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Final Dysphagia Exam > Strategies & Therapies > Flashcards

Strategies & Therapies Flashcards

1
Q

Dysphagia treatments are divided in two main groups: ________________ & __________________

A

Compensatory Strategies

Therapies

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2
Q

What are the COMPENSATORY strategies?

A

Diet modification
Positional
Oral Sensory
Prosthetics

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3
Q

What are the types of THERAPIES?

A

Maneuvers
Exercises
Surgeries

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4
Q

Which compensatory strategy is done as a LAST RESORT?

A

Diet modification !!!

Why? Because this affects QOL
this is done only if other comp. strategies fail or if the pt. is severely cognitively impaired.

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5
Q

T or F: Compensatory strategies are designed to ELIMINATE SYMPTOMS.

A

TRUE!

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6
Q

T or F: Compensatory strategies are NOT dependent of the caregiver and increases motor control of swallow.

A

FALSE!
Caregiver is in CONTROL!
DOES NOT INCREASE motor control of swallow.

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7
Q

T or F: Therapies INCREASE the swallow anatomy & physiology and INCREASE ROM , control and strength

A

TRUE

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8
Q

What is the difference b/w DIRECT vs. INDIRECT therapy?

A 
Direct = use of swallow to perform therapy. 
Indirect= swallowing is not involved to perform therapy.
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9
Q

Diet modification involves changes in bolus ______?

A 
consistency
size
volume
viscosity 
taste
temperature
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10
Q

What are the consistencies of LIQUIDS?

A

THIN -(water)
NECTAR- (v8)
HONEY

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11
Q

What are the consistencies of SOLIDS?

A 
PUDDING
PUREE - (apple sauce) 
MECHANICAL SOFT - (scrambled eggs) 
CHOPPED - (corn hash) 
REGULAR - (cracker)
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12
Q

Mention all of the POSITIONAL (6) strategies:

A

1) Sitting at 90 degrees
2) Head Rotation
3) Head Tilt
4) Head Back
5) Chin Tuck
6) Lying on side

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13
Q

Mention all of the ORAL SENSORY strategies:

A

1) Thermal tactile stimulation
2) Sour bolus
3) Cold bolus
4) Pressure with spoon against tongue
5) Bolus requiring chewing
6) Suck-swallow

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14
Q

What does a person do with the thermal tactile stim?

A

Vertically rubs anterior facial pillars 4-5 times with a lemon swab or a cold laryngeal mirror
**helps w/ oral awareness and triggers pharyngeal swallow

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15
Q

What is the suck-swallow?

A

Vertical JAW-TONGUE SUCKING with LIPS CLOSED

**triggers pharyngeal swallow and draws saliva back

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16
Q

Sitting up at 90 degrees

A

Directs bolus down (w/ gravity)

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17
Q

Lying on side

A 
Lie on STRONG SIDE!
Eliminates residues (no gravity)
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18
Q

Chin Tuck

A 
Places EPIGLOTTIS IN PROTECTIVE position
NARROWS AIRWAY entrance 
INCREASES LARYNGEAL ELEVATION & VF CLOSURE
WIDENS VALLECULAE (avoid penetration)
PUSHES TONGUE BASE BACK
19
Q

Head rotation

A

Rotate to WEAK SIDE! (close off damaged area)

Directs bolus to strong side.

20
Q

Head tilt

A

Tilt to STRONG SIDE!

Directs bolus to strong side (w/gravity)

21
Q

Head back

A

CLEARS ORAL CAVITY (w/gravity)

22
Q

What are the types of PROSTHETICS that can be done?

A

Dentition
Soft palate
Palatal lowering (hard palate)
Lingual

23
Q

What is the purpose of the prosthetics?

A

Improve speech intelligibility & oral prep/phase (chewing, bolus formation, bolus transport, bolus control etc)

24
Q

Who can get a PROSTHETIC?

A 
CONGENITAL DEFECTS (cleft lip/palate, disease, bifid uvula) 
ACQUIRED DEFECTS (disease, trauma, burns)
25
Q

What are the 4 types of MANEUVERS?

A

1) Effortful
2) Supraglottic
3) Super-supraglottic
4) Mendelsohn

26
Q

Steps: EFFORTFUL SWALLOW

A

1) SQUEEZE hard all of your throat/pharyngeal muscles BEFORE SWALLOW
2) SWALLOW while SQUEEZING

27
Q

Steps: SUPRAGLOTTIC

A

1) Inhale and HOLD BREATH before swallow
2) Place BOLUS IN BACK OF TONGUE
3) Swallow
4) Cough before inhaling
5) Swallow & breath

28
Q

Steps: SUPER-SUPRAGLOTTIC

A

(effortful + supraglottic)

1) Inhale and HOLD BREATH before swallow
2) Place BOLUS IN BACK OF TONGUE
3) SQUEEZE while swallowing (bear down)
4) Cough
5) Swallow

29
Q

Steps: Mendelsohn (hardest to teach!)

A

1) PUSH TONGUE AGAINST ROOF OF MOUTH
2) HOLD SWALLOW - THRYOID CARTILAGE UP for at least 3 seconds

  • Should have pt. practice with dry swallows to feel their thyroid lift up.
30
Q

What are the EXERCISES?

A

1) Shaker
2) Masako
3) Oral Motor

31
Q

Steps: SHAKER (head lift exercise)

A

1) LAY FLAT ON BACK (bed or floor)
2) LIFT HEAD and LOOK AT FEET for 1 minute! (do not raise shoulders!!!)
3) TAKE 1 minute BREAK
4) REPEAT SEQUENCE TWICE
5) RAISE HEAD 30times & LOOK AT TOES (don’t sustain)
6) REPEAT ENTIRE THING 3 TIMES per day!

32
Q

Steps: MASAKO

A

1) STICK TONGUE OUT
2) GRIP w/ LIPS
3) DRY SWALLOW!

33
Q

Oral motor exercises increase _______, ________, and ___________.

A

ROM
Resistance
Bolus maintenance

34
Q

What are the types of surgeries (5)

A

1) CP MYOTOMY
2) DIVERTICULECTOMY
3) VF MEDIALIZATION
4) PALATOPEXY
5) DILATION

35
Q

What are the types of EXPERIMENTAL treatments available for dysphagia?

A

1) DPNS - (Deep Pharyngeal Neuromuscular Stimulation)
2) NMES - (Neuromuscular Electrical Stimulation)
3) Myofascial release
4) Botox

36
Q

Which of the experimental treatments is a MANUAL TECHNIQUE?

A

Myofascial release!

37
Q

Which experimental treatment is mainly used for achalasia, CP dysfunction, & motility issues?

A

BOTOX!

38
Q

Which experimental treatment places frozen lemon ice sticks in 9 sites in mouth and throat?

A

DPNS!!!

39
Q

Which experimental treatment uses surface electrodes applied over swallowing muscles?

A

NMES

40
Q

Which NMES company is more efficacious (Dr. C’s opinion)

a. Vital Stim
b. E-Swallow
c. Ampcare

A

C- AMPCARE

why? b/c it involves only one channel of electrodes (suprahyoid muscles)

41
Q

What is the main PURPOSE of DPNS?

A
  • TREAT neuromuscular weakness or incoordination
  • ACTIVATE MUSCLES
  • STRENGHTEN neuro m. signals
  • INCREASE m. strength
42
Q

What is the main PURPOSE of NMES?

A
  • INCREASE m. strength

- FACILITATE MOTOR MVMT

43
Q

What is the main PURPOSE of MYOFASCIAL release?

A
  • LOOSEN TIGHT MUSCLES and fascial adhesions

- IMPROVE CIRCULATION

44
Q

What is the main PURPOSE of BOTOX?

A
  • DEADENS TRANSMISSION OF NERVE TO M.

- RELAX muscle

Final Dysphagia Exam (2 decks)

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