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dysphagia treatments Flashcards

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1
Q

List the treatments for dysphagia? (9)

A
  1. diet modification
  2. positional
  3. oral sensory
  4. maneuver
  5. exercises
  6. prosthetic
  7. surgery
  8. experimental
  9. other (multiple swallows, food presentation, liquid wash etc…)
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2
Q

Do compensatory strategies change the motor control of the swallow?

A

No therapies do

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3
Q

Do therapies change the motor control of the swallow?

A

yes

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4
Q

T Or F The compensatory strategies are under control of the caregiver.

A

True

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5
Q

T or F therapies do not change the swallow anatomy and physiology.

A

False they do change the A&P of the swallow

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6
Q

What three things are therapies designed to increase?

A

ROM
control
strength

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7
Q

T or F compensatory strategies are therapeutic because they are designed to increase the timing of the swallow.

A

True

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8
Q

T or F Compensatory strategies are designed to eliminate symptoms.

A

True

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9
Q

what are the 4 categories of compensatory strategies?

A

positional
oral sensory
prosthetics
diet modification

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10
Q

What compensatory strategy is considered the “last resort” option?

A

diet modification

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11
Q

what compensatory strategy do you use if other compensatory strategies or therapies fail?

A

diet modification

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12
Q

Why would you use diet modification with a client? (3)

A

if other compensatory strategies or therapies fail
if a building block
if too cognitively impaired

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13
Q

what things can you change when you are doing a diet modification? (4)

A

bolus viscosity
bolus volume (size)
temperature
taste

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14
Q

What are the liquid consistencies?

A

thin
nectar
honey

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15
Q

What are the consistencies for solids?

A 
pudding
puree
mechanical soft
chopped
regular
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16
Q

what are the positional compensatory strategies? list them (6)

A
  • sitting upright at 90 degrees
  • lying on side
  • chin tuck
  • head rotation
  • head tilt
  • head back
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17
Q

What position contributes to gravity to direct the bolus down?

A

sitting upright at 90 degrees

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18
Q

what side do you lie the patient down on?

A

the strong side

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19
Q

what is the lying down on side good for?

A

it eliminates the gravitational effect on pharyngeal residue

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20
Q

what does the chin tuck positional strategy change in a swallow?

A
  • prevents penetration by widening the vallecula
  • narrows airway enterance
  • increases laryngeal elevation
  • increases vf closure
  • pushes tongue base backward toward the pharyngeal wall
  • puts epiglottis in a protective position
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21
Q

what side do you have the ptnt turn to when you are doing a head rotation and why?

A

to the weaker side to close off damage side and direct bolus to the strong side.

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22
Q

When you do a head tilt what side do you tilt ur head toward?

A

the stronger side it directs the food down to the stronger side by gravity

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23
Q

why would you use a head back?

A

when you have oral transit problems you use the gravity to clear the oral cavity.

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24
Q

what are the oral sensory compensatory techniques?

A
  • downward pressure of spoon against against tongue
  • sour bolus (lemon juice)
  • cold bolus (thermal tactile stim)
  • bolus requiring chewing
  • suck-swallow
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25
explain thermal tactile stimulation? (what do you do/how do you do it/and why you would do it?)
vertically rub anterior faucial pillars 4-5 times (dr. c 3x's) with a cold laryngeal mirror or ice sticks -heightens oral awareness and triggers pharyngeal swallow
26
explain the suck-swallow compensatory oral sensory technique and why you would do it?
vertical tongue-jaw sucking with lips closed | -triggers pharyngeal swallow, draws saliva to the back of the mouth
27
what are some types of prosthetics used for dysphagia?
dentition palatal lowering soft palate lingual
28
what does palatal lowering (hard palate) prosthetics do?
decreases volume of the oral cavity | increases bolus transit and tongue-palate contact
29
What prosthetic do you use for the soft palate and what does it do?
restores contact btwn palate and posterior tongue to maintain bolus control and direct bolus - aid in mastication - avoid pharyngeal spillage (slow down transit) - and avoid nasal regurgitation during swallow
30
What do lingual prosthetics do?
decrease oral cavity size (decrease pooling) increase tongue soft palate contact (increases bolus control) increase eating increase articulation and resonance
31
what categories (3) are considered therapies?
maneuvers exercises surgeries
32
What are the maneuvers (4)?
effortful supraglottic super supraglottic Mendelsohn
33
what are the exercises (3)?
shaker masako oral motor
34
what are some maneuvers and/or exercises that are considered direct?
effortful supraglottic super-supraglottic Mendelsohn Masako
35
what are some therapies that are indirect?
shaker | oral motor exercises
36
Explain how to do the effortful and why?
1.squeeze hard with all of your muscles and 2.swallow with a squeeze it increases posterior tongue base movement & epiglottic movement and decreases pooling in the valleculae
37
Explain the supraglottic and why you would do it?
1. inhale hold breath 2. place bolus at the back of the tongue 3. swallow while holding breath 4. cough after swallow be4 you inhale 5. swallow again to clear material you may have expectorated voluntary breath hold that closes the VF before and during the swallow
38
Explain the super-supraglottic and why you would do it?
1. inhale and hold breath 2. place bolus at the back of the tongue 3. hold breath and bear down while swallowing 4. cough before you inhale 5. swallow again effortful breath hold tilts arytenoids forward which closes the vfolds before and during the swallow (quickens closure) *valsalva maneuver increases the vf closure and shortens swallow
39
Explain the Mendelsohn and why you would do it?
1. push tongue against roof of the mouth (hard) 2. dry swallow several times while feeling the thyroid lift 3. hold thyroid up for several seconds - prolonged laryngeal elevation which prolongs and opens the UES to decrease pyriform pooling - normalizes/coordinates timing of pharyngeal swallow events
40
What are the exercises to treat dysphagia>
shaker Masako oral motor
41
What is the shaker?
- head lift exercise - increases UES opening and decreases hypo pharyngeal intrabolus pressure 1. lay flat on your back on the floor or a bed 2. without lifting your shoulders hold your head off the floor and look at your feet for 1 minute 3. relax you head back down for 1 min break 4. repeat sequence 2 more times 5. raise your head 30 more times and look at your toes 6. repeat entire exercise 3 times per day
42
Does Dr. C often abbreviate the Shaker?
Yes its too intense
43
what is the secondary benefit to the Shaker that Dr. C said?
increases neck strength
44
What is the masako?
it's an exercise anterior posturing of the tongue strengthens pharyngeal constriction done only with dry swallow -stick tongue out hold with lips and dry swallow
45
Oral motor exercises work on?
rom resistance bolus maintenance: lip seal, jaw strengthening, tongue strengthening (elevation, retraction, protrusion, lateral)
46
What are some surgeries?
cp myotomy diverticulectomy palatoplexy vf medialization: augmentation/thyroplasty
47
what is a cp myotomy?
cp is not opening cut the cp muscle it is permanently open have to be careful of reflux
48
What is a diverticulectomy?
remove diverticulum | pockets in esophagus are removed
49
What is dilation of the esophagus?
if there is a stricture or narrowing they insert a balloon blow up/expand the area and then take the balloon out
50
What is thyroplasty (vf medialization)?
implant to pufh v.f's medially
51
what are the experimental treatments for dysphagia?
DPNS: deep pharyngeal neuromuscular stimulations NMES: Neuromuscular electrical stimulation Myofacial release botox
52
Explain DPNS?
deep pharyngeal neuromuscular stimulation - designed to treat neuromuscular weakness or incoordination - frozen lemon stick applied to 9 sites in mouth and throat - ------bitter taste buds (tongue base/back) - ------soft palate - ------superior & medial pharyngeal constrictors - designed to activate muscles - repeated application attempts to strengthen neuromuscular signals and increase muscle strength
53
What is NMES?
Neuromuscular Electrical Stimulation Surface electrodes applied over swallowing muscles stimulation attempts to facilitate motor mvmt. (neuromuscular transmission) and strengthen muscles for swallow
54
What three companies make NMES machines?
E-swallow Vitalstim Ampcare
55
T or F. Evidence is lacking for the efficacy of NMES.
True
56
What would you use NMES for?
hyolaryngeal excursion
57
What muscles do you put the electrodes on or should you if you are trying to increase hyolaryngeal excursion?
suprahyoids
58
What is myofacial release?
Manual technique - palpation with joint and soft tissue mobilization/release of lips, tongue, jaw, neck - attempts to loosen tight muscles and fascial adhesions, improve area circulation
59
what is fascia?
fascia is a layer that is like a spider web that covers all of a person's organs and muscles and it is all one piece a knot can create an adhesion
60
What would botox be used for?
motility disorders cp hypertonicity/dysfunction achalasia
61
What are some other strategies used to treat / help dysphagia?
``` food presentation multiple swallows to clear residues liquid cash throat clear adduction techniques EMST ```
62
What are some adduction techniques you could use to help with dysphagia?
``` cough LSVT hard glottal attack sustained phonation pitch range to falsetto ```
63
EMST what is it?
expiratory muscle strength trainer used with pd ptnts increase cough bc it increases expiratory strength and respiration coordination help with fold adduction

dysphagia final (2 decks)

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