treatment

Question 1

patient cannot form a bolus: what’s the treatment?

Answer 1

ROM tongue exercises
-stretching the tongue to each side as far as possible inside the mouth

Question 2

material falls into the anterior sulcus: what’s the treatment?

Answer 2

hold a cohesive bolus:
1. start with paste consistency
2. place bolus on tongue
3. move bolus without losing material

Question 3

material falls into the lateral sulcus: what’s the treatment?

Answer 3

same as anterior sulcus (paste consistency, place on tongue, don’t lose material)

Question 4

delayed oral onset of swallow: what’s the treatment?

Answer 4

1. increasing sensory stimulation by..
   -putting pressure on a spoon
   -cold bolus
   -large bolus
   -sour bolus
   -textured bolus
2. or titling head back for gravity to take over

Question 5

patient has residue in the anterior sulcus: what’s the treatment?

Answer 5

same as before or using a smaller bolus

Question 6

patient has residue in the lateral sulcus: what the disorder? what’s the treatment?

Answer 6

D: reduced buccal tension or tone
T: same as before, using a smaller bolus, or neuromuscular electrical stimulation

Question 7

the patient has residue in the floor of the mouth: what’s the treatment?

Answer 7

1. Hold a cohesive bolus:
   paste consistency

place bolus on tongue

move the bolus without losing the material

2. smaller bolus size

Question 8

the patient has residue on the tongue: what’s the treatment?

Answer 8

1. ROM tongue exercise: stretch the tongue to each side as far as possible in the mouth
2. Resistive lingual exercises: use of pressure sensitive bulb and have patient compress bulb
3. thin bolus

Question 9

the patient has residue on the hard palate: what’s the treatment

Answer 9

1. ROM tongue exercise: open mouth as wide as possible and elevate the tongue as high as possible in the front and hold for 1 second

rest is similar to tongue residue

Question 10

the patient is experiencing incomplete tongue-palate contact: what’s the treatment?

Answer 10

ROM tongue exercise: open mouth as wide as possible and elevate the tongue as high as possible in the front and hold for 1 second

Question 11

premature loss of bolus: what’s the treatment?

Answer 11

1. Hold a cohesive bolus: paste consistency, place bolus on tongue and, move the bolus without losing it
2. Thick bolus
3. Chin tuck
4. Supraglottic swallow

Question 12

aspiration before the swallow as the head of the bolus enters the pharynx before the pharyngeal swallow has been triggered: what’s the treatment?

Answer 12

1. Thermal tactile stimulation
2. Thick bolus
3. Chin tuck
4. Supraglottic swallow

Question 13

bony outgrowth from cervical osteophytes: what’s the treatment?

Answer 13

smaller bolus or supraglottic swallow

Question 14

there is coating on the pharyngeal wall after the swallow: what’s the treatment?

Answer 14

1. Neuromuscular Electrical Stimulation
2. thin bolus
3. lying down on one side to eliminate the gravitational effect on pharyngeal residue
4. Supraglottic swallow

Question 15

there is vallecular residue after the swallow: what are some treatment options?

Answer 15

Masako Maneuver
Thin Bolus
Chin Tuck
Effortful Swallow

Exercise: pull the tongue straight back in the mouth as far as possible and hold it for 1 second

Question 16

there is coating in a depression on the pharyngeal wall: what’s the treatment?

Answer 16

thin bolus
supraglottic swallow

Question 17

residue at the top of the airway: what’s the treatment?

Answer 17

Slide up the pitch scale as high as possible and hold for several seconds

Thin bolus

Mendelsohn maneuver

Question 18

there is residue in the pyriform sinuses: what are some treatment options?

Answer 18

Slide up the pitch scale as high as possible and hold for several seconds

Shaker exercises, thin bolus, head rotation, mendelsohn, or vital stim

Question 19

how do we treat generalized pharyngeal dysfunction?

Answer 19

laryngeal elevation exercises
-slide up the pitch scale and hold for several seconds

masako, vital stim, thin bolus, lying down on one side, Mendelsohn

Question 20

laryngeal penetration: what’s the treatment?

Answer 20

laryngeal elevation exercises (pitch glides or shaker)

thin bolus

mendelsohn

Question 21

aspiration during swallow: what’s the treatment?

Answer 21

laryngeal vestibule closure exercises
-it and hold breath and bear down on the chair for a second then go

thick bolus, chin down and head rotated to damaged side, super-supraglottic swallow

Question 22

aspiration occurs after the swallow: what’s the treatment?

Answer 22

vital stim
laryngeal elevation exercises (pitch scale)

mendelsohn

Question 23

the patient is unable to lateralize with their tongue: what is the treatment?

Answer 23

ROM tongue exercises (stretching tongue from side to side as much as possible inside the mouth)

Question 24

unilateral vallecular residue: what’s the treatment?

Answer 24

Masako Maneuver
Thin bolus
Chin tuck
Effortful swallow

Question 25

residue in one pyriform sinus: what's the treatment?

Answer 25

Shaker exercises Thin bolus Head rotated to damaged side, chin down Effortful swallow

Question 26

reduce vocal fold adduction: what's the treatment?

Answer 26

Vocal fold adduction exercises: begin phonation on /ah/ with a hard attack Supraglottic swallow Chin down, head rotated to damaged side