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57 Cards in this Set

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