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ASHA recommends fiberoptic endospcopic evaluation of swallowing "genric identifier"
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If upper airway sensory tseting is added to FEES it is?
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Dysphagia FEES/TX
FEES and treatmetn
| Question | Answer |
|---|---|
| ASHA recommends fiberoptic endospcopic evaluation of swallowing "genric identifier" | FEES |
| If upper airway sensory tseting is added to FEES it is? | FEESST (Sensory Testing) |
| Why is it usually easier to see and try more therapeutic strategies with FEES than MBS? | Because the SLP is in control (no radiologist) and there is no x-ray |
| T/F The following is the only goal of FEES: evaluate anatomy and physiology of the swallow mechanism. | FALSE, not the ONLY goal: also evaluate phsyiology of swallow, identify patterns of impairments, identify consequences of four phases, how does disorganized tongue affect etc. Predict outcome,determine whether and why pt is aspirating |
| What judges prognosis? | Motivation, cognitive status, if phsiology will allow it, if pt is stimulable for correct or improved behavior. |
| T/F If you want to assess phases in action chose: FEES. IF you want to assess impact of swallow and therapy chose MBS. | FALSE. Opposite is true If you want to assess phases in action chose: MBS. IF you want to assess impact of swallow and therapy chose FEES. |
| Differences between MBS and FEES include: | Technique (no x-ray-FEES invasive with Camera, MBS invasive with x-ray beams) Image perspective: view is not lateral or AP like MBS POrtability (much easier to do at bedside) Repeatability (can do many times, cheaper, easier) Upper airway sensory asse |
| T/F. An FEESST gives direct information about CN function, MBS not as much | TRUE, gives direction info about upper airway sensitivity by blowing puff of air into larynx |
| _______ happens when the vagus nerve is overstimulated, it can cause patient to pass out, vomit and can happen with anything in nose, or with laryngectomy patient, very dangerous because vagus nerve controls heartbeat | Vasovagal reaction, if this happens during FEES stop activity |
| T/F The endoscope used for FEES is the same used for assessment of voice? | TRUE |
| T/F a camera is required and always used with FEES | False, a camera can be used to record, (most often) nice because can watch again, but you can also look with naked eye |
| What are some specific goals of FEES? | Assess. of pharyngeal anatomy including laryngeal structures Eval. of movement and sensation of pharyngeal structures Assess. of secretions Direct evaluation of swallowing fucntion with liquids and solids EVal. of the impact of therapeutic maneuvars. |
| T/F it is best to have kids bring their own food, other foods tested include: thin liquid, thicker liquid, pudding, soft solid, solid | TRUE |
| T/F Patient instruction is important so pt. realized the scope will be int he nose for awhile | True typically 10-30 minutes |
| T/F an SLP can administer anesthetic without medical supervision | FALSE, must be applied under medical supervision. |
| All oral motor exercises should only be used if they are either, increasing strength, range of motion accuracy or _______ | Speed |
| What do we look for in a physical assessment using FEES? | Bilaterality, color, size, position, snesory testing (FEEST) |
| What can we ask patient to do to get velum to drop so we can pass scope | Humming can get velum to drop |
| What normal swallow activities do we look for? | Falsetto, throat clearing, cough, valsalva maneuver, voicing, sniffing (maximal abduction) breath holds. |
| T/F. We describe and diagnose structural abnormalities | FALSE. WE describe but we DON'T DIAGNOSE. |
| T/F. There is only one procedure for doing a FEES you always start with liquids | FALSE. start with best texture, or standard protocol. Foods should be easily observable. (apple juice instead of water) |
| T/F FEES allows observation of secretion management better then MBS | TRUE |
| What is observed when you blow air into larynx? | LARYNGOSPASM |
| T/F with FEES may actually see aspiration penetration as it is happening | FALSE. MBS can see aspiration as it is happening, FEES only see the affect of aspiration |
| When choosing a technique we have to consider: | purpose, what are the details, what is the impact on swallowing, this allows us to give rationale |
| Management is _______ while rehabilitation is _______ | Managment is compensatory rehabilitation is treatment (fascilitative) |
| What are some therapy techniques? | POstrual adjustments (body/head) Modifying liquids and solids Oral motor exercises Supraglottic swallow, super supraglottic swallow, mendelsohn maneuver, effortful swallows, multiple swallows. |
| A postural adjustment is a _____ technique | Compensatory teechnique (management) |
| Postural adjustments purpose may invovle: | entire body or just head/shoulders, may redirect the swallow, may increase speed of swallow, no single posture change will help all patients |
| Type of Body posture which involves patient in the supine or side lying position | Body posture change, supine position will bypass the oral cavity. Side lying will decrease space in paralyzed vocal chord. |
| Head posture changes have 3 major changes: | Extension: raising chin, widens oropharynx Flexion: chin tuck, facilitates airway protection and Rotation, good for unilateral pharyngeal changes Head tilt/less common, assists chewing on stronger side |
| T/F Thickening liquids decreases the chances of pneumonia | FALSE. Thickening liquids does decease aspiration, but not always, furthermore decreasing aspiration of water does not decrease chances of pneumonia |
| What one hospital calls the ___________ means that patietns can drink as much water as they want, thera has been no increase in pneumonia and a decrease in dehydration | free water protocol |
| T/F. When we decrease to purees, we decrease quality of life and decreases nutritional benefit | TRUE |
| T/F. Modified diets should be coupled with nutritional counceling | TRUE, research shows we are overly restrictive with patients, modified diets need to be monitored and re-evaluated at regular intervals |
| T/F. Oral motor exercices should be used to strengthen artiulation muscles and are beneficial for children with apraxia of speech | FALSE, should not be used for articulation or phonology, cleft lip/palate or children with Apraxia of speech |
| What type of patients could benefit form OME's? | Bruxism (teeth grinding), drooling (help increase lip closure), dysphagia (tongue strengthening) etc. |
| What are goals of OME's? | Strengthen motor unit, increase range of motion Increase speed of motion INcrease coordingation/accuracy of motion, must know what our goals is to make OME"s effective |
| What two types of treatment methods are there? | Direct: changes four phases and Indirect: compensation/facilitation taht don't change the four phases, help person safe swallow but nothing to improve status of anatomy or physiology |
| Tube feeding recomendations, calorie and food intake measures, secretion management, structring the eating environment, safety precautions, diet modifications are types of __________ treatment | Indirect treatment |
| Oral motor exercises, stimulation of the swallowing reflex and improving closure of airway are the three main types of _______ treatment | Direct Treatment |
| This type of direct treatment includes oral motor exercises, range of motion, coordingation, compensatory maneuvars, sensory stimulation, bolus modification, and devices | Exercises to improve oral motor conorol and voluntary stages of swallowing |
| Thermal, gustaltory stimulation and bolus modifcations are exames of _______ direct therapy | Improving stimulation of the swallowing reflex |
| Valsalva maneuvars, high-pitched vocalizations and effortful swallos all _________ and are a direct therapy | Improve laryngeal closure |
| Chin-down posture (flexion), head-back posture (extension) and head tilt posture (rotation) are ________compensations and are a direct thearpy | Postional compensations |
| T/F turning face to weaker side (rotation) decreases pharyngeal space by 50%, closes pyriform sinus on that side, increase vocal fold clsoure, decresae tone of cricopharngeaus, bolus is directed toward "good side". | TRUE |
| What does tilting head to stronger side do? | Sends food to good side, gravity assists. |
| What are some compensaotry maneuvars: | Double swallows, effortful swallow, supraglottic swallow, super-surpaglottic swallow, mendelssohn maneuvar. |
| This compensatory maneuver is indicated for patient who cannot attain laryngeal closure prior to,during or aftera a swlalow, exertion of voluntary control over otherwise involuntary swallowing events, may cause increased feeding time | Supraglotttic Swallow |
| This compensatory maneuver is identical to supraglottic swallow but uses incrased effort, valsavla and may not be used with patient who have cardiovascular disease or strokes | Super-Supraglottic Swallow |
| This compensaotry maneuver is specifically for patients who show incomplete pharyngeal clearance from incomplete tongue base retraction, leading to exessive redidue, gets tongue base moving ,decreaseing residue | Efffortful swallow |
| This is a natural reaction, and is used as a compensatory meaneuver. However, little evidence to support this, doesn't mean its bad | double swallow |
| Designed to maintain elevation of larynx at highest point which decreses pooling in pyriform sinuses, improves extend and ROM of opening of cricopharhyngeus, icnrases stregnth and range o f elevation for tongue base retraction | Mendelssohn Maneuver |
| Modifciations to bolus, can have definite affect on onset and duration of swallow events | TRUE |
Created by:
shayc09