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Flashcards in Midterm II Deck (62)
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FEES allows you to view:




the swallow immediately before and after triggering the swallow





What can you observe when using a FEES?


-VP closure
-structural integrity of larynx/pharynx
-excess secretions
-sensation via touching epiglottis / arytenoid cartilage
-and TVC adduction/abduction





The FEES can also allow you to see what important instrumental information?


Premature spillage/pooling


Pharyngeal residue

Effectiveness of cough

Effectiveness of dry swallow
*as well as the effectiveness of various postures and compensatory measures




What is the order of consistencies given when conducting an MBSS?


Thin liquids
thick liquids if needed
soft solid
regular solid





What are some of the downsides to conducting an MBSS?



Exposure to radiation

takes time to take patient to radiology

not enough time can be spent on swallow study






When observing an MBSS in the Oral Stage, what are you looking for?

bolus formation - gathering on tongue blade

bolus maintenance - spreading or spillage of bolus anteriorly or onto sulci 

bolus transit - is it smooth, tongue pumping, able to push against hard palate

oral residue 

premature spillage - normal in solids

ability to chew/masticate





During the pharyngeal stage of MBSS what are you looking for?

adequacy/ timing of VP closure

BOT retraction

epiglottic inversion/retroflexion

hyoid movement/laryngeal elevation

contraction of pharyngeal constrictors

CP/UES relaxation/opening
*laryngeal penetration: how deep, cough, clear
*aspiration: can person clear it thru cough





During the Esophageal Stage what are you looking for when conducting an MBSS?



backflow food/liquid from esophagus

food/liquid sticking or clearing slowly through cervical esophagus





What are some other additional observations when conducting an MBSS?

Zencker's Diverticulum

Cervical Osteophytes

Head and Neck Cancer Pts:
resected structures
lymph edema




True or False:

One of the ways you can help with swallow is first change the diet and then compensatory technique









Chin Tuck helps with

reduced premature spillage by letting gravity help keep bolus in cavity

widens vallecular space in order to hold more food/liquid before swallow

promotes better base of tongue to posterior Pharyngeal wall contact

decreases opening to the laryngeal aditus/vestibule





Head Turn helps with:

increased TVC closure via extrinsic pressure

promote passage of bolus through stronger side of pharynx

promotes reduced resting pressure of the CP segment by pulling cricoid cartilage further away from posterior pharyngeal wall

used when pyriform sinus and pharyngeal wall residue
*can be combined with chin tuck for increased clearance and improved airway protection 





Effortful Swallow allows for:




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





Supraglottic Swallow you must:



voluntarily hold one's breath prior to and during swallowing, then coughing immediately after swallow, then dry swallow

*protects airway during swallow





Super Supraglottic Swallow is:




effortfull swallow + supraglottic swallow






Mendelsohn Maneuver is:



where the individual voluntarily prolongs duration of laryngeal elevation resulting in increased duration/extent of laryngeal elevation and therefore increased duration of CP opening





When making decisions in regards to diet after conducting an MBSS you should consider:

kind of diet
level of supervision during feeding
will SLP continue or will patient be discharged
is a repeat MBSS needed
patient candidate for dysphagia therapy
did aspiration occur (how much, silent, effectiveness of cough)
postures/procedures help reduce aspiration





Frazier Free Water Protocol should be used:




between meals





When writing an MBSS report it should include the following:

Medical History
Diet History
Consistencies given during eval
Oral Stage observations
Pharyngeal Stage observations
Overall impressions
diet recommendations
recommended precautions





Name some of the medical treatments for Dysphagia:

Feeding tube - NGT/PEG
*paralyzed vocal fold due to open heart surgery
Cricopharyngeal Dilation: stick a tube and expand tube and expand cricopharyngeus
Inject botox and paralyze muscle (done every 3-6 months)

Cricopharyngeal Myotomy - muscle cutting (last choice)
*gastric juices and lung juices never meant to come into contact

GERD meds
Appetite stimulants for elderly





What are the behavioral treatments for Dysphagia?



Diet modifications
Oral-Facial Exercises
Compensatory Postures
Thermal Gustatory Stimulation




Bolus Maintenance and Lip Seal is meant to help which phase of swallowing?




Oral Phase





For whom is the Bolus Maintenance/Lip Seal exercise meant for?


for patients who drool

*alternate puckering/spreading lips with and without resistance

opening mouth wide and then puckering slowly

pressing lips tightly together for a few seconds




For those who have trouble with mastication/formation of bolus, maintenance of bolus, posterior bolus propulsion, premature spillage, and oral residue: you should



increase tongue strength, ROM, and coordination:

*tongue lateralization with/without resistance

tongue tip elevation/de-elevation into the anterior Sulci/Buccal Sulci





Thermal Tactile Stimulation is good for:



delayed trigger in swallow

*cold laryngeal mirror brushes anterior faucial pillars





Chin Tuck helps with:



premature spillage
*by having gravity move bolus to the front

*widens the vallecular space allowing for more food/liquid to be held safely until a swallow is triggered





When patient has tongue pumping with premature spillage:


instruct patient to consciously try to reduce pumping action and initiate a hard deliberate post tongue movement
*can use sEMG for biofeedback and see electrical activity spike when there is improvement





If you see delayed pharyngeal swallow and pooling of food into hypopharynx befor swallow you can:



Present cold and sour boluses: may heighten sensory input and result in less delay
*stroking of faucial pillars with cold laryngeal mirror: less delayed swallows following afterwards





If someone has Vallecular Residue (Pharyngeal Phase) due to BOT weakness; you can do the following



Effortful swallow
*chin tuck (widens vallecular space)
Masako Maneuver: holding tip of tongue gently between front teeth while swallowing




If there is pharyngeal wall residue and pyriform sinus residue (due to weak pharyngeal contraction); you can:



do effortful swallow
Masako Maneuver may strengthen superior constrictor
sEMG Feedback (demonstrate the strength necessary to swallow)
Head turn to weak side