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45 Cards in this Set
- Front
- Back
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What qualities should a patient have to be a candidate for oral motor exercises?
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1. Cognitively capable of following directions
2. Motivated 3. Sensory deficits 4. Motor deficits |
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Name three levels of NPO feeding approaches.
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1. IV
2. NG tube 3. G tube |
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What considerations would one make in determining the best type of NPO nutrition?
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* Gastrointestinal history
* Patient’s behavior- agitated patient may pull out NG tube * Patient’s preference * Patient’s medical dx * A patient who aspirates 10% of each bolus, should not be eating orally. |
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What's the difference between direct and indirect therapy?
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Direct therapy involves postures and swallowing approaches with food, indirect involves only oral motor movements (no food).
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What types of exercises can you do to increase laryngeal closure?
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Coughing
Increasing loudness of voice Sustained phonation Sustained phonation at various pitches. Lee Silverman Voice Treatment. |
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What are some compensatory (indirect) swallowing therapies?
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OM exercises
Shaker exercises Thermal Tactile Stim |
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What are some direct swallowing therapies?
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1. Supraglottic swallow
2. Super supraglottic swallow 3. Effortful swallow 4. Mendelssohn maneuver |
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What are the steps of the supraglottic swallow?
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Take a breath and hold it while you take food and swallow, after the swallow cough.
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What is the efforful swallow?
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Using more effort throughout the duration of the swallowing process to increase the amount of movement that takes place.
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What is the Mendelssohn maneuver and when is it used?
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Try a couple dry swallows while palpating the larynx. Place the thumb and forefinger under the thyroid cartilage and hold the larynx in the elevated position while swallowing. It is used to improve laryngeal elevation and UES opening.
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What do compensatory swallow approaches include? What is another name?
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Compensatory swallow approaches consist of OM or neuromotor exercises to increase strength and control of muscles involved in the oral prep and oral phases of swallowing. Another name is 'indirect approach'.
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What is the rationale for OM exercises and which muscle areas do they target?
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OM can be used to control passage of the bolus, increase awareness of bolus, and maximize the driving forces. Whenever possible, they should be combined with other tx modalities. They target muscles of the lips, tongue, mandible, and VFs.
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What is the Shaker exercise?
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A series of head lifting exercises while in supine position. Designed to strengthen muscles involved with opening the UES (specifically digastricus, mylohyoid, geniohyoid), Also aimed at decreasing hypopharyngeal bolus pressure.
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What is thermal stim?
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Stroking with a cold probe to provide heightened awareness and an alerting stimulus to cause pharyngeal swallow to trigger faster.
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What are rehabilitative swallow tx and what is another name?
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These tx combine the use of various food consistencies to practice swallowing techniques, maneuvers, and compensatory postures. Also known as 'direct swallow tx'.
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What is the supraglottic swallow and when is it used?
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A 5 step maneuver:
1. Inhale and hold breath 2. Place bolus in swallow position. 3. Swallow while holding breath. 4. Cough after swallow before inhaling. 5. Swallow again (dry). Used to improve VF closure or to protect airway in delayed pharyngeal swallow. |
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What is the super supraglottic swallow and what is it used for?
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Use the same 5 steps as supraglottic, but bear down (Valsalva Maneuver) while holding breath.
Used for reduced airway closure. |
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What is the effortful swallow?
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Squeeze muscles while swallowing. Good for those with cog trouble, b/c it's simple single step direction.
Used for reduced posterior movement of tongue base. |
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What is the Mendelsohn maneuver?
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Have client initiate several dry swallows. Palpate the thyroid cartilage and hold it in the elevated position while swallowing. This sustained position enhances the opeing of the UES.
Used for reduced laryngeal movement. |
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Name 6 nonsurgical methods for controlling aspiration.
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1. Oral motor exercises
2. Head position maneuvers 3. Postural compensations 4. Swallow retraining 5. Diet modification 6. NPO diet |
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What are the 5 different postural techniques and when are each used?
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1. Head back- uses gravity to enhance oral transit.
2. Chin down- narrows the airway when there is a delay in swallow trigger. 3. Head turned- directs bolus to stronger side. 4. Lay on side- eliminates gravity allowing larynx to elevate before fluids fall. 5. Head tilt- directs bolus to stronger side. |
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What is a palatal lowering prosthesis and how is it used?
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It is a prosthesis to lower the soft palate when the tongue has been resected. It decreases the volume of the oral cavity and increases the tongue to palate contact pressures.
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What is the major effect of a one way speaking valve (Passe-Muir valve)?
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Increases subglottic air pressure to increase protection of airway during swallow.
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What is VF medialization and when is it recommended?
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Injectables include gelfoam, autologus fat tissue, and teflon.
Used for unilateral VF paresis or paralysis to bulk up one fold. Can be temporary or permanent. |
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What is medialization laryngoplasty and when is it used?
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It is an implant between the thryoid cartilage and the VF.
Used for those with unilateral VF paralysis, paresis, or atrohpy. A reversible procedure whose LT effect is unknown. |
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What is a cricopharyngeal myotomy and when is it used?
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Cutting of the UES, used for pt who have incomplete relaxation of the UES during swallowing. Contraindicated in those with pharyngeal muscles weakness, may cause GERD or air in esophagus.
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What is palatoplexy and when is it used?
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Unilateral palatal adhesion to Passavants Pad.
Used to compensate for VPI and to remediate nasal regurgitation. |
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What are three types of surgical closures of the larynx?
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1. Laryngotracheal separation- permanent blind pouch and stoma created from the distal trachea.
2. Laryngotracheal diversion - same process as above but with an anastomosis connecting the larynx to the esophagus. 3. Tracheostomy- mechanical ventilation, trachea and larynx remain connected, one way speaking value. Results in greater swallowing dysfunction and aspiration. |
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When referring to food, what is a constitutive equation?
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An equation relating to stress with strain and sometimes other variables (e.g. time, temp, concentration).
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What is a creep test?
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A test to determine the deformation of a material exposed to a constant stress.
An example is a weight on top of a cake, recording the deformation over time. |
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What is viscosity?
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Resistance to flow as a result of molecular cohesion.
Measured in centipoises (CP). |
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What is rheology?
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The study of properties of fluids.
Mathematical expressions providing a 'flow fingerprint' for fluid foods. |
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What are the 8 most significant textures in a dysphagia diet?
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1. Adhesiveness
2. Cohesiveness 3. Firmness 4. Fracturability 5. Hardness 6. Springiness 7. Viscosity 8. Yield stress |
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What is the traditional oral diet Level I?
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The most conservative level:
Pureed food and thickened liquids. Used for pt with severe oral prep, oral, and pharyngeal dysphagia. |
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What is the traditional oral diet Level II?
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Pureed and mechanically altered foods and thick or thickened liquids, soft foods requiring minimal chewing.
Used for those with suspected or ID'd aspiration. |
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What is the traditional oral diet Level III?
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Mechanically altered and soft foods with liquids allowed as tolerated.
Used for those beginning to chew and to rehab chewing. |
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What is the traditional oral diet Level IV?
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Soft foods and all liquids avoiding rough and course foods.
Used just before advancement to regular diet. |
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What is the National Dysphagia Diet (NDD)?
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Level I- pureed, homogeneous, cohesive, requires bolus control but no chewing.
Level II- mechanically alt, cohesive, moist semi-solids, requires chewing. Level III- advanced, soft foods, requires chewing. Level IV- regular, all foods. |
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What are some food categories not well tolerated by those with dysphagia?
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Crumbly and non cohesive
Mixed consistencies Sticky |
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What is a NG tube and what are +/-?
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It is through the nose, to the stomach.
+= short term, min invasive, and transitional to bolus feeding. -= Cosmetic, sinusitus, stomach must fx OK |
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What is a nasoduodental tube
and what are +/-? |
Through nose and into initial segment of the small intestine.
+= min invasive, ST, decreased risk of aspiration, does not require stomach. -= radiographic placement, cosmetic, requires long tube, may migrate. |
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What is nasojejunal tube and what are +/-?
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Through nose with tip placed further down intestine.
+= min invasive, decr risk asp, dn require stomach, decr migration. -= radiographic placement, long tube. |
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What is cervical esophagostomy and what are +/-?
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Tube through neck to stomach.
+= cosmetic, no need to undress, can be LT. -= LES stented open, GERD |
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What is a gastrostomy and what are +/-?
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Tube directly into stomach.
+= OK for LT, cosmetic, no migration, tube can be larger, OK for homemade formula, bolus feeding is an option. -= Aspiration, GERD, insertion site care, skin excoriation at site, fistula at site. |
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What are factors in an NPO decision? (6)
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1. Time required to swallow
2. Energy level of pt 3. Need for alternate route for meds 4. Repeated dehydration 5. Weight loss/malnutrition 6. Pneumonia episodes 7. Aspirating more than 10% of food/liquid. |
