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final exam Flashcards

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1
Q

what is a feeding disorder

A
  1. persistent failure to eat adequately which results in a significant loss of weight or failure to gain and growth delay
  2. onset usually in first year of life but can go to 6
    unsafe or inefficient swallowing
    3.lack of tolerance to food textures and taste
  3. poor appetite regulation
  4. rigid eating patterns
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2
Q

what is a swallowing disorder

A

type of feeding disorder with unsafe or inefficient swallowing
increases the risk for aspiration

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3
Q

what is inefficiency

A

unable to meet caloric needs because swallow is not effective

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4
Q

what is overselectivity

A

restrictive in taste, type, texture or volume of foods eten

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5
Q

what is refusal in a feeding disorder

A

complete refusal to feed due to medical issues, GI distress, or traumatic experiences

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6
Q

what is a feeding delay

A

delayed development of feeding milestones

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7
Q

What is AFRID

A

Avoidant REstrictive Food Intake
lack of interest in eating
avoidance based on sensory characteristics of food
concern about aversive consequences of eating
causes significant weight loss, nutritional deficiency, dependence on feeding tube or supplements
interference with psychosocial function

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8
Q

what are risk factors for feeding disorders

A
  1. low birth weight
  2. developmental disabilities (Downs, autism, Cerebral palsy) that result in motor or muscle weakness or sensory defensiveness
  3. prematurity
  4. prenatal drug exposure
  5. diet restrictions ( diabetes, PKU) that cause feeding challenges
  6. craniofacial abnormalities
  7. neurologic issues
  8. cardiac and respiratory conditions
  9. nutritional and GI issues
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9
Q

what are some behavioral causes of feeding disorders

A
  1. negative parent behaviors: over and understimulatng, rigid, chaotic, overly anxious
  2. undesirable child behavors during mealtimes
  3. eating too slow
  4. eating too fast
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10
Q

what are factors in an infant for postitive feeding

A 
infant must be:
positive
alert
calm
show readable cues for hunger and fullness
willingness to try tastes and textures
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11
Q

what are factors in toddlers for positive feeding

A 
toddlers must exhibit
interest in eating
indicate hunger and fullness
follow a predictable meal schedule
show positive behaviors
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12
Q

what affects a child’s eating abilities

A 
environment
nutritional status
developmental status
learning style/capacity
senses
muscles
organs
environment
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13
Q

what is prenatal swallowing

A

1.fetus swallows anmiotic fluid to mature digestive tract
2.pharyngeal swallow is developed by 15 weeks
consistent swallowing by 22-24 weeks
3. oral motor movements and suckling around 10-14 weeks
4. true suckling around 18-24 weeks (backwards/forwards movement)
5. suckling is the only pattern used by neonates because the tongue fills the oral cavity and does not extend beyond labial border
6. by 34 weeks gestation, healthy preterm infants suckle and swallow well enough for full oral feedings
7. decreased rates of fetal sucking are associated with digestive tract obstruction or neurologic damage

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14
Q

what is required for oral feeding

A
  1. coordination of suckling, swallowing, and breathing
  2. sequential timing of tongue, larynx and laryngeal muscles
  3. infant must be able to maintain heart rate, respiration before they can swallow
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15
Q

what are adaptive responses

A

babies compensate when they are not comfortable
they may stop feeding if something is wrong
they try to send cues

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16
Q

what motor development is important for feeding

A

head and trunk control to achieve jaw stability
pincer grasp to finger feed
must be able to reach across midline before you will see tongue lateralization

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17
Q

what is the developmental food continuum

A

breast/bottle: birth to 12 month
thin cereal: 5-6 month
thicker cereal 5.5-6.6 months
baby food puree: stage 1 food 6-7 months
thicker cereals and smooth puree stage 2 7-8 months
soft masked table food 8-9
hard munchables 8-9
meltables: 9 months
soft cubes (avocado, kiwi, vegtable soup) 10 months
soft mechanical single texture (muffins, small pasta) 11 months
mixed texture: stage 3: 12 months
soft table foods 13-14
hard mechanicals (cheerios, cookies) 15-18 months

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18
Q

what is protocol for infant feeding eval

A

chart review for birth/medical history, parent/staff interview
oral mech

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19
Q

what are clinical signs of ORAL difficulty in infant

A
  1. inefficient extraction
  2. disorganized suck swallow
  3. anterior spillage
  4. decreased ability to latch on to nipple
  5. disorganized tongue/jaw function
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20
Q

what are clinical signs of PHARYNGEAL difficulty in infants

A

coughing/throat clearing
spitting/gagging
physiological changes: drop in O2 saturations, increase in HR
changes in upper airways sounds via cervical auscultation
weak, hoarse or wet sounding cry

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21
Q

what should be in an infant chart review

A 
feeding readiness
medications
pulmonary issues
GI issues
previous intubation or ventilator
failure to thrive
neurological involvement
imaging is done
bottle or breast
current nutrition source
feeding schedule
craniofacial abnormalities
GERD
alertness
syndromes
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22
Q

what are components of beside swallow for child

A

involves joint OT if sensory issues
uses childs cups/ utensils and introduced foods
chart review
oral mech

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23
Q

what are signs of ORAL difficulties >1 year

A 
inefficient extraction
poor labial seal on spoon or cut
decreased mastication
anterior spillage
decreased bolus control
disorganized tongue/jaw movement
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24
Q

what are signs of PHARYNGEAL difficulties >1 year

A 
coughing/throat clearing
gagging or emesis
physiologic changes
changes in upper airway sounds 
wet, gurgly vocal quality
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25
What are critical decision options for pediatric (recommendations)
1. cleared for PO diet no restrictions 2. modified temporary diet 3. remain NPO 4. begin treatment 5. allow time to improve 6. change meds 7. wean O2 8. FVSS 9. temporary NGT or G tube 10. results impacted by presence of NGT
26
what are major reasons for outpatient evals
1. picky eater 2. not transitioning from baby foods 3. choking/gagging 4. not gaining weight 5. dysphagia 5. NPO children who families need guidance on oral stimulation, are ready to try oral feeds, or need dysphagia treatment
27
what is included in an outpatient pediatric eval
history of problem: when, traumatic events, differences in different settings medications medical history weight/height allergies bowel habits previous diagnosis: child on altered textures home environment for meals: do they graze all day? what is child routine how does child tolerate different sensory input
28
why are stools important
lead you to cause of problem food allergies constipation will make reflux worse or make child feel full
29
what is a pediatric eating assessment tool PediEAT
questionnaire of observable symptoms of problem feeding in children 6 months to 7 years completed by caregiver
30
what do you assess in an oral motor exam
``` jaw stability lip closure tongue protrusion/retraction tongue lateralization hard/soft palate number of teeth ```
31
what are typical diagnosis in outpatient rehab
``` sensory based feeding disorder oral motor dysfunction pharyngeal dysphagia picky eater GI issues parental issues ```
32
what is the difference between a picky and problem eater
1. picky eater will eat >30 foods, problem <20 2. foods lost are reacquired in picky eater not in problem 3. tolerates new foods 4. eats >1 food from most groups Problem refuses entire category 5. picky adds new foods in 15-25 steps, problem >25 6. eats with family vs. alone 7. referred to as picky eater at well child checks vs across multiple checks
33
what are typical recommendations for picky eater
direct feeding therapy refer to GI for reflux, constipation, or futher assess consider allergy test refer to nutritionist
34
home programs for problem eaters
``` establish feeding schedule seating adjustments change in feeding utensils/cups change in textures of foods oral stimulation ```
35
what are some interventions for infant feeding
``` modified side lying external pacing specialty nipple cheek support frequent burping chin support ```
36
what are goals of intervention for infants
improve quality experience by reducing stress engaging families to assume an active role teaching parents to read and respond to infants cues
37
what are oral motor treatments
``` proper seating with support jaw stability lip closure tongue lateralization chewing alterning presentation beckman's massage ```
38
what are sensory/behavior based treatments
1. decrease anxiety around food 2. encourage messy play 3. pair foods with same color together in therapy 4. food chaining: change only one characteristic of a food at a time 5. engage in food play during session 6. use nuk brushes vibration, spicy foods 7. encourage child to help prepare foods 8. use behavioral strategies such as checklists, special placemats, special utensils
39
what is auscultation and how do you use it
using a stethoscope to assess breathing and swallowing sounds listen to breath prior to bolus to get a baseline after bolus does it change?
40
What is NMES
neuromuscular electrical stimulation | electric current stimulates nerve to aid muscle strengthening for hyolaryngeal excursion
41
what are NMES precautions
``` dementia reflux pacemaker deep brain stimulator implantable ardioverter defibrillator seizures ```
42
when is NMES contraindicted
over carotid sinus over active cancer over active infection
43
what are the goals of compensation
airway protection maintain nutrition and hydration maintain general health
44
how are swallowing disorders managed
``` oral hygiene teaching feeding strategies restricting viscosities therapeutic and postural intervention ongoing education and counseling ```
45
what are non-oral feeding methods
NG tube: short term thru nose J tube: into intestines: predigested food PEG tube: directly into the stomach surgically
46
what is a PEG tube
percutaneous endoscopid gastrostomy
47
what is a j tube
jejunostomy tube
48
what are some compensatory strategies
1. chin tuck: swallow initiation, airway protection 2. head back: oral stage deficits 3. small sips and bites 4. repeat swallows 5. thickening 6. head tilt to strong 7. head rotation to weak 8. supra glottic maneuver
49
what principles of motor learning are used with rehab
1. task specificity 2. intensity 3. feedback: both biofeedback and clinician driven 4. need to know physiology to apply exercises 5. key aspect is plasticity of skeletal muscles 6. drill is essential 7. efforts to increase strength should follow rules for strength training
50
what are different types of neural plasticity
perilesional: around the lesion ipsilateral: same hemisphere different area contralateral: different hemisphere same area
51
what is plasticity
the ability to change over time because of practice
52
what 3 elements interact for movement to be learned
1. learner needs to understand task and be motivated 2. the task needs to be appropriate with correct intensity and specific 3. the enviornment: specific to the bolus and time of day
53
what exercises target oral prep and transfer
Iowa Tongue Pressure Inventory: isotonic and isometric | therabite: maximized jaw opening
54
what is trismus
lock jaw
55
what exercises target delayed initiation of swallow
thermal-tactile stimulation
56
what is FEESST
Fiberoptic endoscopic evaluation of swallowing with sensory testing goes thru arytenoids with another device which sends air pulses response to stimulation is the laryngeal adductor reflex detects silent aspiration
57
what is HRM
high resolution manometry | assesses pharyngeal pressure changes
58
what exercises target BOT retraction
Masako Effortful Swallow Tongue pull-back maneuver
59
what exercises target hyolaryngeal excursion
mendelsohn maneuver shaker exercise chin tuck against resistance CTAR
60
what exercise targets impaired airway protection
supraglottic swallow | EMST expiratory muscle strength training (cough)
61
what are isometric exercises
done in static position
62
what is the free water protocol
improves QoL by allowing water to patients who aspirate thin liquids candidacy: good oral hygiene, cognitive status water permitted between meals not during or until 30 minutes after no thin liquids with meds
63
how is masako performed
tip of tongue between teeth patient dry swallows 10 reps
64
how is effortful swallow performed
imagine ping pong ball in mouth to swallow | 10 reps
65
how is supraglottic swallow performed
``` hold breath swallow hard cough swallow again 10-12 times without breathing between do not use with stroke patients because of valsalva ```
66
how is mendelsohn maneuver performed
at peak of swallow patient squeezes and holds document length of time 10 reps
67
how is the shaker exercise performed
patient lies flat isometric: lifts head and looks at toes hold for 20 sec isokinetic: repeatedly look at toes 20-30 times may cause pain in cancer patients
68
what is onstage vs offstage
timing related to meds and parkinsons patients
69
what are other rehab options
1. pitch gliding: improves airway protection 2. myofascial release: massage that strengthens pharyngeal musculature 3. expiratory muscle strength training: strengthens expiratory muscles 4. free water protocol: improves subglottal pressure and vestibular squeeze
70
what are behavioral interventions for pediatric feeding disorders
1. shaping, 2. prompting, 3. modeling, 4. stimulus fading, 5. alternate behavior, 6. basic mealtime principles (schedules), 7. food chaining
71
what are pediatric postural techniques
``` chin tuck chin up head rotation upright position (45 degree angle at hips and knees head stabilization reclining position side lying position for infants ```
72
what are adaptive techniques for pediatric dysphagia
``` postural equipment/utensils biofeedbac if active participant oral motor stimulation (increases sensation) sensory stimulation prosthetics ```

Dysphagia (3 decks)

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