WCU SLP 532 Final Study Guide

Feeding disorder

Inappropriate development of oral intake and its associated medical, nutritional, and psychosocial consequences

Swallowing Impairment

Related to problems with deglutition

Deglutition

Semi-Automatic motor action of the muscles of the respiratory and GI tracts that propels food from the oral cavity into the stomach

Swallowing

The entire act of deglutition, from the placement of food and liquid into the mouth until they enter the upper esophagus; includes sucking, chewing, and swallowing

Dysphagia

A swallowing deficit

Oral sensorimotor

All aspects of motor and sensory function in of structures in the oral cavity and pharynx from lips until the onset of the pharyngeal phase

Nutrition

Process by which all living organisms obtain the food and nourishment necessary to sustain life and support growth

Feeding

The act of supplying food and nourishment

Jaw Thrust

Most common with hypertonicity, Sudden forceful jaw opening or exaggerated up- and - down movements

Jaw Thrust Intervention

Mouth play with child's fingers, Assisted toothbrush, sustained jaw closer by having child hold cloth or object between teeth

Jaw Retraction

Most common with hypertonicity, limited range of movement

Jaw retraction intervention

Prone positioning during feeding for gravity to enable tongue and jaw to move into a more forward position, place hand under child's jaw slight pull forward to enlarge airway.

Jaw clenching

Hypotonicity, Likely related to postural instability and low tone in the trunk

Jaw Clenching Intervention

Use fingers to gradually open the jaw, Replace with measurable mouth play

Jaw Instability

Hypotonic, Shift of the jaw to one side or forward

Jaw Instability Intervention

Place the middle finger under the chin and the index finger between the chin and lower lip

Tongue Retraction

Child may press the tongue against the hard palate for stability or to prevent the tongue from obstructing the airway

Tongue Retraction Intervention

Rhythmic stroking of the tongue with a finger, moving from mid tongue to front (one stroke per second)

Tongue Deviation

Observed when child protrudes tongue and when child manipulates in the mouth

Tongue Deviation Intervention

Stimulation of the less active side of the tongue via finger, toothbrush or toys

Tongue Thrust

Tongue moves forward beyond the border of the gums and may protrude between the lips

Tongue Thrust Intervention

Create firm and gentle downward press on the middle of the tongue with a spoon to help activate a downward movement of the upper lip to assist lip closure around the spoon

Tonic Bite

Jaw moves upward into a clenched position on presentation of a feeding utensil (e.g., nipple, spoon) into the mouth when contact is made to the biting surfaces of the side gums or teeth

Tonic Bite intervention

Apply pressure with a finger to the temporomandibular joint on both sides of the face

Autonomy

Self-determination and the individual's ability to make reasoned, informed decisions about factors affecting their health care. Parents/caregivers assume autonomy over infants and children

Beneficence

Benefit only. Taking positive and direct steps to help others. Balances the costs or risks of treatment with the benefits

Nonmaleficence

Avoiding the causation of harm or inflicting the least harm possible to reach a beneficial outcome

Justice

The element of fairness in all medical decisions and fair distribution of healthcare resources, including equal distribution of scarce resources and new treatments (distributive justice)

Clinical expertise/expert opinion

The knowledge, judgment, and critical reasoning acquired through your training and professional experiences

Evidence (external and internal)

The best available information gathered from the scientific literature (external evidence) and from data and observations collected on your individual client (internal evidence)

Client/patient/caregiver perspectives

The unique set of personal and cultural circumstances, values, priorities, and expectations identified by your client and their caregivers

Bioethics

The multidisciplinary application of ethics to medicine and health care

Clinical ethics

The professional behaviors (code of ethics) for each discipline and to clinical care decisions (e.g., ASHA's Code of Ethics)

Organizational ethics

An organization's definition of its core values and mission, identification of value conflicts, and solution for resolution of conflicts

P

Refers to the patient or population or problem and the characteristics of disease process of interest

I

Intervention that the therapist plans to expose the patient to

C

Comparison to the alternate intervention strategies to the one chosen

O

Refers to the relevant outcomes following the chosen intervention

Multidisciplinary Rehabilitation Treatment Taxonomy (RTT)

Theory-driven approach to formulate hypotheses about how treatments are supposed to work and then organizes treatment based on inductive or bottom-up definitions of treatment activities

The target

What is expected to change because of treatment; measurable

Mechanism of action

How the treatment is hypothesized to work; inferred

Ingredients

The specific actions taken by the clinician to effect changes in the target (e.g., direct treatment, indirect treatment, prevention)

Direct treatment

More hands-on targeted intervention to the oral mechanism itself

Indirect treatment

More hands-on modifications to the environment or what happens during mealtimes

Drooling (sialorrhea)

Abnormal and unintentional spillage of saliva from the mouth

Compensatory Intervention Strategies

Alter the food and fluid bolus or the environment to aid in safe oral intake. Do not require active participation of the child

Habilitative/Rehabilitative Intervention Strategies

Aimed at altering swallowing physiology. May not be appropriate for infants, young children, or those with developmental disorders due to their inability to follow directions

Xerostomia

Dry mouth or poor saliva production

Anterior drooling

Spillage of saliva or oral contents onto the face or clothing

Posterior drooling

Saliva that spills from the mouth into the hypopharnx that can enter trachea and cause aspiration and pulmonary consequences

Abnormal drooling

Salivary incompetence, sialorrhea, hypersalivation and ptyalism

3 primary glands that produce saliva

Submandibular gland, sublingual gland, parotid gland

3 functions of saliva

1. Facilitates chewing and swallowing as well as initiating the enzymatic breakdown of proteins and carbs in the process of digestion 2. Provides protection from dental disease and oral infections as well as decreasing breath odor 3. Enables ease of movement of the tongue and lips for proper articulation

Craniofacial anomalies

Congenital malformations of the soft tissue and skeleton of the face

Common complex syndromic conditions that may result in craniofacial anomalies

Deletion syndrome, craniofacial microsomia, pierre robinson sequence, CHARGE syndrome, Moebius syndrome

Oral Prep Phase

Getting food into the mouth and forming a bolus

Oral Transit Phase

The tongue pushes on the hard palate and drops in the back to allow food to fall toward the back of the mouth soft palate starts to lift

pharyngeal phase

pharyngeal constrictors begin pushing food down UES opens elevation, excursion, and epiglottis flips down

esophageal phase

UES open and then closes, Peristalsis wave pushes food down, LES opens then closes