Behavioral Therapies
What are three behavioral therapies widely accepted in clinical practice?
Shaker exercise
Tongue strengthening
Masako maneuver
EMST
Transcutaneous e-stim
Effortful pitch glide
What is an effortful pitch glide? What is its target?
The client phonates on a low-to-high pitch glide with effort, elevating the arytenoids/larynx and constricting the pharynx.
Target = improve pharyngeal constriction, reduce residue, improved laryngeal elevation (for swallowing safety)
What are facilitative maneuvers?
Physiologic postures or gestures that have been shown to improve swallowing safety or efficiency
Clients need to be counseled about the ___________ orf surgery so that their expectations will be realistic.
Name two instrumental outcomes that can be used as outcome measures.
VFSS, FEES
What is EMST? What is it and what is its purpose?
EMST = Expiratory Muscle Strength Training
It is a calibrated, one-way loaded spring valve designed to exercise the expiratory muscles by allowing air to flow through the device once the client produces enough air flow to open the valve.
T/F: Masako maneuver can be done with a bolus.
False!
What is an effortful swallow? What is its physiological target?
The client swallows as hard as possible, engaging muscles of the throat.
Target = Post-swallow residue, poor pharyngeal constriction, poor base of tongue to posterior pharyngeal wall constriction
List three common anatomical corrections and/or reconstructions.
Lips
Tongue
Palate
VF augmentation
VF medialization
Name two scales associated with the measurement of residue.
Normalized residue ratio scale
Yale pharyngeal residue severity rating scale
What is the Masako Maneuver? What is its physiological target and desired outcome?
Swallow in which the client holds their tongue between their teeth during the swallow. It is intended for those with poor tongue to posterior pharyngeal wall contact.
Goal = to improve bolus driving forces and to reduce post-swallow residue
What can be used for tongue strengthening in the absence of an IOPE (Iowa Oral Performance Instrument)?
Tongue depressor
What is the Mendelsohn Maneuver? What is its physiological target?
The client prolongs elevation of the larynx during swallowing.
Target = Hyolaryngeal excursion, prolong UES opening, poor pharyngeal constriction, post-swallow residue
When is a surgical treatment indicated?
If dysphagia is caused by structural or anatomical abnormalities, the clinician should consider referral for surgical correction.
Name two scales with patient-reported outcomes related to swallowing.
EAT-10
SWAL-QOL
What is the Iowa Oral Performance Instrument (IOPI)? What does it do? What does it target?
It is a device with a pressure-sensitive bulb. Its goal is to strengthen the client's tongue by providing resistance.
Targets poor bolus formation, premature spill, oral and/or pharyngeal residue, poor base of tongue to posterior pharyngeal wall contraction
What is transcutaneous electrical stim (e-stim)? What is its goal?
Use of electric current to stimulate nerves/nerve endings that innervate muscles beneath the skin
Goal = To induce muscle contraction through peripheral stimulation
What is the supraglottic swallow? What is its physiological target?
The client closes the airway prior to bolus entry into the pharynx, with the goal of keeping the airway closed for the duration of bolus transport
Target = Premature spillage, delayed swallow initiation, delayed/poor laryngeal closure
What is a cricopharyngeal bar? What is the name of the surgical treatment associated?
Failure of the cricopharyngeus muscle to relax during swallowing. Can cause difficulty with varying textures and significant post-swallow residue. Can be caused by fibrosis, GERD, neuromuscular disease.
Surgery = Myotomy (the cricopharyngeus muscle is cut)
Name three parameters we measure using instrumental outcomes.
Kinematic parameters (using VFSS)
Timing parameters (using VFSS)
MBSiMP scores (using VFSS)
Swallowing is a __________ task, but requires a '__________ _______' for safe/efficient swallowing.
submaximal, functional reserve
What are the two types of neural stimulation used as swallowing treatments?
rTMS = Repetitive Transcranial Magnetic Stimulation: Non-invasive, uses a coil to elicit small electrical currents
tDCS = Transcranial Direct Current Stimulation: low-current, delivered directly to the cortical area of interest
What is the super supraglottic swallow? What is its physiological target?
The client performs a supraglottic swallow PLUS bearing down during airway closure (like they are about to lift something heavy)
Target = Premature spillage, delayed swallow initiation, delayed/poor laryngeal closure PLUS difficulty with VF closure
What is Zenker's Diverticulum? What is the name of the surgical treatment associated?
A ballooning out of the pharyngeal wall due to high pressure, causing a pouch (diverticulum)
If small, no surgical treatment is warranted; otherwise, endoscopic stapling or fiberoptic laser
What is the DIGEST?
DIGEST = Dynamic Imaging Grade of Swallowing Toxicity
Scale with safety and efficiency scores based on specific rules. Assign with a 0 (no impairment) through 4 (severely impaired)