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Flashcards in Test 3 Deck (42):

Strengths of MBS

-“Gold standard”
-Most comprehensive view available
-Follow bolus from oral cavity to esophagus
-Vallecula and pyriform sinuses (%) “guess”
-Widely practiced and accepted


Limitations of MBS

-Radiation exposure
-Unnatural replication of eating (taste & viscosity)
-Positioning may be difficult (e.g. obese; movement disorders, agitation ataxia)
-Staffing and scheduling requirements (Varies by facility: Physician; radiologist; SLP)


Strengths of FEES

-Objective info when MBS is unavailable
-View mucosal surface
-View post-surgical changes
-Observe laryngeal function/airway protection
-Observe available secretions and dryness
-View events before & after swallow


Limitations of FEES

-Invasive, uncomfortable/painful
-No set criteria for “mastering” procedure (but MUST have physician on site
-Need to infer disordered physiology of swallow (Epiglottis gets in the way of seeing the actual swallow)
-Can’t see UES/PES function during swallow
-Can’t see esophagus
-White out: epiglottis comes over
-Gunking: secretions on camera
-Anatomy variation can limit view
-Allergy to blue dye (Use green now)


List 6 structures you could see during an MBS.

Hyoid bone, Epiglottis, Valleculae, True vocal folds, Pyriform sinuses, UES/PES


List postural changes used in dysphagia therapy.

-chin tuck
-chin elevation
-head rotation
-head rotation and chin tuck
-lie down


List sensory techniques used in dysphagia therapy.

-carbonated bolus
-sour bolus
-textured bolus
-thermal-tactile stimulation


List voluntary controls used in dysphagia therapy.

-super supraglottic swallow
-supraglottic swallow
-Effortful swallow
-Mendelsohn maneuver


List strengthening exercises used in dysphagia therapy.

-Masake's technique
-Showa maneuver
-Shaker exercise
-Tongue strengthening
-Range of motion


Postural change- Chin tuck:

-Decreases distance between tongue base and pharynx
-Narrows airway entrance
-Widens vallecula
-Directions: Tuck your chin as close to your chest as possible and swallow


Postural change- Head rotation:

-Usually used for stroke patients
-Closes weaker side of pyriform sinuses
-Directs food to stronger side
-Pushes VFs together (for extra protection)
-Directions: Chew up your food and when you’re ready to swallow, turn to [weaker side] and swallow


Postural change- Head rotation and chin tuck:

-For weakness and penetration
-Directions: Chew up your food and when you’re ready to swallow, turn to [weaker side], tuck your chin as close to your chest as possible, and swallow


Postural change- Chin elevation:

-Uses gravity
-Requires rapid triggering of pharyngeal phase
-Need good airway protection
-Directions: Lift chin up and swallow


Postural change- Lying down:

-Gravity affects residue
-Consider if residue is in pharynx after swallow
-Due to poor laryngeal elevation
-Poor B/L pharyngeal contraction
-Must cough before sitting up (to clear)
-Ex: MS


Sensory techniques- Carbonated bolus:

-alka-seltzer or other
-Increases speed of swallow
-Alternate between carbonated and regular liquid


Sensory techniques- Sour bolus:

-½ lemon juice, ½ water/barium
-Increases speed of swallow
-Alternate sour and regular liquids


Sensory techniques- Textured bolus:

-Add solids to puree or liquids
-Put solids in gauze with floss attached
-Chewing practice
-Taste stimulation
-Nerves in mouth are stimulated to various textures


Sensory techniques- thermal-tactile stimulation:

-Evidence questionable
-cold Laryngeal mirror against anterior faucial arches
-Increases rate of pharyngeal phase
-Caution if hyper gag reflex


Voluntary control- super supraglottic swallow:

-Closes airway before and during swallow
-Speeds onset of laryngeal elevation
-Take breath, hold it, and bear down (like going to the bathroom) and swallow… cough to clear any residue
E.g. vocalize and stop vocalizing - hold it to feel (“bearing down”)


Voluntary control- supraglottic swallow:

-Closes airway at VFs before and during swallow
-Take breath, hold, and swallow… cough to clear any residue


Voluntary control- effortful swallow:

-Increases pressure by tongue and tongue base during swallow
-Reduces residue in pharynx (practice contraction)
-Squeeze hard with tongue as you swallow; exaggerate your swallow


Voluntary control- Mendelsohn maneuver:

-Increase laryngeal elevation
-Increase width of cricopharyngeal opening
-I’m going to have you swallow but catch it (hold breath) halfway through, hold it for 3 seconds then relax. Swallow and feel your voice box lift. When it reaches its highest point, hold it for 3 seconds, then relax


Strengthening exercises- Masake's technique

-Works glossopharyngeal muscles
-Hold front of tongue between teeth and swallow hard
-Feel muscles of pharynx and slight pharyngeal delay
-DO NOT use food or liquids


Voluntary control- Showa maneuver:

-Targets base of tongue and larynx
Pull tongue straight up and back in mouth
Yawn and hold when tongue is farthest back
Pretend to gargle and hold tongue when farthest back


Voluntary control- Shaker exercise:

-Strengthen muscles that lift hyoid
-Lay supine on back and lift head to see toes while leaving shoulders on ground. Do for one minute then rest. Repeat 10-30 times.
-Make sure they have no neck problems


Voluntary control- Tongue strengthening:

-Apply resistance to tongue, lips, or jaw
-Use tongue blade
-Anterior, superior, and lateral directions


Voluntary control- Range of motion:

-LMN or structural damage
-Stretch target structure and hold for one second then relax


National Dysphagia Diet levels

NDDI - Dysphagia Pureed (baby food)
NDDII - Dysphagia Mechanically altered (chopped really small)
Cohesive, moist, some chewing
NDDIII - Dysphagia Advanced (can’t have little pieces: seeds, rice, etc.)
Soft solid foods, requires chewing, no hard foods
NDDIV - Regular


Four levels of liquids (thinnest to thickest)



Zenker’s Diverticulum

-Pharyngeal pouch
-In the posterior wall of pharynx near UES/PES
-Due to weakness
-GERD, Coughing up food after eating
-Viewed best anteriorly/posteriorly on MBS


Piecemeal deglutition

swallow pieces rather than cohesive bolus; saliva breaks away bits


Cricopharyngeal bars

-Cricopharyngeal muscle weakness
-Occurs with aging
-Dysphagia? Cough into trachea
-Tx: dilation
-MBS: visible bars/shelves & food gets caught on top


Passive approaches

-Prophylactic or preventative approach: Severe deficits (e.g. coma leads to alternative feeding), Acute phase (e.g. stroke…), Diet/texture change, Assistance with feeding



rapid heart beat



slow heart beat


Rooting reflex:

sensation around perioral area, infants turns head to stimulation, opens mouth


Moro reflex:

startle response



slow writhing movements


Development of feeding in infants to 24 months:

-Birth-6 months (breast or bottle): Milk, liquids
-4-6 months (spoon): Cereals, puree
-6-9 months (spoon, cup drinking @ 9 months): Mashed, chopped soft
-9-12 months (wean from bottle/breast, self-feed): Chopped and finger foods
-15-24 months (spoon, cup, fork, self-feed): Full diet with some exclusions (difficult to masticate)


How do infants’ structures for dysphagia grow as they age into adolescents?

-“Out and down”
-4-6 months
-Lips move outward
-Tongue is lower in mouth
-Uvula and epiglottis > further apart
-More complete airway protection
-Larynx is lower


What constitutes best practice for dysphagia?

-Experimental evidence
-Clinical experience
-Pt./family desires (may not agree)


Considerations for dysphagia therapy

-Airway protection: reduce/eliminate recurrent chest infections
-Sufficient nutrition and hydration
-Cognitive deficits
-Motor and sensory limitations
-Etiology of Pt. (e.g. dementia)
-Severity of dysphagia (Changes over time)
-Eating history (motivation, cultural bias - certain foods won’t eat or have to have)
-Psychosocial factors (Depression, anger)