Compensatory Strats
All compensatory treatments are meant to be done during this.
What is mealtime?
This is the purpose of restorative treatments. (like a definition)
What is improving the sensorimotor control systems involved in the physiology of a swallow?
This suffix refers to surgical removal of tissues specified by the prefix.
What is "ectomy"?
In babies, this body part is larger to minimize the need for coordination of bolus control and to allow for easier latching.
Your client has experienced a stroke and is diagnosed with pharyngeal dysphagia. They have also been diagnosed with non-fluent aphasia and a mild cognitive impairment. Dysphagia symptoms include pharyngeal residue on the left side and reduced hyolaryngeal elevation.
Name one compensatory and one restorative strategy you would use along with rationale.
- effortful swallow
- shaker
- Mendelsohn with visuals
- head turn to the left side
- head tilt to the right side
The rationale for this treatment is that it keeps the larynx lifted and therefore protected for longer.
What is the Mendelsohn maneuver?
This excercise produces a change in muscle tone without the change in length of the muscle.
What is an isometric exercise?
This type of swallowing disorder occurs when high energy x-rays used to treat HNC leads to fibrosis of the swallowing muscles.
What is radiation-induced dysphagia?
Adults have voluntary mastication and involuntary pharyngeal trigger, pharyngeal phase, and esophageal phase. In neonates, all phases are this.
What is involuntary?
Create a goal for reduced base of tongue retraction.
The client will independently complete the Masako maneuver (10 repetitions, 3x/day) to improve retraction of the base of tongue.
DOUBLE JEOPARDY!!!!!! Answer both, get double points
Head tilt to the _____________. (1)
Head turn to the ____________. (2)
What is strong side (1) and weak side (2)?
This excercise works on the retraction/range of motion of the back of the tongue.
What is the masako maneuver?
This screening tool is used to determine the need for an instrumental swallowing assessment specifically in patients with HNC.
(extra 100 points if you can tell me what the acronym stands for)
What is Mann Assessment of Swallowing Ability - Cancer (MASA-C)?
The normal ratio for sucking-swallowing-breathing coordination. (two possible correct answers)
What is 1:1:1 OR 2:2:1?
You are seeing a 1.5 year old who has been on tube feed since birth due to premature birth. OSM therapy has been implemented and the client is eating 10 different foods by mouth. They're swallowing safely, have improved their oral skills, and have adequate nutrition. The parent is still worried and does not want to discontinue services. This is the decision you make.
Continue therapy until parent reports satisfaction/comfortability with child's feeding and swallowing abilities.
**Remember each case is different, so it's okay to disagree with my answer as long as you provide rationale**
This diet modification is defined as cohesive and mixed with lots of sauce or dressing, but still requires some chewing.
100 extra points if you can draw the IDDSI symbol (including the number) for this diet mod.
What is minced and moist?
**down-turned orange triangle, number 5**
This exercise is implemented when weak pharyngeal contraction and pharyngeal residue are indicated.
What is the effortful swallow?
Compensatory strategies for this HNC dysphagia symptom include use of flavored gum or a water spritzer bottle and increase frequency of liquid use during mealtime.
Double points if you can name what the symptom results from.
What are mucosal and muscle changes?
What is radiation therapy?
Symptoms of dysphagia in babies in the pharyngeal phase. (Name at least 4.)
What is poor suck-swallow-breath coordination, wet-gurgly breathing, cough, penetration/aspiration, delayed trigger, pharyngeal residue?
Client is currently on a PO diet. Their VFSS shows the following observations:
thin liquid: Aspiration PA scale 6 on 3/5 trials, no residue
mildly thick liquid: Pentration PA scale 2 on 2/5 trials, mild right vallecula residue
puree: no penetration or aspiration. moderate right vallecula residue later cleared
solid: no aspiration, no oral residue, moderate right vallecula residue later cleared, increased pharyngeal transit time
What liquid and solid diet would you recommend for this patient? Provide reasoning.
Continue PO diet, temporary use of moderately thick liquids, continuation of regular solid foods with liquid present OR compensatory strategies to clear residue
This protocol indicates that all patients are entitled to access to water by mouth due to the indication that it is safer to aspirate a clean thin liquid than any liquid through an unclean mouth.
What is the Frazier/Free Water Protocol?
This technique is used to enhance the patient's ability to sense temperature.
What is thermal-tactile stimulation?
These exercises are preventative, used to promote swallowing ability, and used to improve quality of life before and during chemotherapy or radiation therapy.
This treatment is used to modify a baby's current oral motor skills and sensory processing abilities for eating and drinking and to achieve maximum functional capacity.
What is Oral Sensory Motor Therapy (OSM)?
A 60 y/o had a brainstem stroke 2 months ago and is NPO, receiving all nutrition by PEG tube.He is anxious about the possibility of aspiration but is motivated to initiate oral feeding. Frazier water protocol has been followed in the assisted living facility and the nurse reports minimal signs of aspiration when sipping water from a cup. Endoscopic evaluation revealed slight paresis of left vocal fold and left pharynx. Fluoroscopic evaluation revealed incomplete swallow attempts with limited hyolaryngeal excursion, limited opening of UES (only small amount of bolus entered esophagus), post swallow mild pharyngeal residue for thicker materials, and inconsistent aspiration with thin liquids. He demonstrated strong reactive cough to the aspiration and the ability to clear residue back into his mouth, which was spat out.
Make one compensatory goal and one rehabilitative/restortative goal.
**just examples**
The client will complete the Mendelsohn maneuver as a compensatory strategy 100% of the time to reduce the risk of aspiration with thin liquids, given 25% verbal reminders.
The client will independently complete effortful swallows a rehabilitative exercise (30 repetitions, 3x/day) to improve pharyngeal strength and contraction.