Infants
What are some strategies to support successful infant feeding?
Chin/lower lip support, stimulation, positioning, nipple choice and placement, viscosity
What maneuver would you recommend for someone with decreased peristalsis?
Effortful swallow
What are two exercises that strengthen the muscles that lift the hyoid to pull open the UES and help bolus move through the upper esophagus
What is Shaker (sha-kur) exercise and Chin Tuck against resistance (CTAR)
Patient presents with pharyngeal stage dysphagia characterized by swallow delay/neurosensory deficits and posterior escape of the bolus resulting in _________ so I recommend __________.
Penetration/aspiration before the swallow
chin tuck, supraglottic swallow, super-supraglottic swallow, vocal quality check
A patient with a trach tube is most likely to aspirate on what consistency?
What is thin liquids
List some exercises and/or strategies for a baby who is unable to extract liquid from the nipple.
oral motor exercises to improve suck
gloved finger to get them to practice sucking
Warm up oral cavity
use a cross cut nipple to allow more flow
What maneuver would you recommend for someone who is having airway closure problems?
What compensatory strategies would you recommend for them as well?
Maneuver: Supraglottic swallow or Super-supraglottic swallow
Comp Strat: chin tuck
*Will also accept head turn if it was noted patient had unilateral weakness
Name 4 maneuvers that can be done with a patient while eating.
1. Effortful/Hard Swallow / Valsalva Maneuver
2. Supraglottic Swallow
3. Super-supraglottic swallow
4. Mendelsohn Maneuver
Patient presents with oral stage dysphagia characterized by tongue weakness/incoordination and decreased sensation resulting in ________ so I recommend ________
Neck extension
Place bolus on strong side
modify bolus size
slurp and swallow
What are the CNs involved in swallowing? (all of them)
I, V, VII, IX, X, XI, XII
List some exercises and/or strategies for a child who is losing formula out of their mouth.
NUK brush to increase oral motor stimulation and control
Smaller nipple
Slower rate
positioning
jaw and cheek support
increase lip strength
Recs for Buccal Pocketing?
liquid wash
lingual or finger sweep
multiple swallows
What is a postural change that could be used as a treatment strategy to eliminate aspiration in a left CVA w/ unilateral pharyngeal paresis?
What is a head turn to the left
Describe thermal stimulation and when/why/with who would you use it?
Use:for swallow delay
How: Apply cold and sour material to faucial arches or eat cold/sour bolus after mastication of primary bolus
Why: cold and sour material is most easily sense and is most likely to trigger swallow if normal bolus does not
How do you determine the "weaker side" in a patient?
drooping or paralysis
tongue/oral movement
lack of rotary chew
medical record diagnosis
List some exercises and/or strategies for a child who has naso-pharyngeal reflux
positioning, slower rate, changing texture of food
Delayed swallow reflex?
thick liquids
Puree?
Easy to manipulate and ready to swallow as soon as it hits faucial pillars
Patient has pre-mature spilling that comes from poor lingual functioning, what do you recommend?
Puree (need food that will not move too quickly in the PL phase of swallow prior to being ready, will go down as a whole)
plus comp and rehab strategies..... neck extension?
IOPI bulb exercise?
Patient has decreased pressure generation for bolus propulsion, what rehabilitation exercise(s) could you recommend to increase muscle strength?
Neuromuscular Electrical Stimulation (NMES) (e.g. VitalStim)
The primary reason swallowing function is altered when a trach tube is placed is due to a change in what??
What is subglottic pressure
List some exercises and/or strategies for a child with aspiration BEFORE the swallow
oral sensory stim
thicker liquids to allow for more time during transit
Describe the Mendelsohn Maneuver
mid swallow hold, keep hyoid suspended for 2 secs
What are two examples of swallowing motor exercises?
McNeil Dysphagia Therapy Program (MDTP)
Iowa Oral Performance Instrument (IOPI)
Madison Oral Strengthening Therapeutic (MOST) Device
Patient has decreased tongue base retraction, what rehab exercise could you recommend?
Masako Maneuver, place tongue between teeth or on alveolar ridge and swallow (not with bolus)
Targets superior pharyngeal constrictor muscle contraction/strengthening & base of tongue retraction
Dysphagia takes its name from the greek word _______ meaning to ingest or engulf
What is phagein