Dysphagia Final Flashcards

Question

Solids - Regualr diet

Answer 1

corn, apple, salad, fried chicken

Answer 2

pasta, salmon, tuna fish salad

Answer 3

chopped veggies etc

Answer 4

chicken salad, cottage cheese

Answer 5

meals blended up to be a puree

Answer 6

viscosity range 1-50 water, coffee, etc

Answer 7

viscosity range 51-350

Answer 8

viscosity range 351-1750

Answer 9

hard to swallow, ex) milk will prematurely spill while eating cereal watermelon, cereal, fruit cocktail, chicken noodle soup

Answer 10

corn starch based, xanthum gum based (no gritty taste), medical grade etc

Answer 11

really hard to swallow, it expands

Answer 12

by the American Dietetic Association - introduced in 2002 as an effort w a goal to standardize diets NDD1- Puree NDD2- Mechanically altered- semisolid food requiring some chewing NDD3- Advanced- soft foods require more chewing ability Regular ISSUE- missing chopped and ground food

Answer 13

International Dysphagia DIet Standardisation Initiative Framework consisting of 8 levels on a continuum Categorize based on texture and flow characteristics Use more universal terminology Drinks are levels 0-4 Foods are levels 3-7

Answer 14

IDDSI level depends on liquid remaining after 10 secs flow 1. cover nozzle w finger 2. pour to fill line 3. remove finger from nozzle as you start the stopwatch 4. stop at 10 secs

Answer 15

new framework rollout cost staff training/turnover FDA approval of products (Varibar, etc.)

Answer 16

pills whole capsules cut crushed time release

Answer 17

1. keeps straw in front of mouth to keep anterior to posterior bolus travel 2. coffee stirrer- limit volume and rate of liquid 3. straw- promoting a chin tuck, most effective- not noticeable/dignified 4. cup handles 5. french fry cup - help w sip 6. wider brim 7. syringe feeding - do not recommend syringe feeding pts bc not ethical/allowed BUT acceptable for head and neck cancer/when tongue is removed/ jaw wired shut 8. weighted spoons, with holes, etc 9. plate guards, etc.

Answer 18

compensation- short term adjustments to facilitate safe oral intake. adjustments to - posture, food, pt. rehabilitation- improvement in swallow physiology that permits increased/expanded safe oral intake prevention- avoiding or minimizing negative outcomes; food or liquid restriction, nutrition/hydration deficits, infections and more - preventing or minimizing dysphagia in high risk populations

Answer 19

etiology- what is the cause of the dysphagia? severity- how severe is it? what is the impact to the patient? psychosocial factors- how will this impact the patient? anticipated medical course? expected improvement or decline? caregiver factors?

Answer 20

vf intervention for glottic closure - medialization thyroplasty- surgically move cord - biomaterial injection (collagen, teflon) - laryngectomy feeding tubes PES opening intervention -myotomy - dilation - botulinum toxin injection

Answer 21

- the body is approx 60% water - tap water is a clear neutral pH and so it is compatible with other body fluids - will not cause a chemical injury as might be expected with other liquids such as coffee, tea, or soda - if a drink of water is aspirated, it will be absorbed by the lung mucosal tissues without harm RISK- if bad oral hygeine

Answer 22

developed at Frazier Rehabilitation Hospital - complete oral care at least 2x/day - always complete good oral care before 1st meal of day - only drink thickened liquids while eating/do not drink thin water while eating - pts must wait 30 mins after eating to drink thin water - if appropriate for patient safety water may only be allowed when requested and in small volumes - pts cannot take meds w water - use swallowing strategies - enterally fed pts may drink water during and directly after meals

Answer 23

anti refulx prokinetics/gastric motility salivary management

Answer 24

chin tuck head turn to right or left chin up posturing trunk postural changes may need support pillows/wedges

Answer 25

increasing oral transit time to prevent premature spillage gravity pulls bolus at front and tongue has to pull to back of oral cavity change anatomy to protect airway more but can also open up airway at times 50/50 - sometimes can make things worse

Answer 26

bolus hold tongue sweep/finger sweep- aids oral residue

Answer 27

swallow an egg/golf ball (more pharyngeal contraction) to reduce valleculae residue- for pharyngeal stripping increased BOT retraction, tongue propulsion, oral pressure, duration/extent of hyoid movement, TVF closure, PES relaxation

Answer 28

take a deep breath, hold breath, swallow, cough, exhale - addresses reduced or shortened VF closure - prolonged airway closure, increases anterior laryngeal movement, increased tongue base movement, and increased PES opening - can use as compensatory technique - can use as exercise- 10x/day; 5 mins; 5 swallows

Answer 29

take a deep breath, BEAR DOWN, hold breath, swallow, cough, exhale - prolonged airway closure, increases anterior laryngeal movement, increased tongue base movement, and increased PES opening - bearing down increased ventricular fold and assist in closing posterior glottis - may be contraindicated for cardiac Pts.

Answer 30

- addresses reduced laryngeal movement and poor coordination - extends the duration of laryngeal excursion and UES opening - exercise only - no longer recommended as a compensatory strategy - sEMG can validate if done correctly (often wrong) - prolong the swallow mid-swallow, pressing tongue up against the hard palate, to extend laryngeal closure

Answer 31

oral care as a stimulation technique and clearing of oral cavity increases initiation timing for swallow

Answer 32

carbonation temperature bolus viscosity and volume variation trials menthol (chemesthesis) flavor - all provide sensory input

Answer 33

cold laryngeal mirrors size 00- need sterilzation cold, sour, metal stimulation combination apply to faucial arches 5-10x effects are only noted when stimulated and do not carry over

Answer 34

kinesiotape- increase subcutaneous blood flow, facilitates weak muscles and relaxes tense muscles kinesio tape training required- check w PT place over and under lips and work with tape on (tongue depression lips, spoon stripping, straw drinking). tape into the desired state when removed it will resume to droop, etc.

Answer 35

can vary straw size up and down with different viscosities

Answer 36

behavioral intervention for dysphagia in acute stroke high intensity, aggressive therapy is more effective than diet monitoring

Answer 37

effortful swallow supraglottic swallow super-supraglottic swallow I-PRO- Isometric progressive resistance oropharyngeal therapy (new term for lingual exercise with resistance) masako maneuver IDR

Answer 38

must have a specific target- lips? tongue? face? approach must be 'load based' with high freq and intensity include range of motion, sensation, resistance

Answer 39

targets UES opening shaker is flat on plinth, hold head up to look at toes for 60 sec, rest 60 sec x3. lift head 30x, complete 3x

Answer 40

chin tuck against resistance if cannot do shaker - can sit upright and complete the same tasks as a chin tuck. use device to push chin against (partially deflated ball, etc.); less strenuous than Shaker, greater submental activity Neck slimmer- mimics Shaker exercise with different resistive springs Iso Swallowing Exercise device- open jaw against it- more movement, but like neck slimmer

Answer 41

yawn gargle /k/; /g/ current research? limited functional carry-over

Answer 42

for pharyngeal clearance- increasing tongue base retraction and pressure - do not do with food/bolus - stick out tongue, bite down gently, and swallow - 10 reps, 10x a day - use resistance? and assistance?

Answer 43

- joanne robbins- using isometric resistance lingual exercise 'swallow strong' device - tongue depressors for resistance and endurance building - 3 sets, 10 reps, 3x/day (anteriorly, elevated, laterally) - showed no difference between IOPI/Swallow Strong and tongue depressor (Robbins research)- devices give the pt biofeedback that tongue depressor doesn't have biofeedback - also a tongue press device- press water bulb between tongue and palate (cheaper) - MRI measured increased lingual strength and mass

Answer 44

exercise addressing lingual strength

Answer 45

Joanne Robbins I-PRO - new term for lingual exercise with resistance

Answer 46

incorporates the exercise principles of specificity and intensity with frequent therapy sessions and variety to facilitate enhanced coordination during swallowing patients receive daily therapy sessions that are structured to evoke mass practice of swallowing. swallowed materials are introduced sequentially to facilitate progressive resistance or speed and coordination of swallowing clinicians must be trained and follow specific rules to advance patients during treatment based on patient performance

Answer 47

exercise based treatment targeting inspiratory and expiratory muscles - handheld trainer devices provide resistance against inspiration and expiration - simple to use and inexpensive - can be individualized and adjusted over time - 4-12 week tx timeframe - some terms IMT, EMT, EMST

Answer 48

using calibrated RMT devises to provide progressive resistance

Answer 49

targets abdominal muscles, and some upper airway muscles

Answer 50

targets diaphragm, inspiratory muscles, and some upper airway muscles

Answer 51

pt exhales into spring loaded divide at 60-80% of max respiratory pressure, finding the comfortable highest resistance level blow into 25x, 5 days a week complete inhalation as well improves cough for airway protection improved afferent stimulation to brainstem velar closure increased hyoid elevation increased activation of submental muscles

Answer 52

increased hyoid movement increased PES opening hold jaw open for 10secs; rest 10secs; repeat 5x 2 sets a day for 4 weeks with or without resistance can use neck slimmer also

Answer 53

- developed in 2013 and published in 2016 by Malandraki, et. al - a comprehensive and intensive rehabilitation approach based on the principles of neuroplasticity and exercise physiology with specific integration of adherence-inducing features - patients w moderate severe neurogenic dysphagia - patients seen 2x/week in the clinic (Mon/Thurs or Tues/Friday) for 60 mins with a home program daily (3x/day for 45-60 mins/day) - usually 4,8, or 12 weeks

Answer 54

daily evidence based oropharyngeal training daily targeted swallowing function adherence inducing features

Answer 55

increasing gradually based on exercise physiology guidelines two evi.based exercises are selected and completed on alternating days. this allows for muscle rest and recovery and helps to sustain patient motivation. the intensity of the exercises increase biweekly based on exercise physiology principles. each exercise should target diff muscle groups or goals evidence based exercises include - lingual strengthening -effortful swallowing - mendelsohn maneuver - shaker exercises are chosen based on - underlying pathophysiology - ability to perform exercises - general health - cognitive status

Answer 56

increases gradually in complexity following the principles of experience dependent brain plasticity this is where you challenge the swallow w a bolus. you can advance or downgrade what you are presenting the patient determined by the patient's performance and health status small sets of single swallows of materials identified during the instrumental assessment are used. use textures/viscosities that are observed to be difficult but relatively manageable with the use of compensatory strategies. W/ TSP, you are continually having the pt use the swallowing mechanism and the central/peripheral neural circuits engaged in swallowing

Answer 57

pts are more likely to complete 1 exercise/day that they understand bc you explain what the 2 chosen exercises do, rather than completing a long list of seemingly meaningless exercises daily pt chooses flavors of the challenge swallows salience enhances experience-dependent neuroplasticity caregiver becomes the coach at home

Answer 58

applies electrical current to cause sensory and motor nerves to become active

Answer 59

evidence based systematic review: effects of neuromuscular electrical stimulation on swallowing and neural activation - traditional use on physical therapy to augment mvmt - tissue closest to electrode receives the most curren skin; deeper tissues get weaker electrical current - more effective when placed over the motor point (where the nerve enters the muscle) - laryngeal system is more complex than the limbs - many layers deep to reach laryngeal muscles - cannot differentiate which muscles are in the field- possibly may activate muscles that are opposing in mvmt

Answer 60

risk of aspiration INCREASED w stimulation rated swallows as less safe w stimulation w NIH-SSS no vf change evident

Answer 61

needle or wire inserted into specific muscle for direct stimulation bypasses skin layer, fat layer, overlying muscles experimental research currently

Answer 62

biofeedback during therapy, po trials, strategies, techniques

Dysphagia Final Flashcards

(87 cards)