Dysphagia: Treatment, Ethics, & Clinical Management

Vocabulary flashcards covering major terms, interventions, ethical considerations, and clinical management concepts from the Week 9 Dysphagia lecture.

Dysphagia

Difficulty or disorder of swallowing affecting airway protection, nutrition, and hydration.

Airway Protection

Primary therapeutic concern of dysphagia management to prevent penetration and aspiration.

Evidence-Based Practice (EBP)

Integration of best research, clinical expertise, and patient values in clinical decision making.

Restorative Treatment

Interventions aimed at improving or restoring impaired swallowing physiology (e.g., strength exercises).

Compensatory Treatment

Strategies that alter bolus flow or patient posture to ensure safe swallowing without changing physiology.

Swallowing Exercises

Direct or indirect drills that strengthen weakened muscles and improve coordination of the swallow.

Motor Learning

Practice-related processes leading to relatively permanent changes in movement capability.

Labial Exercises

Resistance or range-of-motion tasks to improve lip strength and seal during swallowing.

Tongue Exercises

Resistance, ROM, or IOPI-based drills that enhance bolus control and propulsion.

Masako (Tongue-Hold)

Base-of-tongue exercise where patient swallows with tongue gently held between teeth.

Shaker Exercise

Head-lift task to strengthen suprahyoid muscles and increase UES opening.

Pitch Glide

High-to-low phonation used as a laryngeal elevation exercise.

Effortful Swallow

Volitional maneuver instructing patient to squeeze hard during swallow to improve pharyngeal clearance.

Supraglottic Swallow

Maneuver combining breath-hold, swallow, cough, and re-swallow to protect airway.

Super-Supraglottic Swallow

Supraglottic swallow plus bearing down to increase airway entrance closure.

Mendelsohn Maneuver

Prolonged laryngeal elevation during swallow to enhance UES opening.

Neuromuscular Electrical Stimulation (VitalStim)

FDA-approved modality that delivers surface electrical current to stimulate swallowing musculature.

Expiratory Muscle Strength Training (EMST)

Respiratory exercise using pressure threshold device to strengthen expiratory and airway-protective muscles.

Inspiratory Muscle Strength Training (IMST)

Program targeting inspiratory muscles to support swallowing and respiratory function.

Biofeedback (sEMG)

Real-time display of muscle activity used to guide and measure swallowing exercises.

Maneuvers

Volitional changes in timing/force of swallow used as exercise and/or compensatory strategy.

Postural Changes

Head or body adjustments (e.g., chin tuck, head turn) that redirect bolus flow and protect airway.

Chin Tuck

Head-down posture widening valleculae and narrowing airway entrance to reduce aspiration risk.

Head Turn

Rotation toward or away from damaged side to direct bolus to stronger hemipharynx or decrease UES pressure.

Sensory Enhancement

Use of taste, temperature, or pressure stimuli to trigger oromotor response or pharyngeal swallow.

Thermal-Tactile Stimulation

Cold mirror strokes to anterior faucial pillars to reduce swallow delay.

National Dysphagia Diet (NDD)

2002 U.S. framework defining four levels of solid textures and four liquid viscosities.

International Dysphagia Diet Standardisation Initiative (IDDSI)

Global 2012 effort that standardized terminology and testing for dysphagia foods and liquids (Levels 0-7).

Thin Liquid

IDDSI Level 0; flows like water (1-50 cP).

Nectar-Like Liquid

Moderately thick liquid (51-350 cP) that pours in a continuous stream.

Honey-Like Liquid

IDDSI Level 3; spoon-dripping consistency (351-1750 cP).

Spoon-Thick / Pudding

IDDSI Level 4; holds shape on spoon, flows slowly if at all (>1750 cP).

Free Water Protocol

Guideline allowing known aspirators to drink water under strict oral care and timing rules.

Alternative Nutrition

Non-oral feeding methods such as NG tube, G-tube/PEG, J-tube, or intravenous TPN.

Nasogastric (NG) Tube

Short-term feeding tube placed through nose into stomach.

Gastrostomy Tube (G-tube/PEG)

Long-term feeding tube inserted directly into stomach through abdominal wall.

Jejunostomy Tube (J-tube)

Feeding tube placed into the jejunum for patients with gastric intolerance.

Total Parenteral Nutrition (TPN)

IV delivery of nutrients when gastrointestinal tract cannot be used.

Oral Care

Mechanical and chemical cleaning that reduces biofilm and pneumonia risk in dysphagia patients.

Competence

Having necessary knowledge, skills, and ability to provide safe, effective services.

ASHA Code of Ethics

Guiding document outlining SLPs’ duties of welfare, competence, integrity, and professional dignity.

Autonomy

Ethical principle respecting a person’s right to make their own health decisions.

Beneficence

Ethical obligation to act for the patient’s good.

Nonmaleficence

Ethical duty to do no harm.

Justice

Ethical mandate to treat individuals fairly and equitably.

Malpractice

Negligent or improper professional actions causing patient harm; basis for liability claims.

Advance Directive

Legal document (living will, durable POA) that specifies medical wishes if patient loses capacity.

Shared Decision Making

Collaborative process where clinicians and patients integrate preferences, evidence, and goals to choose care.

Comfort Feeding

Hand feeding focused on pleasure and quality of life rather than nutritional goals, common in advanced dementia.

Standard of Care

Level of caution and skill a reasonably prudent clinician would provide in similar circumstances.

Skilled Service

Intervention requiring SLP’s expertise, judgment, and cannot be performed safely by untrained personnel.

Documentation

Timely, accurate, and code-able record of assessment, treatment, education, and patient response.