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Dysphagia Final Flashcards

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1
Q

`Effortful Swallow (What does it do?)

A

Improves pressure at BOT and PPW including upper pharynx

Increases time of LVC, hyolaryngeal excursion, and PES opening

Place tongue against hard palate and sustain hold while swallowing “hard”

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2
Q

Effortful Swallow (Impairment/Deficits)

A

BOT and PPW

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3
Q

Masako Maneuver (What does it do?)

A

Aka “tongue hold swallow”

Improves BOT to PPW contraction

Stick tongue between teeth/gums, bite down gently to hold tongue, perform swallow while keeping tongue protruded

Further the tongue is protruded = harder/more exercise

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4
Q

Masako Maneuver (Impairment/Deficits)

A

BOT and PPW

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5
Q

Falsetto Exercise (Impairment/Deficits)

A

Laryngeal elevation and laryngeal vestibular closure

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6
Q

Mendelsohn Maneuver (What does it do?)

A

Elevates larynx, improves LVC, opens PES * Start swallow, sustain hold in most elevated position, complete swallow

Longer hold = more exercise

Often most challenging exercise for patient to learn

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7
Q

Mendelsohn Maneuver (Impairment/deficits)

A

Laryngeal elevation and laryngeal vestibular closure

Impairment: hyoid excursion

Impairment: PES opening

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8
Q

Shaker exercise (What does it do?)

A

Improves anterior hyoid excursion and PES opening

Supine position w/ head lift to look at toes while keeping shoulders flat

Sustained holds up to 1 min

Repetitive quick stretches

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9
Q

Shaker exercise (Impairment/deficits)

A

Impairment: hyoid excursion

Impairment: PES opening

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10
Q

Chin tuck against resistance (CTAR) (What does it do?)

A

Improves anterior hyoid excursion and PES opening

Using ~4 inch resistive device (ball, towel, balled up socks, pool noodle, etc.) placed below the chin and cued to push chin into the device

Sustained holds up to 1 min

Repetitive quick stretches

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11
Q

Chin tuck against resistance (CTAR) (Impairment/deficits)

A

Impairment: hyoid excursion

Impairment: PES opening

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12
Q

IDDSI Framework Drink Consistency Levels

A

Thin (0), Slightly Thick (1), Mildly Thick (2), Moderately Thick (3), Extremely Thick (4)

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13
Q

IDDSI Framework Food Consistency Levels

A

Liquid (3), Pureed (4), Minced & Moist (5), Soft & Bite Sized (6), Easy to Chew/Regular (7)

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14
Q

Why alter a patient’s food consistency?

A

Prolonged mastication, oral residue, pharyngeal residue, reduced PES opening, BOT, PPW, pharyngeal stripping wave

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15
Q

Why alter a patient’s liquid consistency?

A

Reduced oral or pharyngeal control, labial escape, aspiration

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16
Q

SOAP Abbreviation

A

Subjective, Objective, Assessment, Plan

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17
Q

Information in subjective section

A

Current diet, details of swallowing complaints, weight, recent pneumonia, adverse pulmonary sequelae, prior SLP intervention, speech changes, voice changes, other

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18
Q

Information in objective section

A

Bulk of the note, everything accomplished during session, details of OME, speech, voice, resonance, details of eval, strategies trialed and effectiveness, detailed report of intervention, education

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19
Q

Information in assessment section

A

Presence/absence of dysarthria, dysphonia, dysphagia, severity of dysarthria, dysphonia, dysphagia, suspected or known etiology of deficits

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20
Q

Information in plan section

A

Diet recommendations (food/liquid, use of feeding tube, medication), compensatory strategies, goals, referrals, ongoing SLP care

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21
Q

3 exercise physiology principles

A

Overload, specificity, reversibility

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22
Q

Overload principle

A

Overloading system to increase endurance

“If you habitually overload a system it will respond and adapt”

Chronic adaptations to repeated exercise

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23
Q

Specificity principle

A

Focus on one part so that the specific part converts to overload

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24
Q

Reversibility principle

A

Stop working muscle so it returns to baseline

Use it or lose it

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25
5 ways to modify exercise principles
Mode, intensity, duration, frequency, progression of exercise
26
Both type _ and type _ muscle fibers are important for _______ and ________
Both type 1 and type 2 muscle fibers are important for endurance and strength
27
Type 1 Muscle Fiber
Slow-twitch and slow to fatigue, Aerobic oxidative. Has more capillaries around them. Relies on Mitochondria for steady oxygen supply Help with endurance during meal (ex: BOT)
28
Type 2 Muscle Fiber
Fast-twitch but easy to fatigue, Anaerobic, Glycolytic Respond quickly when swallowing
29
Differences between infant and adult swallowing anatomy/physiology
Cavities are smaller and more condensed Larynx is higher in infants In infants, the oral cavity is small, the tongue and palate is flatter. The epiglottis is almost attached to the soft palate. The airway and foodway are separated except when swallowing. In adults, the larynx is lower in the neck, and the food way and airway cross in the pharynx
30
Difference between high APGAR/low APGAR
APGAR = Appearance, Pulse, Grimace, Activity, and Respiration Scoring system based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth 1 color * 2 heart rate * 3 reflexes * 4 muscle tone * 5 respiration
31
Neurogenic Dysphagia
Difficulty swallowing as a result of neurologic disorder Impaired motor and/or sensory functions of oral and pharyngeal swallow May also impact esophageal phase, although incidence not as high and less symptomatic Dysphagia may be the result of concurrent issues unrelated to neuro diagnosis (tumor, diverticulum, stricture, etc) Patient may present with or without neurologic diagnosis (If no dx, VFSS recommended)
32
Trauma/injury/disorder above the _________ is an increased dysphagia risk severity
Brainstem Brainstem is more likely to result in dysphagia than cortical or subcortical disease
33
Bilateral trauma/injury/disorder is an ______ dysphagia risk severity
Increased
34
Diagnoses/disorders associated with dysphagia
Stroke, traumatic brain injury (TBI), cerebral palsy, dementia, Parkinson's disease, Huntington's disease, Multiple Sclerosis, Age-related changes, Psychogenic dysphagia
35
Common dysphagia symptoms (oral)
Labial spill, drooling, excess saliva, dry mouth, mastication difficulty, oral residue, use of fingers to manipulate bolus, difficulty initiating swallow, difficulty swallowing pills
36
Common dysphagia symptoms (pharyngeal)
Aspiration, silent aspiration, discoordination between breathing, multiple swallows per bolus, nasal regurgitation, wet voice, throat clearing, difficulty managing secretions, aspiration pneumonia (PNA), delayed initiation of pharyngeal swallow
37
Common dysphagia symptoms (esophageal)
Slow motility, difficulty swallowing pills, regurgitation, heart burn, chest discomfort, globus sensation
38
Common dysphagia symptoms (other)
Smaller, more frequent meals, weight loss, prolonged meal times, dehydration, malnutrition, loss of pleasure, reduced appetite
39
How is dysphagia treated for neurogenic dysphagia?
Compensatory strategies are often more effective than traditional swallowing therapy Assessment of swallowing safety and identification of current risks Discussion of future management options Recommendations for diet modification, bolus size modification, adaptive feeding aids, oral hygiene, positioning
40
Complex Medically Undefined Dysphagia
Unclear boundaries, possible disagreement regarding problem/solution, contrary evidence, non-linear, fluctuating symptoms
41
Complicated Medically Undefined Dysphagia
Requires expertise, cause/effect requires analysis, fairly linear, ask questions, analyze, respond
42
Simple Medically Undefined Dysphagia
Close cause/effect, clear response
43
Chaotic Medically Undefined Dysphagia
No relationship between cause and effect at symptom level, unclear boundaries, unclear problem, act first
44
Appropriate terminology for Medically Undefined Dysphagia
Muscle tension dysphagia, muscle tension dysphonia, medically unexplained dysphagia
45
Treatment of Medically Undefined Dysphagia
Myofacial release, resonant voice, vocal hygiene education, cough suppression treatment, SOVT, conversational voice training, progressive therapeutic PO trials
46
Treatment considerations for Medically Undefined Dysphagia
Patients may exhibit underlying or contributing cause for laryngeal muscle tension with concurrent disorders of GERD, anxiety, stress, LPR Manage sinonasal, laryngeal, psychosocial irritants and addressing laryngeal sensitivity Management of irritants often requires multidisciplinary care Prescription of neuromodulators
47
Muscle Tension Dysphagia (MTDg)
Layngeal muscle tension disorder manifested as dysphagia Categorized as primary or secondary based on presence or absence of an underlying or contributing organic cause Can occur with or without associated signs of laryngeal hyperresponsiveness (LHR) or non-specific laryngeal muscle inflammation (NLI) Laryngeal muscle hyperfunction is dominant etiology in both primary and secondary MTDg
48
MTDg presenting complaints
Swallowing primary complaint, globus sensation, tightness of throat, throat pain, throat clearing, choking, voice issues, PVFM, cough
49
Primary MTDg
Laryngeal muscle tension (hyperfunction) results in improper laryngeal motion during deglutition and contributes to dysphagia symptoms. No anatomical abnormality
50
Secondary MTDg LHR/Irritable Larynx Syndrome
Anatomical abnormality. Chronic cough, paradoxical vocal fold motion, inducible laryngeal obstruction, globus pharyngeus
51
Secondary MTDg NLI/Non-specific laryngeal inflammation
Anatomical abnormality. Erythema (redness of skin), edema arytenoids/postcricoid region, interarytenoid pachydermia (thickening of skin), hypopharyngeal wall cobblestoning (inflamed bumpy tissue)
52
Medically Undefined Dysphagia presenting symptoms
Swallowing primary complaint, can't swallow, won't swallow, spitting, gagging, weight loss, diet restrictions, true fear, may be able to provide specific traumatic swallowing event
53
Short term radiation dysphagia symptoms
Odynophagia (painful swallowing), xerostomia (dry mouth), dysgeusia (altered taste), mucus, may need ANH
54
Long term radiation dysphagia symptoms
Radiation fibrosis (soft tissue injury from radiation, progressive dysphagia, increased aspiration risk, may need ANH)
55
Common side effects from radiation
Xerostomia (dry mouth), exessive mucosa, dysgeusia (altered taste), odynophagia (painful swallowing), trismus (tight jaw), dysarthria, dysphonia, dysphagia
56
Dysphagia treatment for oral cancer surgery
Compensatory strategies, assistive cups, oral prosthetics, oral exercises, airway protection
57
Dysphagia treatment for total glossectomy
Compensate for oral phase difficulties, dump and swallow head tilt back, teach to protect airway, glossectomy spoon or syringe and tube, many return to full oral diet
58
Treatment options for head and neck cancer
Surgery (to remove tumor), radiation therapy (high-energy rays damage cancer cells), systemic therapy (chemotherapy, immunotherapy), combined approach (using two or more options)
59
What is cancer?
Large group of diseases that affect the body at cellular level, can divide without stopping and spread into healthy tissue, can form a mass of solid tissue, cancer of blood does not form solid tissue
60
Under what circumstances FEES vs MBS would be indicated
FEES Evaluates pharyngeal and laryngeal function Perform it when there are concerns of radiation (ex. pregnancy), suspected nasal regurgitation, inability to leave bedside (ex: ventilators) AIRWAY CLOSURE and VOCAL FOLDS MORE EASILY OBSERVED VFSS/MBS Evaluates oral prep, oral transit, pharyngeal, and/or esophageal phase Perform it when there is a FEES aversion, unexplained PNA, diagnosis or suspected presence abnormalities in nasal, oral, pharyngeal, upper esophageal structures **BOTH FEES AND VFSS/MBS assess for residue, penetration/aspiration**
61
What disorders can contribute to pediatric dysphagia?
Tracheal Esophageal Fistula (TEF) Frothy white bubbles in the mouth, coughing and/or choking during feeding, vomiting, trouble breathing, very round full stomach Omphalocele (abdominal organs are external to body) Tetralogy of Fallot (combo of 4 heart defects) Hypoplastic Left Heart (affects normal blood blow through heart) Pierre Robin Sequence with mandibular distraction Difficulty coordinating suck-swallow-breath pattern and managing a faster flow Micrognathia – small lower jaw Glossoptosis – large tongue Cleft Palate Down's Syndrome ■ Hypotonia - low muscle tone ■ Tongue that tends to stick out of the mouth Praeder Willi Neurological involvement - IVH (1-4), Hypoxic Ischemic Encephalopathy Non accidental trauma
62
FOIS Scale Tube Dependent Levels
Levels 1-3
63
FOIS Total Oral Intake Levels
Levels 4-7
64
If someone were on a minced and moist diet, what FOIS level would they be?
Level 5
65
If someone were on a puree diet, what FOIS level would they be?
Level 4
66
Chin tuck/down
Brings BOT closer to PPW, narrows airway, widens valleculae, prevents premature spillage, can open PES, LVC closure, reduce pharyngeal residue
67
Chin-up
Gravity facilitating to improve oral clearance
68
Dry swallow
Improves oral and pharyngeal clearance
69
Head turn
Typically towards the damaged or weak side to direct bolus to stronger side of pharynx, can open PES and close off airway
70
Head tilt
Towards strong side for gravity facilitated bolus flow to stronger side
71
Cued cough
Redirects penetrated or aspirated material
72
Pediatric dysphagia physical signs to look for
Tracheal Esophageal Fistula White frothy bubbles in the mouth, coughing, choking during feeding, vomiting, trouble breathing Down's Syndrome Low muscle tone (hypotonia), protruding tongue Pierre-Robin Sequence Difficulty managing suck-swallw
72
Pediatric dysphagia physical signs to look for
Tracheal Esophageal Fistula White frothy bubbles in the mouth, coughing, choking during feeding, vomiting, trouble breathing Down's Syndrome Low muscle tone (hypotonia), protruding tongue Pierre-Robin Sequence Difficulty coordinating suck-swallow-breath pattern and managing a faster flow, micrognathia (smaller jaw)
73
Laryngeal Elevation & LVC Closure swallowing exercises
Mendelsohn Maneuver, Supraglottic swallow, Suprasubglottic swallow, effortful swallow
74
BOT to PPW swallowing exercises
Masako Maneuver, Effortful Swallow
75
PES opening exercises
Mendelsohn Maneuver, Shaker, CTAR
76
Anterior Hyoid Excursion exercises
Shaker and CTAR
77
What are the 3 components to determining the stage of cancer?
TNM
78
What does TNM stand for?
Tumor, Node (regional spread), Metastasis (distant spread)
79
Post-Operative oral surgery dysphagia symptoms
increased oral residue, premature spillage, prolonged oral transit, reduced pharyngeal contraction, reduced airway protection, nasal regurgitation, reduced PES opening, reduced laryngeal elevation, resonance issues
80
Post-Operative Total Laryngectomy symptoms
Generally no issues with safety of swallow, swallow efficiency issues, reduced smell/taste, loss of pleasure in eating, more effort/multiple swallows, slow swallow, residue, stricture
81
Hypotonic
Weak muscle tone
82
Hypotonic disorders
Cerebral palsy, muscular dystrophy, Down syndrome, prematurity, brain and spinal cord injury, brain infections
83
Hypertonic
Tight and high muscle tone
84
Deficits for Parkinson's disorder
Reduced oral and pharyngeal swallow, prolonged mastication, prolonged OTT, premature labial spillage, reduced LVC, reduced BOT to PPW, reduced PES opening, reduced laryngeal elevation, penetration, aspiration
85
Compensatory strategies for Parkinson's disorder
Chin tuck/down, effortful swallow, dry swallow, reducing bolus size
86
Swallowing exercises for Parkinson's disorder
CTAR and effortful swallow
87
Compensatory strategies for laryngeal cancer
Head turn, head tilt, ROM exercises
88
Swallowing exercises for laryngeal cancer
Mendelsohn Maneuver, CTAR, Effortful swallow

Dysphagia (1 decks)

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