Swallowing: Therapy Techniques – Flashcards
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20 minute feeding time limit
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Check into causes for lag
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Techniques
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Compensatory Improve oral sensation modification of food prosthesis direct/indirect treatment: swallowing manuevers
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Treatments
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Not EVP
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Techniques: Principals
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Position Distractions Food:temp, consistence, diet restrictions, flavor Oral care
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Feeding
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Hand over hand, verbal prompts, standby Feed to midline or non affected side Vision(reduced visual field) LARGE ENOUGH BOLUS TO STIMULATE SWALLOW VERBAL QUE TO CHEW AND MANIPULATE FOOD MONITOR TO LAryNGEAL GARGLE 20 MINUTES
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General Guidelines
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maintain upright position modest bolus .5 to 1 tsp at a time eat intentionally avoid socializing food into stronger side of the mouth. bite reflex, dont scrap food at the end of the meal check pocketing chin down dont mix liquids and solids avoid liquid chaser, unless in plan, relaxed atmosphere, limit distractions following meal, sit upright for 30-45 minutes
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Postural Techniques: Eliminate Aspiration or Residue
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Flouroscopy: Inefficient transit Posture: Head back Rationale: Gravity clears oral cavity
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To eliminate arpiration or residue-Delay in triggering pharyngeal swallow
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CHIN DOWN: Widens valleculae to prevent bolus from entering airway(maybe)
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To eliminate aspiration or reside-Tongue weakness
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CHIN DOWN:Push tongue base backward
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To eliminate aspiration or residue-Unilateral VF paralysis
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HEAD ROTATED TO THE AFFECTED SIDE:Extrinsic pressure on the thyroid, improving VF app, directs bolus to stronger
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To eliminate aspiration or residue-Reduced pharyngeal contraction
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LYING ON ONE Eliminates gravitational effect on ....
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To eliminate aspiration or residue-Unilateral pharyngeal paresis
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HEAD ROTATED TO THE AFFECTED SIDE
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To eliminate aspiration or residue-Unilateral and pharyngeal weakness on the same side (residue in mouth and pharynx)
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HEAD TILT TO STRONGER SIDE:Directs bolus....
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To eliminate aspiration or residue-Cricopharyngeal dysfunction (residue in pyriform sinuses)
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HEAD ROTATED: Cricoid cartilage away from the posterior pharyngeal wall, reducing pressure in cricopharyngeal sphincter
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Feeding Techniques: Set the Stage
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Environment Social expectations of meals Limit socialization Alertness Sensori: glasses, hearing aid Your position: lightning visual fields Smells/appearance of food
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Thermal Stimulation
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#00 Laryngeal Mirror, in ice water, to stimulate swallow by touching faucil arches(4-5) times
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Diet modifications; thin
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Dysphagia Level l
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Diet modifications; nectar
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Dysphagia Level 2
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Diet modifications; honey
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Dysphagia Level 3
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Solid Food Modification
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Pureed, Mechanical Altered(ground/chopped), Soft, DAT(diet as tolerated)
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Thing to avoid
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Salad sticky(peanut butter/cream cheese) stringy(fiberous fruits) crumbly(corn muffins/dry cake/crackers) small pits hard(raw veggies/bagels)
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Food characteristics
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Viscosity Cohesiveness shear taste temp presentation
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water protocol
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Clean tap water is safe. Negative affects atr attributed to: Chronic aspiration of saliva by an immunocomprmised ===========
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Frazier Water Protocol
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SLIDES
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Frazier Hydration
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Free water consumption is encouraged Risk/cost of IV fluids should be decreased Post discharge surverys of Fraizier dysphasic patients indicate water often is the primary means if hydration
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Compliance to water
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patients report thickened liquids did not quench thirst water eliminates thirst and patient complaints are ow less frequent patients appear more likely to comply with the thin liquid restriction preparation of thickened liquids often becomes burdensome cost preparation energy
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Considerations
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Availability Likability mixing characteristics ----------------------
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thickners
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do not cause constipation or reduce fluid absoption
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conclusions
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patinets do no like thickened liquids causing reduced intake..offer them what ever fluid they will take
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slick jello
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lubricates the system:recipe on slide
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sarcopenia
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age related muscle weakness can be reveresed with excersise
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FORCEFUL SWALLOW
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collect all the saliva in your mouth onto the center of your tongue keep lips closed and tight pretend you are swallowing a grape whole # reps is patient specific(repetitions and resistance)
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Superglottic swallow
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Inhale and hold breath swallow while holding your breath cough immediately after you swallow without breathing in FOR ASPIRATORS-closes airway
