Feeding and Swallowing Quiz #3 NEW

Pharyngeal stripping wave consists of=

Pharyngeal constrictor muscles:

-superior pharyngeal constrictor

-middle pharyngeal constrictor

-inferior pharyngeal constrictor (thyro/cricopharyngeus)

Superior pharyngeal is parallel w/

oral cavity

Pharyngeal stripping wave function

generate pressure and push the bolus down

Two divisions of tongue muscle

extrinsic/ intrinsic

Extrinsic tongue muscles list

palatoglossus, genioglossus, hyoglossus, styloglossus

Palatoglossus

Origin: palate

Insertion: tongue

Innervation: CN X

Action: tongue elevation

Genioglossus

Origin: mandible

Insertion: tongue

Innervation: CN XII

Action: tongue protrusion

Hyoglossus

Origin: thyroid

Insertion: tongue

Innervation: CN XII

Action: tongue depression

Styloglossus

Origin: styloid process

Insertion: tongue

CN: XII

Action: Posterior tongue movement

Intrinsic tongue muscles list

transverse, vertical, inferior longitudinal, superior longitudinal

Transverse

Origin: tongue

Insertion: tongue

Innervation: CNXII

Action: tongue shaping

vertical

Origin: tongue

Insertion: tongue

Innervation: CNXII

Action:tongue shaping

inferior longitudinal

Origin: tongue

Insertion: tongue

Innervation: CNXI

Action: tongue shaping

superior longitudinal

Origin: tongue

Insertion: tongue

Innervation: CNXII

Action: tongue shaping

extrinsic

origin outside of structure

intrinsic

origin and insertion on the structure

What do you do as a speech therapist (swallowing)

-evaluation and treatment of people with swallowing problems

-behavior modification

-improve quality of life

-swallow studies

First main evaluation of swallowing

-Clinical swallowing evaluation

-start here before instruments

-aka "bedside swallowing eval"

Who can do a clinical swallowing evaluation?

Any TRAINED medical professional

-NOT just an SLP

Screenings characteristics

quick, cost effective, minimally invasive, pass/fail, determine next step NOT diagnosis

Screening definition

Refer to minimally invasive eval. procedure that provides quick determination of

-likelihood of dysphagia

-referral for further assessment

-safe to feed orally?

-nutrition/hydration support

NPO

nil per os (nothing by mouth)

Can we skip screening?

Medical hx can allow you to skip screening but NEVER CSE

Types of screening

questionnaire, med history review, gag reflex, overt difficulty, OME, swallowing trials, voice quality, pulse ox,

Sensitivity

ability to correctly identify who HAS dysphagia

specificity

ability to correctly identify who DOES NOT have dysphagia

Common current screenings

-The Massachusetts General Hospital- Swallow Screening Tool (MGH-SST)

-TOR-BSST Toronto Bedside Swallowing Screening Test

-YALE Swallow Protocol

MGH-SST

-flow chart

-originally for stroke patients

TOR-BSST

-bedside

-20 to 30 mins to administer... a long time

YALE Swallow test

water protocol

-most common

Next step after screening

Clinical Swallow Evaluation

CSE steps long

1. Slp order

2. chart review

3. patient interview

4. Oral mech/ CN exam

5. Oral trials

6. decision making

7. further eval?

Oral trials order

1.saliva (one of the safest ways),

2.ice chip,

3.thin liquid (spoon then cup then straw),

4.apple sauce/pudding- spoon (8-12 spoons)

5.soft solid as needed,

6.graham cracker/regular solids as needed

Assessing solids

assess chews, duration, look for residue, are they asking for water to get it down?

CSE can decide

-NPO, modify diet (could be for solids or liquids), more thorough evaluation, compensatory strategies, continue regular diet, thickened liquids, etc.

sign

what you observe- objective

symptom

what the patient describes- subjective

Summarized CSE steps

1. Comprehensive medical

history

2. Oral Mech examination

3. Cranial Nerve

examination

4. Assessment of food

intake

Medical history qualities

-extensive

-patient, family member, healthcare worker, dysphagia questionnaire

common self-assessment tools

EAT-10, SWAL-QUOL, SSQ, DegHI, DHI, M.D Anderson Dysphagia Inventory

Medical history should include

-past and current medical history

-previous swallowing assessment

-socioculture status

-medications

-advance directives

In your mind while doing a medical hx...

-form hypotheses

-neurological, structural, systemic, iatrogenic, psychogenic

general observations to gather

outside room, entering room, posture, suctioning, tracheostomy, coughing/ throat clear , mental status, nutritional status, respiratory status

Mental status exam

alertness, orientation, place, time, situation

orientation

-two identifiers

-name, DOB

place

where are you now, where are you from

time

day, time of day, time of year

situation

what happened to you, why are you here

Respiratory rate

generally 10-20 within functional limits

SpO2

oxygen saturation... around 100ish is normal

NG tube

nasogastric tube

G tube

gastrostomy tube

-surgical procedure

Duotube (aka nasoduodenal tube)

yellow tube from nose to duodenum

NJ tube

nasojejunal tube

PEG tube

percutaneous endoscopic gastrostomy tube

-endoscopic

J tube

jejunum tube

-surgical procedure

Who can recommend tube feeding

dietician, gastroenterologist, NOT SLP!!!!!!!!!

-SLP can ask Dr. to consider, but NOT recommend

Mealtime observations

resistance to eating or drinking, increased time taken to consume meal, change in taste, difficulty swallowing foods of specific texture, complaints of food stuck in throat, oral residue, swallow patterns vary, coughing, wet vocal quality

observe cranial nerves

at rest, actively, passivel, against resistence

4 characteristics of movement

symmetry, strength, range of motion, coordination

AMR and SMR

alternating motion rates and sequential motion rates

alternating motion rate

p-p-p-p, t-t-t-t, k-k-k-k

sequential motion rate

p-t-k p-t-k p-t-k p-t-k

DDK tasks

Diadochokinetic tasks assessing rapid speech movements

compensatory strategies (if client can't tolerate regular solids and thin liquids)

hard swallow, alternate thin and solid, chin tuck, head turn, etc.