Management of Dysphagia (1)

Question 1

A pt should receive treatment regardless if they’re PO or NPO. T or F?

Answer 1

True; if patient is candidate for treatment, they should receive tx regardless of NP/NPO status

Question 2

What 2 questions should be considered if client is to receive treatment?

Answer 2

1. What type of treatment is most appropriate?
2. If PO, what diet is most appropriate?

Why?
To improve safety of swallowing and quality of life.

Question 3

What are the characteristics (8) to consider when deciding if pt is candidate for treatment?

Answer 3

• medical diagnosis/prognosis
• patient choice/ethical issue/QOL
• ability to follow directions
• reaction to compensatory strategies
• severity of problem
• respiratory function
• caregiver support
• patient motivation

Question 4

What are VFSS/bedside S/S of dysphagia (oral)?

Answer 4

• food falls out of mouth
• bolus spreads through oral cavity
• residue/food remains on tongue or falls into sulcus
• no lingual movement when food in mouth
• residue on tongue
• residue on hard palate
• difficulties moving bolus in AP
• slow oral transit times

Question 5

food falls out of mouth; why?

Answer 5

poor lip closure; CN VII

Question 6

bolus spreads through oral cavity; why?

Answer 6

reduced tongue coordination; XII

Question 7

residue/food remains on the tongue or falls into sulcus; why?

Answer 7

tongue weakness; XII

Question 8

residue on tongue; why?

Answer 8

tongue weakness; coordination problem

Question 9

residue on hard palate; why?

Answer 9

tongue weakness

Question 10

difficulties moving bolus in AP; why?

Answer 10

weakness of tongue

Question 11

What are VFSS S/S of dysphagia (trigger & pharyngeal)?

Answer 11

• delayed triggering of pharyngeal swallow
• nasal regurgitation
• residue on 1/both sides of pharynx
• premature spillage or residue in valleculae
• reduced displacement of larynx
• residue in pyriform sinuses bilaterally
• penetration and/or aspiration

Question 12

nasal regurgitation; why?

Answer 12

weakness in VP port/ CN XII

Question 13

premature spillage or residue in valleculae; why?

Answer 13

weakness of BOT

Question 14

residue in pyriform sinuses bilaterally; why?

Answer 14

poor coordination of pharyngeal constrictors; reduced laryngeal elevation

Question 15

penetration or aspiration; why?

Answer 15

no airway protection

Question 16

What is the main goal of management?

Answer 16

safe non aspirative oral feeding while maintaining adequate nutrition and hydration

Question 17

What is the goal of management for pts who are NPO?

Answer 17

re-establishing oral feeding

Question 18

For all pts w/ dysphagia, goals are to?

Answer 18

resume prior level of diet, tolerate a least restrictive diet, ensure safe swallow and optimize quality of life

Question 19

_________: surgical and nonsurgical :: _________: compensatory strategies and therapeutic/rehab techniques

Answer 19

Medical management

Behavioral management

Question 20

Techniques to improve disorders caused by anatomic/ physiologic abnormalities =

Answer 20

Medical Management

Question 21

Procedures to control for prolonged, unremiting aspiration, including artificial airway =

Answer 21

Medical Management

Question 22

Surgical procedures to provide nutrition and hydration via nonoral means =

Answer 22

Medical Management

Question 23

Laryngeal/Airway-related procedures are meant to?

Answer 23

Improve glottal closure and protect the airway

Question 24

What are the Laryngeal/Airway-related procedures (3)?

Answer 24

− Vocal cord injection
− Laryngeal closure
− Tracheotomy

Question 25

Cricopharyngeal dysfunction procedures are meant to?

Answer 25

Improve opening of PES

Question 26

Cricopharyngeal dysfuncion procedures (2)

Answer 26

Myotomy | Dilation

Question 27

Non-surgical procedure ?

Answer 27

Medications for reflux

Question 28

Compensatory treatment (indirect)

Answer 28

Circumvents the problem using indirect strategies to alter bolus flow: Posture, sensory procedures, manuevers, combine posture and maneuvers, and diet changes

Question 29

Rehab treatment (Direct)

Answer 29

Changing the swallowing pysiology to restore function and directed at improving neuromuscular control: Auditory feedback, sensory therapy, physiotherapeutic ex, and E-Stim therapy

Question 30

Comp Strategies (5)

Answer 30

``` Postural changes Maneuvers Intra-oral prosthetics Increasing sensory input Altering diet/consistencies ```

Question 31

Performed to improve airway protection and/ or improve oral and/or pharyngeal transit of food/ liquid.

Answer 31

Postural changes/adjustments

Question 32

Postural Changes/adjustments (5)

Answer 32

- Chin tuck / chin down - Head back / chin up - Head tilt - Head turn / rotation - Combination **look at maneuver cards**

Question 33

What are pt requirements when applying airway protection maneuvers?

Answer 33

- ability to learn/ intact cognition - motivation - respiratory reserve

Question 34

Airway Protection Maneuvers (3)

Answer 34

- Supraglottic/Super supraglottic - Effortful - Combinations of other compensatory strategies (posture or increasing sensory input)

Question 35

“Inhale, exhale slightly, hold breath, swallow, clear pharynx/cough, swallow again”

Answer 35

Supraglottic

Question 36

Designed to close the airway at the level of true vfs | before and during swallow

Answer 36

Supraglottic

Question 37

Who can benefit from the supraglotitc maneuver?

Answer 37

Pt w/ reduced or late vf closure Pt w/ delayed pharyngeal swallow **may be too stressing for pts with poor respiratory function or hx of heart disease**

Question 38

"hard swallow"; ask patient to "swallow hard"; "swallow forcedly"; "as you swallow, squeeze hard w/ all your muscles and push your tongue to roof of mouth. "

Answer 38

effortful swallow

Question 39

Promotes stronger tongue to palate contact, and stronger BOT to posterior pharyngeal wall contact

Answer 39

Effortful Swallow

Question 40

Who can benefit from effortful swallow maneuver?

Answer 40

Pts w/ reduced tongue base retraction, residue in vallecular space, residue in laryngeal wall

Question 41

To facilitate lingual motion, to improve the triggering of pharyngeal swallow

Answer 41

Increase sensory input

Question 42

Volume of bolus and temoerature ir taste change -->

Answer 42

Increase sensory input

Question 43

Bolus change: decreasing volume of bolus. Why?

Answer 43

Pt may have respiratory issue or poor bolus control

Question 44

Bolus change: increasing volume of bolus. Why?

Answer 44

Pt may have decreased sensation in oral cavity

Question 45

Teaches oral containment and control, while heightening | sensory input of feeling the bolus and good procedure to use with a delayed pharyngeal swallow.

Answer 45

Bolus hold

Question 46

Double or multiple swallows

Answer 46

good for pts with pharyngeal residue