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59 Cards in this Set
- Front
- Back
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Tx of Dysphagia CPT CODE
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92526
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What are Three Ques to Answer when considering tx
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1. What type of nutrition mangmt is necc.
a. oral vs nonoral b. types of nutrition c. nutritional risk 2. Should tx be initated - app/inapp. a. pot to recover b pot to maintain oral intake for a longer pd of time c. pt charac 3. What specific managemt stragegies should be used a. compensatory strat (post, positioning, mod of bolus and/or delivery) b. swallowing maneuv. c. adaptive equipmt d sensory stim e. biofeed back |
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what are some pt characteristics to consider re initiation of tx
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1. diagnosis - speed and potential for recovery
2.prognosis-can tx effect change 3. rxn to cmp strateg. if successful is there need for tx? 4. severity 5. ability to follow directions 6. respiratory function 7 caregiver support 8. pt motivation and interest |
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if pt has impaired resp. function
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may not be able to tolerate arway closure for swallowing maneuvers
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what is the goal of dysphagia tx
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to reestablish oral feeding while maintain adequate hydration, nutrition, and safe swallowing
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what are common surgical options for improved glottal closure
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-medialization thyroplasty (piece of plastic to push up vocal cord that is paralyzed)
-injection of biomaterials-collagen, injected to fatten up vocal cord |
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surgical options for protection of airway
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1.stents
2.laryngotracheal separation:trachea is separated from airway just below the larynx and brought forward to tracheostoma 3. larungectomy 4.tracheostomy tubes 5. feeding tubes |
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surgical options for improving the ues
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1.dilation
2. myotomy 3. botox |
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name the two types of tube feeding
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A. Enteral suppport
B.Parenteral support |
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Describe Enteral support
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inside digestive tract.. gi tract functional
A. NG tube -nasogastric (short term) B PEG-fed directly into stomach thru catheter that sits on outside of stomach C. J-tube - jejunum of the small intestine (predigested formula) |
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Describe Parenteral tube feeding
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outside dig. tract-gi tract not functional
commonly delivered into central vein pts supported 4-6wks |
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what are some factors to consider with oral v. nonoral feeding
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1. clinical and instrumental evals of swallowing
2. medical status 3. nutritional status 4. beh. and cognitive status |
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what are some nonclinical pt factors to consider
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1. pt autonomy
2. ethnicity/cultural beliefs 3.religion |
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if more than 10% of bolus is aspirated
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discontinue oral feeding
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pts that are aware will
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cough to clear but may stop eating bc of discomfort, effort, and fatigue
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for those who are unaware they will
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aspirate excessively
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if more that 10 secs is needed for pral and pharyngeal transit time for EVERY consistency but NO asp
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supplement with nonoral feeding
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if nonoral feedin is longer than 3-4 wks
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nonoral will prob be direct gastric tube
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if nonoral feeding timing is borderline
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dietician may add oral supplements to diet
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what are some physician considerations
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1.pt unable to sustain nutrition or consume sufficient protein and calores for >7-10days
2.pt requires sufficient calories for short-term basis to overcome an acute medical problemt is @ risk for aspiration 3. p |
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whats the purpose of compensatory tx procedures
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1. to control flow of food and change pt's symptoms
2. compensatory proc. DO NOT change phys. of the swallow 3. often under control of caregiver or txist 4. involve less muscle effort |
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what are the types of compensatory tx procedures
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1. postural techniques
2. increasing sensory input 3. bolus modification 4. intraoral prosthetics |
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List the postural techniques
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1. chin down
2. chin up 3. head rotation 4. combo of chin tuck and head rotation 5. head tilt 6. lying down |
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list some techniques for increasing oral sensation
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1. increase downward pressure of spoon on tongue when presenting food
2. sour bolus 3.cold bolus 4. bolus that requires chewing 5. larger volume bolus (3ml +) 6. thermal tactile stimulation 7. suck-swallow |
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what pt populaton needs oral sensory awareness
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swallow apraxia, tactile agnosia, delayed onset of oral swallow or pharyngeal trigger, and reduced oral sensation
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bolus modification
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1. volume of food per swallow
- increase for delayed pharyngeal swallow - decrease weaken pharyng swallow 2. food consistency |
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thin liquids are appropriate for
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1. reduced tongue base retraction
2. reduced pharyngeal wall contraction 3. reduced larungeal elevation and crico pharyngeal opening |
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thickened liquids and foods appropriate for
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1. delayed pharyngeal swallow
2. reduced laryngeal closure |
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what is the last resort
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elimination of particular consistency
done when compensatory strategies dont work |
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Name some intraoral prosthetics
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palatal lift
palatal obturator palatal reshaping prosthesis |
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true or false
no exercise improves pharyngeal paralysis |
true
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true or false
no technique improves pharyngeal contraction at all levels |
true
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what is the purpose of tx techniq.
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1.change swallowing phy
2. improve range of motion 3. improve sensory input 4. pt takes voluntary control of timing and coordination |
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whats the diff btwn direct and indirect tx techniq.
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direct:introduce food/liquid for pt to swallow may practice with dry swallow first-pts follows instruc-cough when needed
indirect: no food or liquid given-focus on improving control of muscles-use inst.assessment before moving to direct |
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name the types of tx techniq.
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1.range of motion
2.sensory motor integration 3. swallow manuvers and exc. |
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range of moion exc
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a. tongue elev. and lateral. including resistince
b. bolus control and propulsion c. vocal fold adduction d. tongue base e. laryngeal elevation |
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2. sensory motor integration
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same as oral sensory awareness
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3. swallow maneuvers
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1supraglottic swallow
b.super-supraglottic swallow c. effortful swallow d. mendelsohn e. masaka f. shaker |
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how can you compensate for cervical ostephytes
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changing head posture/thinning bolus
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how can you compensate for pseudoepiglottis at base of tongue
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head rotation and or swallowing only liquids and thin paste consistencies
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what is the etiology of a cricopharyngeal dysfunction
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1. failure of ues to relax and open adequately
2.reduced laryngeal motion up and fwd 3. poor pressure to drive bolus thru ues |
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explain management of cricopharyngeal dysfunc.
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1.cricopharyngeal muscle spasm-botox or cricophy. myotomy
2.poor laryngeal elevation- Mendelssohn maneuv & head rotation to weaker side if unilateral paresis 3. inadequate pressure 0 exercises to improve tongue base axn i.e. Masaka |
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what are some ways to provide biofeedback in therapy
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1. surface electromyography (EMG)
2. Ultrasound 3. Videoendoscopy 4. Videoflurography |
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When do initate tx
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-as soon as pt medically stable
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when do you initiate tx for head and neck cancer patients
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7-14 days post op when no complications
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when do you initiate tx for cva pts
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2-3 days post when pt is awake and alert
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how often is tx for inpatients
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daily
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how often is tx for outpatients
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weekly
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should trach cuffs be inflated or deflated during assessment and tx
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deflated bc inflated cuff restricts laryngeal elevation and UES opening
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ICD-9 dysphagia unspecified
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787.20
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ICD-9 dysphagia oral phase
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787.21
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ICD-9 dysphagia oropharyng phase
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787.22
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ICD-9 dysphagia pharyngeal phase
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787.23
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ICD-9 dysphagia pharyngesophageal phase
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787.24
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ICD-9 other dysphagia
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787.29
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what is the biggest issue with tx
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continuity of care
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how long is pt there in acute care
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long enough for bedside eval -
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schools
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may complete screening or eval and begin indirect tx until instrumental exam is done
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nursing homes
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interaxn with and education of staff is critical
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