentially best food consistency, and 4) some idea of the patient's swallowing disorder
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4 Items
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When working with patients who are tracheostomized, it is essential to
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Deflate the cuff when medically feasible
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Cuff
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What are the three parts of most tracheostomy tubes?
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Outer cannula, inner cannula, and obturator
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n/a
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The minimal leak technique does what?
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Prevents tracheal stenosis by allowing minimal leak around cuff
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n/a
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Swallowing and respiration are
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reciprocal
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Catchy word:)
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The blue dye test [blank]
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is a screening test for aspiration
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screening
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Can you do swallowing therapy with an intubated patient?
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No
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Duh
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Oral motor examination should provide info on
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range, rate, accuracy of motion for the lips, tongue, soft palate, and pharyngeal wall during speech, reflexive activity, and swallowing
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Think components of oral motor exam
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If a patient cannot open mouth voluntarily, what might help?
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Oral massage (rotary massage of cheek plus firm downward pressure on chin and verbal reinforcement)
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3 components, 1 of them verbal
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If a patient only has apraxia of swallow but no other swallowing disorders, is there need for MBS study?
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No
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n/a
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Is gag reflex function related to swallowing ability?
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NO!
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She keeps stressing this
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Inability to change pitch may imply what?
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Reduced sensitivity within and around larynx
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n/a
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What should swallow therapist consider when deciding whether to do swallows at bedside?
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Risk-benefit ratio
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n/a
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Poor tongue control may be helped with which posture?
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First tilt head downwards as food is introduced, then throw head back to drain materials when ready for swallow
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Two components
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Poor airway control (or delay of pharyngeal swallow) may be helped with
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Tilt head downward
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Tilt head which way?
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WHat does the tilt downward position do?
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Enlarge vallecular space, narrow airway entrance, position epiglottis more posteriorly
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Three components
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Where should food be positioned in the mouth?
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On the side with best function and sensitivity
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Common sense
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Selection of food texture to use during swallowing evaluation should be based on
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1) info collected in history 2) data on oral control and 3) laryngeal and pharyngeal control
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Which utensils are included in evaluation?
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1) size 0 or 0 laryngeal mirror 2) tongue blade 3) cup 4) spoon 5) straw 6) syringe
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Other than deflating the cuff, what should be done prior to beginning swallowing work with tracheotomized patient?
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Suction patient immediately after cuff deflated
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What should patient do during each swallow?
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Occlude tube
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What should patients be told about coughing during swallowing eval.?
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Coughing is encouraged when necessary
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When placing their hand on the patient's chin, the index finger should feel the [blank structure and function], the second/middle finger should feel the [blank structure and function], the third/ring finger should feel the [blank structure and function], and the fourth/pinkie should feel the [blank structure and function]
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1) mandible/initiation of tongue mvt
2) hyoid/hyoid mvt 3) top of thyroid/laryngeal mvt 4)bottom of thyroid/laryngeal mvt |
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What other tasks may be performed after the swallow, if assessing aspiration?
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1) phonate ah for a few secs -- check for gargling
2) pant for a few secs (dislogde bolus from pyriforms if stuck) |
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What are two purposes of MBS study?
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1) ID anatomy and physiology of abnormal swallow
2) Evaluate treatment strategies |
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When are intervention strategies introduced?
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When reason for aspiration has been identified
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During the MBS study, fluoroscopic image should focus on
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1) lips anteriorly
2) hard palate superiorly 3) posterior pharyngeal wall posteriorly 4) esophagus, airway bifurcation inferiorly |
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Patients should be referred for a videofluoroscopy if
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1) they aspirate or
2) pharyngeal disorder is suspected |
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Head back is good for
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Inefficient oral transit
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Head down is good for
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1) Delay in pharyngeal swallow
2) Reduced tongue base motion 3) Unilateral laryngeal dysfunction 4) Reduced laryngeal closure |
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Head rotated to damaged side is good for
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Unilateral pharyngeal dysfunction
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Head rotated is good for
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Cricopharyngeal dysfunction
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Lying down is good for
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General reduced pharyngeal wall contraction
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Techniques to improve sensory awareness are used with which patients?
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1) those with swallow apraxia
2) those with delayed onset of oral swallow 3) those with delayed trigger of pharyngeal swallow |
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Sensory techniques include
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1) increase downward pressure on tongue
2) present sour bolus 3) present cold bolus 4) present chewable bolus 5) present larger volume 6) themal-tactile stim. |
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How do you do thermal-tactile stim.?
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Rub faucial arches with laryngeal mirror, after holding mirror in crushed ice
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Swallow maneuvers include
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1) supraglottic swallow
2) super-supraglottic swallow 3) effortful swallow 4) Mendelsohn maneuver |
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Supraglottic swalllow does
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closes true vocal folds before and during swallow
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Super-supraglottic swallow does
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closes airway entrance before and during swallow
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Effortful swallow does
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increase tongue base posterior mvt during pharyngeal swallow
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Mendelsohn maneuver does
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increase extent, duration of laryngeal elevation (and UES opening)
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Reduced range of tongue motion
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Best food: thin liquid
Food to avoid: thick foods |
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Reduced tongue coordination
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Best food: think liquid
Food to avoid: thick foods |
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Reduced tongue strength
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Best food: thin liquids
Food to avoid: thick foods |
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Delayed pharyngeal swallow
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Best food: thick foods and liquids
Food to avoid: thin liquids |
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Reduced airway closure
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Best food: thick foods, pudding
Food to avoid: thin liquids |
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Reduced laryngeal movement
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Best food: liquid
Food to avoid: thick foods |
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reduced pharyngeal wall contraction
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Best food: liquid
Food to avoid: thick foods |
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Reduced tongue base movement
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Best food: liquid
Food to avoid: thick foods |
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