Dysphagia Assessment and Management Quiz
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Questions and Answers

What symptoms might indicate dysphagia?

  • Always drinking cold liquids
  • Feeling hungry after meals
  • Frequent throat clearing without eating
  • Extra effort needed to chew or swallow (correct)

Which of the following is NOT a specific cause of dysphagia?

  • Spinal cord injury
  • Hypertension (correct)
  • Parkinson’s disease
  • Multiple sclerosis

What is the purpose of the Fiberoptic Endoscopic Evaluation of Swallowing (FEES)?

  • To evaluate taste preferences
  • To measure the effectiveness of medication
  • To assess pharyngeal and laryngeal structure during swallowing (correct)
  • To provide a static view of digestibility

What does the Modified Barium Swallow Study (MBSS) help identify?

<p>The specific site of aspiration and its causes (C)</p> Signup and view all the answers

Which of the following interventions can be used for managing dysphagia?

<p>Dietary modification by thickening liquids (B)</p> Signup and view all the answers

What could be a sign of aspiration during swallowing assessment?

<p>Delayed swallowing onset (C)</p> Signup and view all the answers

Which assessment method focuses on the airway protection during swallowing?

<p>Videofluroscopic swallowing study (B)</p> Signup and view all the answers

What does pocketing refer to in the context of dysphagia?

<p>Keeping food in the mouth without swallowing (B)</p> Signup and view all the answers

What is a potential limitation to using maneuvers for swallowing improvement?

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What role does modifying posture play in feeding therapy for children?

<p>It reduces swallowing difficulties by improving oral control. (B)</p> Signup and view all the answers

Which of the following best describes 'Flavor Mapping'?

<p>It analyzes the child's preferences to identify patterns in flavors and textures. (B)</p> Signup and view all the answers

What is the purpose of 'Flavor Masking' in feeding therapy?

<p>To cover the taste of new foods using familiar flavors. (D)</p> Signup and view all the answers

Which professional is not typically a part of the feeding team?

<p>Physical Trainer (A)</p> Signup and view all the answers

What is the main goal of using transitional foods in feeding therapy?

<p>To help children adjust to new foods by integrating them with favorites. (B)</p> Signup and view all the answers

What is the primary purpose of the supraglottic swallow technique?

<p>To close the vocal folds and protect the airway during swallowing (C)</p> Signup and view all the answers

Which of the following is NOT an example of oral-motor therapy or exercises?

<p>Swallowing food pills (C)</p> Signup and view all the answers

What characteristic distinguishes the Masako exercise from a maneuver?

<p>It focuses on improving movement and strength of the posterior pharyngeal wall. (C)</p> Signup and view all the answers

What is the primary function of a nasogastric tube (NG-tube)?

<p>To deliver non-oral nutrition for short-term use (A)</p> Signup and view all the answers

Which exercise involves lifting the head to facilitate the opening of the upper esophageal sphincter?

<p>Shaker exercise (B)</p> Signup and view all the answers

What feeding disorder is characterized by extreme food selectivity in children?

<p>Avoidant/restrictive food intake disorder (B)</p> Signup and view all the answers

Which type of tube is preferred for short-term non-oral nutrition?

<p>Nasogastric tube (NG-tube) (D)</p> Signup and view all the answers

Which of the following best describes oral hygiene in the context of swallowing therapy?

<p>It is an integral part of maintaining oral health for effective swallowing. (D)</p> Signup and view all the answers

What is a common characteristic of the active sleep state in infants?

<p>Random limb movements occur. (A)</p> Signup and view all the answers

What is the primary function of the rooting reflex in infants?

<p>To help the infant latch onto the nipple (D)</p> Signup and view all the answers

Which of the following best describes nutritive sucking compared to non-nutritive sucking?

<p>Nutritive sucking involves swallowing once followed by breathing in bursts. (C)</p> Signup and view all the answers

During an assessment, if a child is described as having an alert agitated state, which of the following is true?

<p>The child is difficult to comfort. (D)</p> Signup and view all the answers

What occurs during the tonic bite reflex?

<p>The child clamps down on teeth or gums and has difficulty releasing (D)</p> Signup and view all the answers

What is a significant indicator of feeding disorders in children?

<p>Refusal to eat different types of food. (A)</p> Signup and view all the answers

Which abnormal reflex indicates difficulty with oral feeding and manipulation?

<p>Tonic bite reflex (A)</p> Signup and view all the answers

Which of the following describes the muscle tone categories relevant to oral stability?

<p>Normal, tense, flaccid (B)</p> Signup and view all the answers

Which physiological characteristic should be noted during infant assessment?

<p>Heart rate ranges from 120-140 beats/min for both preterm and full-term infants. (B)</p> Signup and view all the answers

What best describes an infant's response during a swallow reflex assessment?

<p>The swallow reflex can be described as delayed or absent. (C)</p> Signup and view all the answers

What type of movement does the swallow reflex perform?

<p>It moves the bolus into the esophagus (A)</p> Signup and view all the answers

What might indicate oral motor weakness in a child?

<p>Poor sucking ability and oral control of the bolus (D)</p> Signup and view all the answers

Which action should be taken to assess suck strength in infants?

<p>Insert the gloved finger into the infant's mouth and assess the tongue's movement. (A)</p> Signup and view all the answers

What respiratory characteristic defines the drowsy state in infants?

<p>Eyes are partly open and smooth limb movements occur. (B)</p> Signup and view all the answers

How does a cleft palate affect sucking ability?

<p>It can create a poor labial seal leading to difficulties in sucking (C)</p> Signup and view all the answers

What is a common characteristic of jaw thrust in children?

<p>The lower jaw appears stuck open, affecting food retention (C)</p> Signup and view all the answers

What is the primary goal of the chin-tuck posture during swallowing?

<p>To redirect the movement of the bolus and narrow the airway opening. (C)</p> Signup and view all the answers

Which postural technique is primarily aimed at assisting patients with unilateral vocal paralysis?

<p>Head rotation (A)</p> Signup and view all the answers

The head tilt technique is used primarily to address which issue during swallowing?

<p>Residue on the weak side (D)</p> Signup and view all the answers

The effortful swallow method focuses on what aspect of swallowing?

<p>Increasing the posterior tongue base movement. (C)</p> Signup and view all the answers

What is a potential risk when applying postural techniques for swallowing?

<p>Excessive strain on the patient's neck muscles. (B)</p> Signup and view all the answers

What is the purpose of the Mendelsohn maneuver during swallowing?

<p>To elevate the larynx and open the esophagus. (D)</p> Signup and view all the answers

Swallowing maneuvers such as the supraglottic swallow mainly focus on what aspect of the swallowing process?

<p>Altering the strength of swallowing movements. (C)</p> Signup and view all the answers

Which of the following conditions may make postural techniques inappropriate for a patient?

<p>Severe cognitive impairment. (B)</p> Signup and view all the answers

Flashcards

Globus Sensation

A feeling of fullness in the neck, often associated with swallowing difficulties.

Dysphagia (Painful Swallowing)

Pain experienced while swallowing.

Frequent Throat Clearing

The act of clearing the throat frequently, often due to excess mucus or a feeling of something stuck in the throat.

Wet or Gurgly Voice

A change in voice quality, often described as wet or gurgly, especially during or after eating or drinking.

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Coughing During/After Eating

Coughing that occurs during or immediately after eating or drinking, often indicating a problem with swallowing.

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Difficulty Coordinating Breathing and Swallowing

The inability to coordinate the act of breathing and swallowing, leading to possible choking or aspiration.

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Effortful Chewing/Swallowing

The need for extra effort or time to chew and/or swallow food, often a sign of swallowing difficulties.

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FEES (Fiberoptic Endoscopic Evaluation of Swallowing)

A procedure that involves using a flexible scope inserted through the nose to visualize the pharynx and larynx during swallowing.

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Chin-tuck

A swallowing technique where the chin is tucked down towards the neck, narrowing the airway opening and potentially improving bolus movement.

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Chin-up posture

A swallowing technique where the head is tilted backwards, potentially improving bolus movement from the mouth.

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Head rotation (turn to the side)

A swallowing technique where the head is turned towards the weaker side, directing the bolus towards the stronger side of the pharynx.

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Head tilt

A swallowing technique where the head is tilted towards the stronger side, keeping food on the chewing surface.

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Effortful swallow

A maneuver that increases posterior tongue base movement to improve bolus clearance.

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Mendelsohn maneuver

A maneuver that elevates the larynx and opens the esophagus during swallowing, preventing food from falling into the airway.

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Swallowing maneuvers

Strategies used to change the timing or strength of swallowing movements. They may involve specific directions and might not be suitable for patients with cognitive impairments.

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Postural techniques

Techniques that involve changing body posture to improve bolus movement within the oral cavity and pharynx.

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Supraglottic Swallow

This technique aims to close the vocal folds by deliberately holding one's breath before and during swallowing. It helps protect the airway, especially in cases where vocal fold closure is delayed or incomplete.

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Masako Exercise

This exercise involves holding the tongue forward between the teeth while swallowing. It's performed without food or liquid to prevent choking and helps strengthen the muscles of the back of the throat.

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Shaker Exercise

This exercise helps open the upper esophageal sphincter. The patient lies on their back and lifts their head to look at their toes, which improves movement of the hyoid bone and larynx.

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Nasogastric Tube (NG Tube)

A thin tube that's inserted through the nose and passes into the stomach. It's used for providing nutrition when someone cannot swallow properly, especially for shorter periods.

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Gastrostomy Tube (G-tube)

A tube that's inserted through the abdomen directly into the stomach. It provides nutrition when someone can't swallow and is typically used for longer-term feeding.

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Oral-Motor Therapy

Specialized therapies that involve exercises and stimulation targeting the lips, tongue, jaw, and other muscles involved in swallowing. This helps improve muscle strength and coordination.

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Feeding Disorder in Children

A condition in children where they avoid or limit what they eat. This is often due to a dislike of specific foods or textures.

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Oral Hygiene

Often used to promote hygiene and prevent infections in patients whose ability to swallow is impaired. It's an essential aspect of overall care.

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Case History (Feeding Assessment)

A detailed account of the child's medical history, including conditions, surgeries, medications, and breathing issues.

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Alerting (Feeding Assessment)

Assessing how well an infant can prepare for and engage in feeding by observing their abilities and reactions.

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Deep Sleep (Infant Sleep Stages)

A phase of sleep with regular breathing, closed eyes, and a relaxed body.

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Active Sleep (Infant Sleep Stages)

A phase of sleep with both regular and irregular breathing, closed eyes, and random limb movements.

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Drowsy (Infant Sleep Stages)

A phase of sleep where the infant shows signs of alertness but easily falls back asleep.

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Non-Nutritive Sucking (NNS) Pattern

A pattern of sucking, swallowing, and breathing during non-nutritive sucking (e.g., sucking on a pacifier).

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Nutritive Sucking (NS) Pattern

A pattern of sucking, swallowing, and breathing during feeding.

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Swallow Reflex (Feeding Assessment)

A reflex that helps protect the airway from entering the lungs.

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Chin tuck posture

A technique where the child's chin is brought towards their chest to improve swallowing and reduce the risk of aspiration. Helps keep food from going 'down the wrong pipe' - a key concept in preventing choking.

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Food chaining

A feeding approach where the child is introduced to new foods that have similar characteristics to their preferred foods, gradually expanding their food repertoire. Helps to 'chain' new foods into acceptance.

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Flavor mapping

Flavor Mapping involves identifying the child's food preferences, breaking it down into categories like taste, texture, and color to uncover patterns. Helps with understanding the child's likes.

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Transitional foods

This approach uses the child's favourite foods to make the transition to new foods easier. Familiar tastes help them try new items.

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Rooting Reflex

A reflex present in babies when their cheek is touched. They turn their head towards the stimulation looking for a source of food. This reflex helps ensure proper latching during breastfeeding.

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Suckling Reflex

This is the reflex that helps babies suck on everything that touches the roof of their mouth. The tongue moves forward and backward, while the jaw moves up and down, creating a sucking motion.

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Tongue Thrust

A reflex in babies where the tongue shoots out to protect from choking. This is a natural defense mechanism to prevent food from going down the wrong pipe.

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Tonic Bite Reflex

This reflex occurs when an infant's gums are stimulated and they clench their jaw tightly, making it difficult to release. This can interfere with feeding and manipulating nipples or cups.

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Tongue Retraction

This is where a baby's tongue pulls back and the tip rests against the hard palate. This can cause difficulties with food removal from spoons and with chewing and swallowing.

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Jaw Thrust

The baby's lower jaw extends down and appears stuck open. This can make it hard for them to receive and keep food in their mouth.

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Strength, Stability & Posture

This refers to the overall strength and stability of the muscles in an infant, particularly in relation to head control and posture.

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Muscle Tone

This refers to the overall state of the muscles, whether they are normal, tight, or loose.

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Study Notes

Swallowing

  • Dysphasia is difficulty moving food from mouth to stomach
  • Feeding disorders are avoidance of certain foods

Phases

  • Oral preparatory phase: food and liquids are manipulated, chewed, and formed into a bolus (voluntary)

  • Oral phase: tongue moves food/liquid to the back of the mouth (voluntary)

  • Pharyngeal phase: involuntary movement. Food is transported from esophagus to stomach

    • Aspiration: food/liquid enters trachea below vocal folds
    • Penetration: food/liquid enters trachea but stays above vocal folds
  • Esophageal phase: food transportation from esophagus to stomach

  • Residue: food left in mouth or pharynx after a swallow

  • Regurgitation: food from the pharynx goes back into the nasal cavity

Oral Phase Issues

  • Poor oral control: weak lips, tongue, or jaw; poor sensitivity
  • Food spill: food/liquid leaks from oral cavity
  • Premature spillage: food falls off tongue before swallow; due to reduced tongue strength/range of motion
  • Chewing difficulty: reduced mandible/tongue strength or poor sensitivity
  • Food residual: food in oral cavity after swallow; residual food between cheeks and tongue, under tongue, on hard palate

Pharyngeal Phase Issues

  • Coughing/choking/wet voice quality: delayed or absent swallow reflex. Reduced laryngeal elevation/closure
  • Nasal regurgitation: food/liquid leaks from nasal cavity due to inadequate velopharyngeal closure

Additional Information

  • Excessive saliva and mucus: due to aspiration and body's attempt to clear away foreign material
  • Signs of dysphagia: drooling, poor oral control, chest infections/pneumonia, food sticking in throat, globus sensation, complaints of pain when swallowing, frequent throat clearing, coughing during/after eating, difficulty coordinating breathing/swallowing, extra effort to chew, malnutrition/dehydration, keeping food in mouth
  • Dysphagia causes: stroke, traumatic brain injury, spinal cord injury, dementia, Parkinson's disease, multiple sclerosis, ALS, muscular dystrophy, developmental disabilities

Assessment

  • Interview/Case history/medical records including potential impact of medications
  • Seating: postural/position evaluation
  • Screening/Bedside assessment
  • FEES (Fiberoptic endoscopic evaluation of swallowing): to view pharyngeal/laryngeal structures, assess adequate airway, timing of swallow, spillage, residue, aspiration, reflux. Identify strategies for swallowing improvement, postural/diet modification
  • MBS (Modified barium swallow study): radiographic procedure to directly view oral, pharyngeal, esophageal function. Evaluate aspiration/penetration, causes, strategies to increase swallowing safety.

Interventions

  • Seating position
  • Dietary modification (thicken up food/liquids, soften, chop food)
  • Postural position technique (chin tuck, rotating head)
  • Swallowing maneuvers (supraglottic swallow, holding breath before swallowing)
  • Effortful swallow (patient instructed to swallow saliva)
  • Masako/tongue hold (prevent coughing/choking) (patient holds tongue forward between teeth during swallow)
  • Shaker exercises/head-lifting: increase opening of the upper esophageal sphincter (helps to increase hyoid/laryngeal excursion)
  • Oral hygiene
  • Nasogastric tube (NGT): inserted to provide non-oral nutrition (short-term use)
  • Gastrostomy tube (PEG/G-tube): for long-term nutrition

Children

  • Feeding disorders: avoidance of eating or limited food types
  • Assessment: case history (medical/feeding status/nutritional information), alterations in feeding-related behaviors (deep/active sleep; drowsy; awake/alert; agitated; crying), physiologic status (heart rate, respiratory rate, oxygen saturation)

Other Features

  • Non-nutritive sucking

  • Primitive reflexes: Babkin, rooting, phasic bite, tongue thrust, sucking, swallow

  • Abnormal reflexes: tonic bite reflex, tongue retraction, jaw thrust

Principles of Oral Structure/Movement/Function

  • Movement of the jaw (size, at rest, movement, strength) , Cheeks (tone, strength), Lips (at rest, tone, strength, deviation), Tongue (size, tone, movements), Palate (at rest, hard/soft), Pharynx and Larynx (vocal quality, gag response), and Facial Sensitivity (face, mouth)

Treatment for Infants & Children

  • Modify posture
  • Manually support jaw/lips/tongue to improve lip sealing and motion
  • Adaptive equipment: modification of nipples or use of straws
  • Alerting food: changing food consistency, temperature
  • Feeding team: Physician, dietitian, behavioural specialist, occupational therapist, SLP

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Swallowing Guide PDF

Description

This quiz evaluates your understanding of dysphagia, including its symptoms, diagnostic methods such as FEES and MBSS, and management strategies. Test your knowledge on feeding therapy techniques and the roles of various professionals involved in treating dysphagia.

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