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663 Midterm 2 > Lecture Slides (Pos. Changes / Manu., Tx, and Biofeedback) > Flashcards

Lecture Slides (Pos. Changes / Manu., Tx, and Biofeedback) Flashcards

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1
Q

rationale behind postural changes and compensatory maneuvers

A

to improve airway protection; to improve oral and / or pharyngeal transit of food / liq

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2
Q

chin tuck

A

gravity facilitates reduced premature spillage; vallecular space widens to hold more food; improved BOT to PPW contact; decreased opening of the laryngeal additus / vestibule

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3
Q

head turn to left / to right

A

extrinsic pressure increases TVC closure; bolus passes through stronger side of pharynx; pulling cricoid further away from PPW reduces resting pressure of CP segment

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4
Q

when to use head turn

A

most often used when there is pyriform sinus and pharyngeal wall residue, particularly when residue collection is asymmetrical

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5
Q

what happens when you combine chin tuck and head turn

A

increased clearance and improved airway protection

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6
Q

effortful swallow

A

stronger tongue to palate contact and stronger BOT to PPW contact

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7
Q

how to supraglottic swallow

A

hold your breath prior to and during swallowing, then cough immediately after, then dry swallow; helps to protect against aspiration before the swallow (premature aspiration)

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8
Q

super supraglottic swallow

A

effortful swallow + supraglottic swallow

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9
Q

mendelson maneuver

A

prolong the duration of laryngeal elevation; results in increased duration / extent of laryngeal elevation and therefore increases duration / extent of CP opening

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10
Q

the “final decision,” based on beside eval, medical hx, and MBSS, includes:

A

NPO or PO (if PO, what kind of diet); aspiration precautions; compensatory postures / maneuvers; level of supervision needed during meals / feeding; whether or not to follow client; whether or not to repeat MBSS (and when); whether the pt is a candidate for dysphagia tx

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11
Q

final decision: NPO vs PO

A

assess occurrence of aspiration, how much, silent or not silent, effectiveness of cough; assess postures / maneuvers that help to reduce aspiration and / or improve swallowing

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12
Q

an MBSS report contains the following sections:

A

medical hx; diet hx; consistencies given during eval; oral stage observations; pharyngeal stage observations; aspiration type; impression statement; prognosis; diet / precautions / comp starts recommendations; tx and / or follow up goals

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13
Q

dysphagia tx is divided into

A

medical treatments and behavioral treatments

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14
Q

dysphagia medical treatments

A

includes prescription medications or invasive surgeries

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15
Q

dysphagia behavioral treatments

A

includes diet changes, postures / maneuvers, oral-facial exercises (relevant to swallowing), and stimulation-biofeedback

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16
Q

dysphagia behavioral treatments using food

A

indirect : without food :: direct : with food

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17
Q

oral phase treatment: bolus maintenance / lip seal; sx: drooling

A

tx: alternate puckering / spreading lips with and w/o resistance, opening mouth wide and then puckering slowly, pressing lips tightly together for a few seconds

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18
Q

oral phase treatment: bolus maintenance / control; sx: poor mastication / formation of bolus, maintenance of bolus, posterior bolus propulsion, premature spillage, oral residue

A

tx: to increase tongue strength, ROM, and coordination

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19
Q

oral phase treatment: bolus maintenance / control; tx: to increase tongue strength, ROM, and coordination

A

tongue lateralization with and w/o resistance; tongue tip elevation / deelevation into the anterior sulci / buccal sulci; use body of tongue to press a tongue depressor wrapped in gauze against the hard palate; manipulation of a button tied to a string throughout oral cavity

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20
Q

oral sensation tx

A

there is no definitive evidence of long term improvements in therapies directed at improving oral sensation

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21
Q

stimulation of the oral cavity with ___ may effect an improvement for the next swallow

A

sour, cold substance

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22
Q

if food tends to collect in one of the sulci, ___ can be used

A

external digital pressure: using your hands or fingers in the mouth to remove food

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23
Q

posterior bolus propulsion; sx: tongue pumping with premature spillage

A

tx: instruct pt to consciously try and reduce pumping action and initiate a hard, deliberate post tongue movement; straw use; sEMG biofeedback

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24
Q

straw usage is not a ___, it’s a ___

A

treatment; compensation

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25
straw usage
places the bolus more posteriorly into the oral cavity and circumvents the tongue behaviors
26
what do you do if straw usage (placing the bolus more posteriorly) causes even more premature spillage
stop using straws
27
delayed pharyngeal swallow; sx: pooling of food / lie into hypo pharynx before the swallow
tx: presenting cold-sour boluses (more sensory input, less delay), stroking faucial arches with cold laryngeal mirrors (subsequent swallows less delayed)
28
delayed pharyngeal swallow tx:
chin tuck widens the vallecular space; allows more food / liquid to be held safely until swallow is triggered
29
tx of pharyngeal phase characterized by vellecular residue
dx: BOT weakness; tx: effortful swallow, chin tuck, masako maneuver (holding tongue tip gently between front teeth while swallowing)
30
tx of pharyngeal phase characterized by weak pharyngeal contraction; sx: PPW residue and pyriform sinus residue
tx: effortful swallow, masako maneuver (strengthens superior constrictor), sEMG biofeedback, head turn to the weak side
31
if there's a lot of residue in the valeculae, it is likely a ___ issue
BOT
32
if residue is dispersed in the pharynx and pharyngeal wall, it is likely a ___ issue
pharyngeal constrictor
33
masako maneuver may strengthen ___
superior constriction
34
what is the downside of FEES
we don't see the oral stage; we don't see the swallow (only see what's immediately before and after the swallow)
35
___ is not a treatment
biofeedback: it is a way of showing someone their performance (a more enhanced feedback to the pt); compare to effortful swallow, which is an actual treatment
36
a form of advanced feedback; is not a diagnostic tool
biofeedback
37
tx of pharyngeal phase characterized by laryngeal penetration / aspiration
tx: chin tuck, effortful swallow, repeat dry swallow, head turn posture, thermal-gustatory or thermal-tactilestim during meals, supraglottic and super supraglottic swallow
38
tx of cricopharyngeal dysfunction
tx: botox injections, surgical anatomy, head turn (may help to pull UES open), exercises to increase laryngeal elevation when poor UES opening is due to poor elevation (for example, shaker exercise which works out the suprahyoid muscle)
39
regarding diet, as patients show improvement in either direct or indirect tx, the clinician should determine ___
when to re-assess and / or advance the patient's diet (for example, NPO, PO, thick liquids, are solids, etc.)
40
according to Robbins, "the best exercise for swallowing is ___"
swallowing
41
interdisciplinary treatment of dysphagia
MD has ultimate responsibility; SLP is the dysphagia team lead; OTs usually covers pediatric swallowing and hand to mouth issues; radiologists help perform MBSS with the SLP
42
the technique of making unconscious or involuntary bodily processes perceptible to the senses in order to manipulate them by conscious mental control
biofeedback
43
according to AAPB, biofeedback tx includes:
non-harmful treatments; uses scientific instruments to measure physiological feedback; leads to self-regulation (and is the learned skill / primary goal of biofeedback); tx always includes a therapist, pt, and monitoring instruments
44
biofeedback applications in speech pathology
stuttering, voice, dysarthria, aphasia, dysphagia
45
biofeedback modalities in dysphagia rehab (Huckabee)
fluoroscopy; endoscopy; auscultation (the clunking sound of the normal swallow); sEMG (shown on a line - the where the peak = the pt's activated swallow)
46
what are the pros of fiberoptic endoscopic examination of swallowing (FEES)?
view structures in real time; visualize bolus residue post swallow; observe postural compensatory techniques; facilitates vocal adduction and airway protection training (supraglottic swallow); facilitates training of velopharyngeal closure
47
describe vital stim
sends an electrical current to help stimulate muscles involved in swallowing
48
describe sEMG
surface electromyography; measures effort and strength of a swallow; electrical activity is easily influenced (oils, shaven / unshaven hair); simply measures electrical activity
49
the basis of EMG signal ___
concerns the activity of the muscle motor units located under or near the electrodes
50
describe motor unit
found inside a muscle; the motor neuron, its axon, and the muscle fiber innervated by the neuron; smallest functional unit of a muscle
51
sEMG biofeedback provides ___
real time visual representation of the swallow (making involuntary function a conscious deliberate process); objective tx expectations, goal delineation, and measurement; accelerated tx process; framework pt driven tx
52
Adams' (1971) closed loop theory of motor learning
closed loop type of learning in which accuracy and repetition are important for refinement of a skill
53
what sEMG doesn't tell us
what the pharynx is doing; when to proceed with PO intake; when to re-evaluate (diagnostics); when the pt is aspirating
54
___ is NOT a diagnostic tool
sEMG
55
current approach to rehab (Huckabee)
muscle function recovers by addressing muscle weakness; three categories: flaccidity or hypofuntion, spasticity or hyper function, muscle dyscoordination or apraxia
56
sEMG treatment (Huckabee)
prep the skin and place electrodes correctly; pt population (cortical-brainstem infarct, cancers, atrophy pts, CP); use caution with pts with unstable cardiac conditions; transient dysphonia is not uncommon; discourage biting / teeth-grinding
57
sEMG treatment protocol (Huckabee)
education; relaxation; patterning of a motor response; muscle recruitment
58
describe tracheostomy
surgical opening in the anterior neck into the trachea; purpose: bypass airway obstruction, long-term easy access to the airway for mechanical ventilation and / or pulmonary toilet
59
effects of trach tubes on swallowing
if cuff is inflated, may compress the esophagus; MAY decrease laryngeal elevation; MAY result in a decrease in sensitivity of the cough reflex
60
describe ethics
the study of human conduct-character focusing on decisions and actions that are right / wrong, good / bad, better / worse
61
compare ethical principals
autonomy : the right to decide for oneself about one's own life :: beneficence : actions done for the benefit of others and actions that produce good :: nonmaleficence : actions that avoid harm or evil
62
describe virtue
a habitual disposition to act well; a habit under the guidance of reason
63
briefly describe informed consent
the right to consent and the right to refuse
64
components of informed consent
adequate disclosure of info; capacity of the pt to understand the information and make an informed decision; voluntary choice without coercion; appreciation of consequences of the choice made
65
describe legal competence
the law's presumption that all adults are competent to decide for themselves what will be done with their person or property; competence to: stand trail, manage property, for medical decision making; this is determined by a court
66
describe decision-making capacity
of comprehension; of choices; of consequences
67
how decisions are made for people without decision making capacity
let others decide; substituted judgement (what would the pt want); best interest (what is best for the ct)
68
describe advance directives
a document enabling people to express their wishes about their health care that will tell others how to care for them and / or make decisions for them if they are unable to; two types: the living will, the durable power of attorney
69
potential benefits of feeding tubes
increased: life span, recovery, return to useful functioning, resistance to infection; improved: QOL, psychological and physiological state, healing of skin and wounds
70
overall burdens of feeding tubes
cannot be absorbed from the gut; does not abstate failure to thrive; physical pain; underlying condition is hopeless; uncomfortable; prolongs dying; spiritual-emotional pain and suffering; indignity; emotional and financial burden on family
71
describe palliative care
improving the QOL of pts and families facing the problems associated with life-threatening illnesses; enrollment in hospice is not required
72
SLP role for NPO and PO
NPO : secretion management, oral care, small PO feeds for oral gratification :: PO : intervention by increasing activity and participation and not restoration of function
73
describe blue dye swallowing test
only for pts with tracheostomy tubes; takes place of a typical clinical / bedside eval; administer food / liq after feeding water with blue veg dye, then suction
74
blue dye swallowing test procedures
start with 1 tsp water with blue veg dye, administer food / liq, then suction; if there are any signs of aspiration / penetration you must suction; if no aspiration / penetration, suction after 2 - 3 tsp to rule out silent aspiration; suction 10 - 15 min after completing the eval to clear out the cuff
75
blue dye swallowing test: if the pt passes the formal exam and is made PO, ___
their food is often tinged blue for a few days to verify safety
76
advantages of FEES
observe structure; able to see pts bedside; no radiation; biofeedback; test sensation using the scope; pts more tolerant of FEES
77
disadvantages of FEES
``` no oral phase assessment, no observation during the pharyngeal swallow (because of squeezing) ```
78
disadvantages of MBSS
radiation; you have to move the pt from their room

663 Midterm 2 (2 decks)

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