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63 Cards in this Set
- Front
- Back
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What exercise would you use for oral weakness for 1) reduced labial closure and 2) reduced lingual control?
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1) hypertonicity- stretching
hypofunction- ROM 2) hyperfunction- stretching hypofunction- ROM |
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What exercise would you use to treat a delayed pharyngeal swallow?
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thermal stimulation
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What is 1 treatment would you use to improve laryngeal excursion, and pharyngeal retraction that may also improve tongue base movement and improve bolus clearance?
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Modified Valsalva/Effortful Swallow
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How would you instruct a patient to complete an effortful swallow?
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As you swallow, push and squeeze with all of the muscles in your mouth and throat. Try to swallow hard, squeezing all the way down through the swallow.
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What does the modified Valsalva/effortful swallow improve?
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laryngeal excursion
pharyngeal retraction tongue base movement bolus clearance |
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What are the (5) exercises designed to increase muscle strenth?
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modified Valsalva/effortful swallow
Masako maneuver/tongue hold vocal adduction exercise Shaker head lift Mendelsohn maneuver |
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What exercise is designed to improve tongue base strength and the strength of a swallow?
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Masako maneuver/tongue hold
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How would you instruct a patient to perform the Masako maneuver/tongue hold?
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Place your tongue between your teeth. Try to keep it there while you swallow. It is helpful to also pair with the effortful swallow.
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What does the Masako maneuver target?
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tongue base strength, strength of swallow
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What are contraindications for the modified Valsalva/Masako maneuver?
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cardiac and VF abuse
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Which exercise is designed to improve laryngeal valving and airway protection?
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vocal adduction exercises
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How would you instruct a patient to perform vocal adduction exercises?
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Sitting in a chair, either push with hands clasped, bear down with arms, or push hands against a partner while producing a sustained phonation. Cough, grunt, laugh
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What do vocal adduction exercises target?
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laryngeal valving & airway protection
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What exercise facilitates UES width opening and duration, and improved laryngeal excursion?
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Shaker head lift
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How would you instruct a patient to do the Shaker exercise?
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Lie in bed without a pillow and slowly lift your head off the bed, holding for up to 10 seconds. Repeat 3 times. Tactile feedback is good (such having them touch a quarter on their chest)
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What is the Shaker head lift designed to target?
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facilitates UES opening (width & duration), improved laryngeal excursion
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What exercise is designed to improve laryngeal elevation and duration of cricopharyngeal segment?
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Mendelsohn maneuver
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How would you instruct a patient to perform the Mendelsohn maneuver?
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Swallow normally and feel with your muscles how the voice box lifts when you swallow (guide to feel the thyroid notch). When you swallow and your voice box lifts to the top of your neck, don't let it come back down for several seconds. Hold it up with your muscles.
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List the (4) categories of compensatory strategies.
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postural techniques
sensory stimulation modifications at mealtime swallowing techniques |
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List the advantages/disadvantages of postural techniques.
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ADVANTAGES: requires no learning, minimal ability to follow directions, significant effect on safety & efficiency of swallow, changes physical dimensions/flow of food, temporary means of improving food intake (can become permanent)
DISADVANTAGES: inappropriate for some patients due to swallow/physical limitations |
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This postural technique results in a widened vallecular space and is appropriate for poor laryngeal closure, and reduced tongue base retraction.
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chin tuck
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What does the chin tongue accomplish?
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widened vallecular space, improves laryngeal closure, assists tongue base retraction
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This technique facilitates gravitational draining of food out of the oral cavity. It improves the speed of oral transit in patients with poor tongue control/part of the tongue surgically removed. It can be combined with chin tuck in patients who lose control of the bolus when food is placed in their mouth.
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head tilt backward
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What does the head tilt accomplish?
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helps gravity drainage of food out of the oral cavity, improves oral transit speed in patients with poor tongue control/tongue section has been surgically removed
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This technique closes the pyriform sinus on that side, which helps patients with unilateral pharyngeal weakness/paralysis as it directs food down the opposite/stronger side. It is used with patients who have reduced airway closure/hemilaryngectomy.
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head rotation
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What does head rotation accomplish?
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closes pyriform sinus on that side, more pressure on the VF side where head is rotated
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This technique generally provides the best airway closure. How?
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head rotation combined with chin tuck
chin down narrows airway entrance dimensions; rotation forces damaged VF to the midline, directing bolus away from the damaged side |
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This technique directs material down that side in the oral cavity and pharynx. It is used with both unilateral tongue dysfunction and unilateral pharyngeal disorders on the same side.
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head tilt to stronger side
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What does head tilt to the stronger side accomplish?
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directs material down that side in BOTH oral cavity & pharynx
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This technique aids patients who aspirate after the swallow because of residue in the parynx (gravity). It is used with patients who have reduced pharyngeal contraction/elevation.
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lying on side/back
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What do we need to be careful of when having the patient use the lying on side/back strategy?
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ensure there is no change of reflux/food reentry into the pharynx
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This technique is designed to improve sensory feedback.
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neurosensory stimulation
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What is the best treatment for swallowing?
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swallowing
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List the mealtime strategies designed to control the bolus.
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lingual sweep
cyclic ingestion dry swallows thermal gustatory stimulation bolus placement bolus size modification adaptations to intake rate slurp & swallow supraglottic & super-supraglottic swallow pharyngeal expectoration vocal quality checks |
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How do we introduce a bolus with more sensory characteristics?
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cold, texture, strong flavor, one that requires more chewing, larger volume, allowing the patient to feed him/herself
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What technique is designed to target sensory input?
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thermal tactile stimulation (to the anterior faucial arches prior to the swallow)
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What is required for the patient to utilize swallowing strategies? What is important when teaching them?
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voluntary control applied to the swallow
cognition & ability to follow direction increased energy (patient can fatigue quickly)Class Facilitator: Tatiana Arena Surprising: aspiration pneumonia, systemic diseases Role of SLP: promote healthy lifestyle, make recommendations, refer to other practicioners if needed teach these BEFORE VFSS as they are difficult to learn & require practice |
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How would you instruct a patient to perform a supraglottic swallow?
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Take a deep breath and hold it. Keep holding your breath and lightly cover your trach tue. Keep holding your breath while you swallow. Immediately after you swallow, cough.
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How would you instruct a patient to conduct a supersupraglottic swallow?
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Designed to close the entrance to the airway voluntarily by tilting the arytenoid cartilage to the base of the epiglottis before and during swallows. Inhale and hold your breath very tightly. Keep holding your breath & bearing down as you swallow.
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List some additional techniques (swallow strategies).
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toss head back using gravity to assist
thinner foods requiring less lingual pressure alternating liquids & solids (increased hydration) |
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What is spaced retrieval?
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The clinician has the client practice recalling information over periods of time (can be done during therapy or staff can be raining), it promotes good episodic memory retention. Problem: insurance reimbursement
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What is the nutrition care process?
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nutrition assessment
" diagnosis " intervention " monitoring & evaluation |
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What the some objectives for medical nutritional training?
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-prevent choking & aspriation (food & beverages)
-promote weight maintenance/gain -individualize diet based on patient needs & preferences -provide moistened foods/thickened beverages for hydration -modify liquids & diet for patient safety -correct any nutrient deficits -support independence in eating, when possible |
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What is the role of the RD in intervention?
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-diet & liquids of appropriate consistently, between meal snacks
-correct nutritional deficits -educate/counsel patient, family, caregiver |
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List an example of NDD1.
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pureed (pudding consistency, no lumps); ex: cream of wheat, yogurt, custard, pudding
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Give an example of NDD2.
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mechanically altered (minimum amount of easily chewed foods, no coarse textures); ex: eggs, pancake with syrup, tuna salad, canned peaches, banana
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Give an example of NDD3.
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advanced- ex: vegetable soup, ham sandwhich, cantaloupe (no hard fruits/vegetables, nuts, crispy, raw, or stringy foods)
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What does SPIKES stand for (counseling strategy)?
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Setting
Perception Invitation Knowledge Emotions Summary |
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What are early ID indicators for dementia? What should we do as clinicians to monitor nutrtion for these indivdiuals?
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weight loss, albumin levels
periodic evaluation, monitor performance, cognitive evaluation |
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What are some symptoms of head/neck cancer (tumor)?
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pain, bleeding, non-healing sore (ulcer)
lump/thickening in throat, dysphagia hoarseness, sore throat |
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Describe TNM Staging.
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TN: size/extend of tumor + "is" + 0-4 rating
N: number, size, location of NODES 0-3 M: metistasis X-?, 0-none, 1-distant |
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Why do patients develop swallowing issues as a result of HNC? Describe treatment protocol in HNC patients.
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Swallowing weakness & insufficiency due to fibrosis (scar tissue overproduction).
There is no standard protocol. Stretching, compensatory strategies, and exercise are used. |
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What are some effects of radiation therapy?
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xerostomia
inflammation pain (soft tissue & bone) loss of saliva flow changes in taste sensation & loss of appetite |
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What are 2 indications for tracheostomy?
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1) airway obstruction
2) respiratory failure/pulmonary toilet |
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What are the components of trach tubes?
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Inner/outer cannula
Obturator Hub Flange Fenestration Balloon Inflation line Pilot/balloon Cuff |
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What is the cuff's job?
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balloons around the airway, prevents junk in the lungs.
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What does a deflated cuff do?
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opens the airway
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List the physiologic effects of tracheostomy.
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Loss of subglottic airflow & pressure
Decreased reflexive cough Loss of laryngeal closure Loss of VF mobility Incoordination of swallowing & breathing |
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What are assessment procedures for tracheostomy?
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clinical swallow eval
blue dye screen FEES VFSS |
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What is the rationale for mechanical ventilation?
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periods of apnea
acute/impending ventilatory failure hyperventilation for intracranial pressure control |
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What are some strategies to minimize/referse the effects of ventilator dependency?
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dysphagia exercises, lingual strength, expiratory muscle training
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When can medications cause dysphagia?
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drug side effect, complication of drug interaction, medicine-induced esophagitis; older populations have more adverse reactions
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List some strategies to increase intake in malnourished patients with dysphagia.
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-use more sweeteners, fats, butter
-use food molds |
