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Dysphagia > Dysphagia Final > Flashcards

Dysphagia Final Flashcards

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
Q

5 ways to modify exercise principles

A

Mode, intensity, duration, frequency, progression of exercise

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26
Q

Both type _ and type _ muscle fibers are important for _______ and ________

A

Both type 1 and type 2 muscle fibers are important for endurance and strength

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27
Q

Type 1 Muscle Fiber

A

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)

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28
Q

Type 2 Muscle Fiber

A

Fast-twitch but easy to fatigue, Anaerobic, Glycolytic

Respond quickly when swallowing

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29
Q

Differences between infant and adult swallowing anatomy/physiology

A

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

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30
Q

Difference between high APGAR/low APGAR

A

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

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31
Q

Neurogenic Dysphagia

A

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)

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32
Q

Trauma/injury/disorder above the _________ is an increased dysphagia risk severity

A

Brainstem

Brainstem is more likely to result in dysphagia than cortical or subcortical disease

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33
Q

Bilateral trauma/injury/disorder is an ______ dysphagia risk severity

A

Increased

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34
Q

Diagnoses/disorders associated with dysphagia

A

Stroke, traumatic brain injury (TBI), cerebral palsy, dementia, Parkinson’s disease, Huntington’s disease, Multiple Sclerosis, Age-related changes, Psychogenic dysphagia

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35
Q

Common dysphagia symptoms (oral)

A

Labial spill, drooling, excess saliva, dry mouth, mastication difficulty, oral residue, use of fingers to manipulate bolus, difficulty initiating swallow, difficulty swallowing pills

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36
Q

Common dysphagia symptoms (pharyngeal)

A

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
Q

Common dysphagia symptoms (esophageal)

A

Slow motility, difficulty swallowing pills, regurgitation, heart burn, chest discomfort, globus sensation

38
Q

Common dysphagia symptoms (other)

A

Smaller, more frequent meals, weight loss, prolonged meal times, dehydration, malnutrition, loss of pleasure, reduced appetite

39
Q

How is dysphagia treated for neurogenic dysphagia?

A

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
Q

Complex Medically Undefined Dysphagia

A

Unclear boundaries, possible disagreement regarding problem/solution, contrary evidence, non-linear, fluctuating symptoms

41
Q

Complicated Medically Undefined Dysphagia

A

Requires expertise, cause/effect requires analysis, fairly linear, ask questions, analyze, respond

42
Q

Simple Medically Undefined Dysphagia

A

Close cause/effect, clear response

43
Q

Chaotic Medically Undefined Dysphagia

A

No relationship between cause and effect at symptom level, unclear boundaries, unclear problem, act first

44
Q

Appropriate terminology for Medically Undefined Dysphagia

A

Muscle tension dysphagia, muscle tension dysphonia, medically unexplained dysphagia

45
Q

Treatment of Medically Undefined Dysphagia

A

Myofacial release, resonant voice, vocal hygiene education, cough suppression treatment, SOVT, conversational voice training, progressive therapeutic PO trials

46
Q

Treatment considerations for Medically Undefined Dysphagia

A

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
Q

Muscle Tension Dysphagia (MTDg)

A

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
Q

MTDg presenting complaints

A

Swallowing primary complaint, globus sensation, tightness of throat, throat pain, throat clearing, choking, voice issues, PVFM, cough

49
Q

Primary MTDg

A

Laryngeal muscle tension (hyperfunction) results in improper laryngeal motion during deglutition and contributes to dysphagia symptoms. No anatomical abnormality

50
Q

Secondary MTDg LHR/Irritable Larynx Syndrome

A

Anatomical abnormality. Chronic cough, paradoxical vocal fold motion, inducible laryngeal obstruction, globus pharyngeus

51
Q

Secondary MTDg NLI/Non-specific laryngeal inflammation

A

Anatomical abnormality. Erythema (redness of skin), edema arytenoids/postcricoid region, interarytenoid pachydermia (thickening of skin), hypopharyngeal wall cobblestoning (inflamed bumpy tissue)

52
Q

Medically Undefined Dysphagia presenting symptoms

A

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
Q

Short term radiation dysphagia symptoms

A

Odynophagia (painful swallowing), xerostomia (dry mouth), dysgeusia (altered taste), mucus, may need ANH

54
Q

Long term radiation dysphagia symptoms

A

Radiation fibrosis (soft tissue injury from radiation, progressive dysphagia, increased aspiration risk, may need ANH)

55
Q

Common side effects from radiation

A

Xerostomia (dry mouth), exessive mucosa, dysgeusia (altered taste), odynophagia (painful swallowing), trismus (tight jaw), dysarthria, dysphonia, dysphagia

56
Q

Dysphagia treatment for oral cancer surgery

A

Compensatory strategies, assistive cups, oral prosthetics, oral exercises, airway protection

57
Q

Dysphagia treatment for total glossectomy

A

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
Q

Treatment options for head and neck cancer

A

Surgery (to remove tumor), radiation therapy (high-energy rays damage cancer cells), systemic therapy (chemotherapy, immunotherapy), combined approach (using two or more options)

59
Q

What is cancer?

A

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
Q

Under what circumstances FEES vs MBS would be indicated

A

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
Q

What disorders can contribute to pediatric dysphagia?

A

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
Q

FOIS Scale Tube Dependent Levels

A

Levels 1-3

63
Q

FOIS Total Oral Intake Levels

A

Levels 4-7

64
Q

If someone were on a minced and moist diet, what FOIS level would they be?

A

Level 5

65
Q

If someone were on a puree diet, what FOIS level would they be?

A

Level 4

66
Q

Chin tuck/down

A

Brings BOT closer to PPW, narrows airway, widens valleculae, prevents premature spillage, can open PES, LVC closure, reduce pharyngeal residue

67
Q

Chin-up

A

Gravity facilitating to improve oral clearance

68
Q

Dry swallow

A

Improves oral and pharyngeal clearance

69
Q

Head turn

A

Typically towards the damaged or weak side to direct bolus to stronger side of pharynx, can open PES and close off airway

70
Q

Head tilt

A

Towards strong side for gravity facilitated bolus flow to stronger side

71
Q

Cued cough

A

Redirects penetrated or aspirated material

72
Q

Pediatric dysphagia physical signs to look for

A

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
Q

Pediatric dysphagia physical signs to look for

A

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
Q

Laryngeal Elevation & LVC Closure swallowing exercises

A

Mendelsohn Maneuver, Supraglottic swallow, Suprasubglottic swallow, effortful swallow

74
Q

BOT to PPW swallowing exercises

A

Masako Maneuver, Effortful Swallow

75
Q

PES opening exercises

A

Mendelsohn Maneuver, Shaker, CTAR

76
Q

Anterior Hyoid Excursion exercises

A

Shaker and CTAR

77
Q

What are the 3 components to determining the stage of cancer?

A

TNM

78
Q

What does TNM stand for?

A

Tumor, Node (regional spread), Metastasis (distant spread)

79
Q

Post-Operative oral surgery dysphagia symptoms

A

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
Q

Post-Operative Total Laryngectomy symptoms

A

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
Q

Hypotonic

A

Weak muscle tone

82
Q

Hypotonic disorders

A

Cerebral palsy, muscular dystrophy, Down syndrome, prematurity, brain and spinal cord injury, brain infections

83
Q

Hypertonic

A

Tight and high muscle tone

84
Q

Deficits for Parkinson’s disorder

A

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
Q

Compensatory strategies for Parkinson’s disorder

A

Chin tuck/down, effortful swallow, dry swallow, reducing bolus size

86
Q

Swallowing exercises for Parkinson’s disorder

A

CTAR and effortful swallow

87
Q

Compensatory strategies for laryngeal cancer

A

Head turn, head tilt, ROM exercises

88
Q

Swallowing exercises for laryngeal cancer

A

Mendelsohn Maneuver, CTAR, Effortful swallow

Dysphagia (1 decks)

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