Direct Therapy Procedures – Flashcards
Unlock all answers in this set
Unlock answersquestion
Oral sensory stimulation for direct therapy procedures
answer
reduced oral sensation, tactile agnosia for food, delayed onset of oral swallow, delayed triggering of pharyngeal swallow, swallow apraxia
question
Oral sensory stimulation: thermal stimulation
answer
delayed/absent swallow reflex
question
Oral sensory stimulation: tactile stimulation
answer
delayed pharyngeal swallow
question
Oral sensory stimulation: tactile stimulation methods:
answer
suck/swallow, quick downward pressure on tongue, massage- nuk massage brush
question
Oral sensory stimulation: food selection: tastes
answer
sour taste (50% lemon juice + 50% barium for MBS; lemon ice) lemon ice recipe (21 meal supply) 1 scoop (8 tsp.) thick it 2 scoop (16 tsp.) lemonade powder 1 tsp. sugar 1/8 tsp. salt 16 oz water
question
food selection: temperature
answer
cold; alternating cold/hot
question
food selection: volume
answer
larger bolus
question
food selection: textures
answer
chewable, carbonated
question
Oral sensory stimulation: desensitization
answer
hypersensitive reflexes
question
Massages (myofascial release)
answer
-manual therapy technique to be used to correct restrictions in muscle and connective tissue and improve one's ability to develop adequate muscular tension for functional swallowing -to improve myofascial system (fascial mobility, muscular mobility, muscular strength) to release tissue restrictions and provide manual soft tissue mobilization for functional swallow -sample techniques: oral cavity techniques strap elongation suprahyoid techniques hypolaryngeal glides infrahyoid techniques
question
Exercises: Oral musculature: strengthening and range of motion
answer
lips, tongue: TheraSpoon, Jaw: TheraBite
question
IOPI system (Iowa Oral Performance Instrument)
answer
device to be used for quantitative measurement and exercises for tongue strengths and lip strengths
question
Exercises: Oral musculature: Bolus Control
answer
gross manipulation (help patients maninpulate bolus in mouth), bolus holding (use gauze or something you can hold on to), bolus propulsion
question
Exercises: Oral musculature: Mastication exercise
answer
Use gauze or something to chew on, cross bar
question
PHARYNGEAL MUSCULATURES: Tongue base exercises
answer
difficult to voluntarily activate
question
PHARYNGEAL MUSCULATURES: Tongue holding (Masako maneuver)
answer
-to strengthen pharyngeal muscles and thus improve pharyngeal wall contraction -contraindication: aspiration may occur if performed with food or liquid
question
PHARYNGEAL MUSCULATURES: airway entrance
answer
pushing/pulling exercise with hands against chair. practice holding breath safely; add voice to increase closure of vocal folds
question
PHARYNGEAL MUSCULATURES: laryngeal elevation (falsetto)
answer
too benign, not specific enough, DONT USE!
question
PHARYNGEAL MUSCULATURES: Head lift exercise (Shaker exercise)
answer
-reduced cricopharyngeal/UES opening -reduced laryngeal opening -reduced base of tongue retraction
question
PHARYNGEAL MUSCULATURES: Head lift exercise (Shaker exercise) CONTRAINDICATIONS
answer
-cervical spine disorder -tracheostomy -uncontrolled high blood pressure and certain cardiac -problems -within 1 hour after tube feeding -unable to exercise independently -history of reflux?
question
PHARYNGEAL MUSCULATURES: Effortful Pitch Glide increases:
answer
-anterior hyoid movement -hyolaryngeal approximation -laryngeal elevation -pharyngeal shortening -pharyngeal wall medialization
question
PHARYNGEAL MUSCULATURES: Effortful Pitch Glide components:
answer
-falsetto -pharyngeal squeeze
question
PHARYNGEAL MUSCULATURES: Effortful Pitch Glide Instructions:
answer
shift /i/ from modal pitch to highest pitch forceful "ee" at the highest pitch
question
PHARYNGEAL MUSCULATURES: Expiratory Muscle Strength Training (EMST)
answer
-respiratory strengthening exercise per resistive loading with a pressure threshold device -to increase activation of hyolaryngeal muscles and laryngeal closure -may improve cough, speech, breathing, and swallow function
question
SWALLOWING MANEUVERS: task-specific exercises Effortful Swallow
answer
reduced tongue based retraction; "give me a strong swallow"
question
SWALLOWING MANEUVERS: Supraglottic swallow
answer
-reduced or late VF closure -delayed pharyngeal swallow -"take a breath, hold bolus in mouth, swallow, then cough"
question
SWALLOWING MANEUVERS: Super-supraglottic swallow
answer
-reduced closure of the airway entrance -"effortful supraglottic swallow"
question
SWALLOWING MANEUVERS: Mendolsohn maneuver
answer
-reduced laryngeal elevation -REDUCED cricopharyngeal opening -discoordinated swallow -"hold hyoid bone as high as possible when you swallow"
question
SWALLOWING MANEUVERS: Lateral Press of Thyroid Cartilage
answer
-unilateral laryngeal dysfunction -unilateral pharyngeal dysfunction -head turning is equivalent to this procedure -"press against damaged side"
question
SWALLOWING TREATMENT PROGRAMS: Transcutaneous electrical stimulation: VitalStim Therapy
answer
-using mild electrical signals, delivered through electrodes attached to throat -to stimulate the muscles of the swallowing mechanism (laryngeal elevation)
question
SWALLOWING TREATMENT PROGRAMS: Transcutaneous electrical stimulation: E-Stim
answer
-a small electric current is passed across the skin into the muscles in the anterior neck through surface electrodes -designed to facilitate laryngeal elevation and pharyngeal contraction -best outcome when paired with an appropriate and functional therapy program
question
SWALLOWING TREATMENT PROGRAMS: Oral Hygiene Program
answer
-twice daily brushing to remove dental plaque from teeth -suctioning of oral secretions to decrease bacterial load -keeping oral mucosa moist soothes and hydrates the lips and oral tissue
question
SWALLOWING TREATMENT PROGRAMS: Water protocol (Frazier Rehab Center's Water Protocol)
answer
-don't use with patients who are impulsive or TBI patients who can't drink safely
question
SWALLOWING TREATMENT PROGRAMS: McNeil Dysphagia Treatment Program (MDTP)
answer
-systematic, exercise-based therapy for severe dysphagia in adults -includes daily transcutaneous NMES with functional swallowing activities following a dietary hierarchy with advancing steps of altered bolus volume (load) and consistency -emphasize "swallow hard and fast" -treatment sessions: 1 hr/day, 5x/week x 3 weeks=15 sessions;limited home assignments -studies showed increased/improved laryngeal and hyoid elevation, lingual-palatal pressures, FOIS score, and oral and pharyngeal temporal events
question
SWALLOWING TREATMENT PROGRAMS: Lee Silverman Voice Treatment (LSVT)
answer
-five essential concepts: 1. voice (think loud/think fast) 2. high effort 3. intensive treatment 4. calibration 5. quantification -treatment sessions: 1 hr/day therapy, 4x/week x 4 weeks = 16 sessions; limited home assignments -to improve lingual motility, quicker swallow, and reduce vallecular residue (safer swallow) -no change in penetration
question
MEDICAL INTERVENTION: Vocal Fold Paralysis: 1. Vocal fold medialization: Paralyzed vocal fold
answer
-vocal fold injection -thyroplasty and/or arytenoid adduction -patient is still able to swallow, therefore surgery is for voice
question
MEDICAL INTERVENTION: Vocal Fold Paralysis: 2. Nerve-to-muscle pedicle
answer
-transferred from the omohyoid muscle to the paralyzed posterior cricoarytenoid -inspiratory activity of the omohyoideus mediated by the ansa hypoglossal results in phasic VF abduction (increasing VF opening) which may be adequate to allow increased ventilation and at the same time protect the airway against aspiration (from Lu)
question
MEDICAL INTERVENTION: Cricopharyngeal Dysfunction: 1. Crocopharyngeal myotomy
answer
-cut slit into cricopharyngeus muscle to relax muscle
question
MEDICAL INTERVENTION: Cricopharyngeal Dysfunction: 2. Cricopharyngeal dilation
answer
-insert tube through mouth to cricopharyngeal opening (in trachea) to widen the cricopharyngeal area
question
MEDICAL INTERVENTION: Cricopharyngeal Dysfunction: 3. Botox
answer
-inject to weaken the muscle -difficult to reach the muscle
question
MEDICAL INTERVENTION: Oral/Velopharyngeal deficits: 1. Palatal lift
answer
-Lifting palate into elevated position -prevents nasal regurgitation
question
MEDICAL INTERVENTION: Oral/Velopharyngeal deficits: 2. Palatal Obturator
answer
-obturating surgical defect, fistula, or cleft palate (closes defect)
question
MEDICAL INTERVENTION: Oral/Velopharyngeal deficits: 3. Palatal Augmentation (lowering/reshaping) prosthesis
answer
-improving tongue-palate contact (makes upper denture thicker)
question
ALTERNATIVE FEEDING: 1. Decision making parameters
answer
-time taken to swallow a single bolus: 10 seconds of oropharyngeal transit -aspiration: 10% of every bolus
question
ALTERNATIVE FEEDING: 2. Rationale for oral/nonoral feeding
answer
-complete oral feeding if - (1) no aspiration (2) oropharyngeal transit times 10 secs or less -oral feeding plus nonoral supplement if - (1) no aspiration, (2) oropharyngeal transit times more than 10 secs -complete nonoral feeding if - aspiration on all foods regardless of intervention
question
ALTERNATIVE FEEDING: 3. Alternative feeding
answer
-nasogastric tube (temporary) -PEG (Percutaneous endoscopic gastrostomy) (goes through stomach) -Pharyngoesophagostomy -Jejunostomy (goes through big intestine, used if patient has GERD)
question
CASE: A male patient who suffered from a cervical spine injury and is now wearing a Halo neck brace, which keeps his head secured in a level, forward facing position. he demonstrates markedly reduced laryngeal elevation due to fixed head/neck positions. What treatment approaches could improve his laryngeal elevation?
answer
Effortful pitch glide
question
CASE: A male patient who underwent a left hemilaryngectomy due to laryngeal cancer. He exhibits obvious signs of aspiration with liquids. What are treatment approaches that could reinforce airway protection during liquid swallowing?
answer
-modified diet (avoid thin liquid in beginning) -Head turn to left , chin tuck -super-supraglottic -lateral press of left thyroid cartilage
question
QUIZ: The liquid diet should be AVOIDED for which condition?
answer
Poor laryngeal closure
question
QUIZ: Foods of thicker consistency, such as puree or soft chewable items, are appropriate for which condition?
answer
-Poor airway protection -delayed swallowing reflex
question
QUIZ: Which taste could best facilitate the triggering of swallowing response?
answer
Sour
question
QUIZ: Tilting the head to the right side is appropriate for which condition?
answer
Left facial weakness
question
QUIZ: Placing foods on the right side of the mouth is most appropriate for which condition?
answer
Left lingual paralysis
question
QUIZ: Which compensatory strategy should NOT be recommended for patients with delayed swallowing reflexes?
answer
head tip-back posture
question
QUIZ: Using the chin tuck posture to prevent aspiration is based on what rationale?
answer
-This posture places the epiglottis in a more overhanging position in relation to the airway -The posture widens the valleculae to prevent bolus from entering the airway ALSO: -pushes tongue base backward toward the pharyngeal wall
question
QUIZ: Which physiological change is a result of the head-turning posture?
answer
-Pyriform sinus is closed on one said that in turn redirects foods to the stronger side of the pharynx ALSO: -increase pressure on thyroid cartilage to improve VF adduction -places epiglottis in a protective position to narrow laryngeal entrance
