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Dysphagia Final Exam
Dysphagia Treatment: Compensatory Strategies, Swallow Maneuvers & therapy
| Question | Answer |
|---|---|
| Key feature of multiple sclerosis? | Halicitization (silent aspiration) |
| Key feature of Alzheimer's ? | Forget to swallow/swallow apraxia/food agnosia |
| Key feature of ALS? | Muscle Spasticity |
| Key feature of Huntington's Disease? | Chorea- jerky movements & aspiration pneumonia |
| Key feature of COPD? | Incoordination of respiration and swallowing |
| Key feature of Parkinson's Disease? | Tremors of the tongue- rocking and rolling |
| Myasthenia Gravis key features? | Progressive fatigue of muscles |
| What compensatory strategy would you use for decreased tongue muscle control and slow oral transit time? | Chin up posture |
| Oral sensory awareness such as downward pressure and changing the taste of a bolus would help someone with? | Swallow apraxia or food agnosia |
| If a patient appears to be fatigued and is holding food in their mouth, what would you do? | DO NOT order MBSS, instead come back at a later time for a bedside swallow evaluation |
| For a patient with decreased acceptance, what would you do? | Start at the food level that they are most comfortable with. |
| How would you help a patient with decreased bolus formation? | Smaller bolus volume or advise a liquid wash after the swallow |
| Your patient has decreased mastication, what could you do besides putting them on a pureed diet to maintain quality of life? | Supplement extra calories such as with Ensure drinks and change their diet to soft which requires less chewing |
| What compensatory strategies and diet changes would you advise for a patient with premature spillage? | Chin tuck as a compensatory strategy, thicken their liquids and decrease the volume of the bolus. |
| A Patient presenting with delayed swallow would benefit from this... | Chin tuck compensatory strategy, supraglottic swallow swallow maneuver, and thermal stimulation therapy |
| If a patient has residue in the valleculae, what would help them? | Chin tuck compensatory strategy, BOT exercises, and the Masaka Maneuver as therapy |
| What would help a patient with residue in the pyriform sinuses? | Head turn compensatory strategy, multiple swallows or liquid wash swallow maneuver, BOT exercises, Shaker Method and Laryngeal elevation therapy |
| What compensatory strategy would help a patient that presents with decreased pharyngeal wall contraction? | Reclined on back compensatory strategy |
| What causes penetration before the swallow? | Delayed swallow, premature spillage and pooling |
| What causes penetration during the swallow? | Decreased laryngeal elevation |
| What can help someone that presents with decreased laryngeal elevation? | Chin tuck, supraglottic swallow, laryngeal elevation exercises and Mendhelson maneuver |
| What causes penetration after the swallow and what can help? | Caused by residue dripping, can be cured by a liquid wash if it is not too much |
| What causes aspiration before the swallow? | Swallow delay or premature spillage |
| What causes aspiration during the swallow? | decreased laryngeal elevation or closure |
| What can help a patient with decreased laryngeal elevation or closure? | Super supraglottic swallow and baring down therapy |
| What causes aspiration after the swallow and what would the SLP advise? | Residue *must change to a safer consistency diet |
| A patient has received a hemi-laryngectomy due to cancer, what compensatory strategy would you use? | Head turn to the damaged side |
| A patient has received a supraglottic laryngectomy due to cancer, what compensatory strategy would you use? | Chin tuck or super supraglottic swallow |
| Your patient presents with a subcortical CVA, what therapy/compensatory strategies would you use? | Thermal tactile stimulation, BOT exercises, and laryngeal elevation |
| What would help a patient with a left cortical CVA? | Oral Sensory awareness therapy |
| What would help a patient with a right cortical CVA? | Thermal tactile stimulation, chin tuck and laryngeal elevation exercises and supraglottic swallow |
| After suffering a stroke in the brainstem, what would help your patient? | Chin tuck and head turn to the damaged side due to unilateral weakness |
| What signs indicate possible aspiration? | Throat clearing, wet voice, respiratory changes, general discomfort |
| What is the safest consistency to aspirate on? | Thin liquids |
| What do you observe during a beside swallow evaluation? | Acceptance, lip closure, anterior spillage, mastication, bolus formation, bolus propulsion, oral residue, oral transit time, swallow response, number of swallows per bolus, hyolaryngeal elevation, regurgitation, pain/discomfort, cough, throat clearing |
| How would you treat a baby with a delayed swallow response? | Thermal stimulation with oral or non-oral feeds |
| What treatment would help a baby with decreased bolus formation? | Thickening the liquid, providing a single bolus or providing small boluses |
| How would you treat aspiration during the swallow for a baby? | Laryngeal elevation/closure and thickening feeds |
| How would you treat residue/aspiration after the swallow in a baby? | Improve pharyngeal pressure with a palatal obturator |
| How would you increase a the oral-facial muscle tone in a baby with hypotonia? | Tapping, vibration or quick stretch of masseter and buccinator muscles |
| How would you treat excessive jaw movement in a baby? | Postural support, external support & increased neck flexion |
| How would you treat a baby with oral-facial hypertonia? | Firm pressure or shaking/vibration |
| What is the chin-up posture used for? | Uses gravity to move material out of mouth; decreased tongue control and slow oral transit time |
| What is the chin-tuck posture used for? | Decreased BOT retraction, airway closure, swallow delay; widens valleculae and narrows airway entrance |
| What is the head turn to the damaged side used for? | Twists the pharynx and closes damaged side; used with unilateral impairment |
| What is the head tilt to the stronger side used for? | Uses gravity to direct the bolus into pharynx; for unilateral oral and pharyngeal impairment, clears residue |
| What is the reclined on back posture used for? | Gravity changes the position of the bolus; used for decreased bilateral pharyngeal wall contraction and reduced laryngeal elevation |
| What is oral sensory awareness used for? | Used with swallow apraxia, tactile agnosia, delayed swallow or decreased oral sensation |
| What are some types of oral sensory awareness therapy? | Downward pressure of spoon on tongue, sour bolus, cold bolus, larger volume bolus |
| How does the suck-swallow help patients? | Exaggerated suck with mouth closed followed by a swallow facilitates pharyngeal swallow |
| How does the supraglottic swallow help patients? | Closes VF before and during the swallow ; decreased VF closure and delayed swallow |
| What does the super supraglottic swallow maneuver accomplish? | help close the airway |
| What are some pharyngeal exercises? | BOT exercises, Masaka Manuever |
| When would you advise a patient to use the Shaker Method? | Used for decreased UES opening |
| What is a special feature of HIV? | esophageal dysphagia and odynophagia due to thrush |
| Fred is a 63 year old Male. He was admitted into the hospital due to a collapsed lung and had to be intubated. Doctors finished his operation and he is now stable. Fred has been extubated. When should you do a bedside swallow evaluation? Why? | A minimum of 4 hours, if after 4 hours he is coughing on thin liquids come back in 24 hours. The tracheostomy tube may have damaged the larynx causing acute temporary dysphagia. |
| What are some possible signs that your patient has dysphagia that could be observed during a bedside evaluation? | Unable to recognize food, cannot control food/liquid in mouth, frequent coughing toward end of meal, throat clearing, recurring pneumonia, weight loss, increased secretions |
| What is the dysfunction if a patient has difficulty accepting food? | Decreased jaw/lip movement - oral prep |
| What dysfunction causes anterior spillage? | Reduced lip closure - oral prep |
| Decreased mastication is an indicator of what dysfunction? | Reduced jaw/tongue movement - oral prep |
| Decreased bolus hold is due to what dysfunction? | Reduced tongue shaping or coordination - oral prep |
| What dysfunction causes decreased bolus formation? | Reduced tongue/cheek ROM and/or coordination - oral prep |
| Material falling into the anterior sulcus is an indicator of what dysfunction? | Reduced lip tension/tone - oral prep |
| What dysfunction causes material to fall into the lateral sulci? | Reduced cheek tension/tone - oral prep |
| What dysfunction would cause residue to stay on the FOM? | Reduced tongue shaping/reduced peripheral seal - oral prep |
| What is the dysfunction called when a patient holds a bolus in their mouth without attempting to propel it? | Swallow apraxia, food agnosia, reduced oral tension - oral |
| Searching tongue movements are a symptom of what? | Swallow apraxia - oral |
| What is the dysfunction when the symptom is tongue pushed forward out of mouth? | Tongue thrust -oral |
| Residue in the lateral sulci is a symptom of which dysfunction? | Reduced cheek tension/tone - oral |
| What is the dysfunction when there is residue on the tongue? | Decreased tongue strength, elevation or A-P movement - oral |
| What dysfunction causes premature spillage? | Reduced tongue control, lowering of velum or BOT elevation -oral |
| If a patient presents with reduced velopharyngeal closure, what is a likely symptom? | Nasal penetration - pharyngeal |
| Coating on pharyngeal walls is indicative of what dysfunction? | Reduced pharyngeal contraction |
| What is the dysfunction when a PT presents with residue in the valleculae? | Decreased BOT retraction, posterior tongue driving force, absent epiglottic movement |
| Residue in the pyriform sinuses is caused by what? | Cricopharyngeal dysfunction (UES does not open), decreased laryngeal or pharyngeal movement |
Created by:
superpuza
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