Swallowing

Helpfulness: +2
Set Details Share
created 8 years ago by tracey_brown4238
33 views
updated 7 years ago by tracey_brown4238
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

5 reasons clts cant feed

poor ROM
poor strength
poor vision
cognitive difficulties (decreased mental)
eye hand coordination

2

5 reasons clts cant eat

poor sucking
impared lip closure
difficult chewing
abdnormal reflex
impaired swallowing ability

3

Systems involved in swallowing

musculoskeletal
sensory
digestive
CNS
visual

4

Stages of eating/feeding

pre-oral
oral
Pharangeal
esophogeal

5

Feeding ADL

looking, reaching for food
Salivation
Jaw openning
Lips closing: muscles

6

Eating ADL

ability to keep & manipulate food/fluid in mouth and swallow

7

What to look for in eval

alertness & posture
poor oral motor control
inadequate oral intake
Oral phase-
Drooling, food pockets, particles on tonge,
difficult intiating swallowing
decrease jaw movement
Coughing up food
Tongue thrust

8

Shaker head lift

Neck strengthening exercise

9

Masako

tongue exercise

10

Medelsohn manuver

Larynx exercise

11

Mendelsohn, Masako, Shaker Head lift

Swallowing maneuvers

12

Swallowing maneuvers

increase swallow safety : decrease symptoms (aspiration) BUT do not change the physiology

13

Correct posture to inhibit impaired oral transit

Head back - utilizes gravity to clear oral cavity

14

Correct posture to inhibit delayed triggering of pharyngeal swallow

Chin down- widens valleculae to prevent bolus from entering airway
Narrows airway entrance
Pushes epiglottis posteriorly

15

Correct posture to inhibit residue valleculae after swallow

Chin down- widens valleculae to prevent bolus from entering airway
Narrows airway entrance
Pushes epiglottis posteriorly

16

Correct posture to inhibit reduced laryngeal closure

Chin down- widens valleculae to prevent bolus from entering airway
Narrows airway entrance
Pushes epiglottis posteriorly

17

Correct posture to inhibit reduced pharyngeal contraction (residue in pharynx)

Lying down on side- Eliminates gravitational effects in pharynx

18

Correct posture to inhibit unilateral oral & pharyngeal weakness

Head tilt to stronger side- directs bolus down stronger side

19

Correct posture to inhibit Cricopharyngeal dysfunction ( residue in pyriform sinuses)

Head rotated- Pulls cricoid carilage away form posterior pharyngeal wall, reducing resting pressure in cricopharyngeal sphincter

20

Correct positioning

firm surface, feet flat on floor, 90* knees, symmetric body weight distribution @ hips, trunk flexedd slightly forward w/ back straight, arms forward on table top, head erect in midline, w/ chin slightly tucked.

21

Side hold position

max to moderate assist

22

Front hold position

min assit

23

First liquid level (best oral skills)

Thin: Water, ice, chips, coffee, ice cream, fruit juices

24

2nd liquid level

Nectar like- Extra thick milkshake/eggnog, strained cream soup, yogurt&milk blended, v-8 juice

25

3rd liquid level

honey-like - Nectar thickened w/ banana or pureed w/ fruit, regular applesauce w/ juice, Eggnogg w/ baby cereal, cream soup w/ mash potatoes

26

4th level

Spoon thick - commercial thickener

27

Dysphagia diet

uniform in consistency & texture
provide sufficient density and volume
Remain cohesive
Proide plesant taste & temperature
Easily removed or suctioned w/ necessary

28

Contraindicated for dysphagia diets

Multiple textures,
Fibrous/stringy vegetables, meats or fruits
Crumbly/flaky foods
foods that liquefy
Foods w/ skin or seeds

29

Dysphagia: After eating a pt should

remain upright for 16-30 min.

30

Dysphagia:To assist w/ pt leaning to one side or w/ difficulties w/ head control

assist in holding correct position & head control
Provide perceptual boundary, may use lateral trunk support
Adjust hips to pt leans forward (100* hip flexion)

31

Dysphagia: What to do if a pt leans to one side

Facilitate trunk strength
Exercise@ mid line,
have client clasp hands, lean down, & touch foot, middle, and other foot
Rotate trunk w/ hands clasped & shoulders flexed to decrease or normalize tone.

32

Dysphagia: What to do if pt can't hold head in midline or move head

Increase tone- neck / head exercises in flexion
Rotate trunk w/ hands clasped & shoulders flexed to decrease or normalize tone.
myofascial realese
Soft tissue mobiization

33

Dysphagia: To assist pt w/ UE difficulties

Guide pt through correct movement pattern,
Provide adaptive equipment As needed

34

Dysphagia: What to do if a pt has decreased UE tone

Facilitate- weight bearing, sweeping, tapping muscle belly of appropriate muscles
strengthening exercises,

35

Dysphagia: What to do if a pt has increased UE tone

scapula mobilization, weight bearing through arem

36

What to do if pt has drooling or food spillage from mouth

Place wet tongue blade between lips & have client hold it there while OT tries to pull it out
Vibrate lips w/ back of electric toothbrush
Lip exercises 2-3X daily
Blow bubbles w/ straw or liquid bubbles
Decreased sensation- fan lips so client feels drool.