Podcast
Questions and Answers
What are the four general steps of EBP?
What are the four general steps of EBP?
Generate a clinical question Search for available scientific evidence Review and evaluate the evidence Integrate clinical expertise, client’s perspective and reviewed evidence
Strategies, not therapy that aim to ensure safe swallows without directly improving the physiology of swallowing __________ ?
Strategies, not therapy that aim to ensure safe swallows without directly improving the physiology of swallowing __________ ?
- Compensatory management strategies (correct)
- Therapeutic exercises
- Medical management
- Modalities
The effortful swallow, mendelsohn maneuver and tongue hold/masako maneuver are therapeutic exercises.
The effortful swallow, mendelsohn maneuver and tongue hold/masako maneuver are therapeutic exercises.
False (B)
What are the four principles of neuromuscular rehabilitation?
What are the four principles of neuromuscular rehabilitation?
Modalities elicit brain plasticity which enables the recovery of muscle function. It allows you to target CN and muscles that are difficult to treat with conventional treatment. Provide 2 examples of how they facilitate cortical reorganization.
Modalities elicit brain plasticity which enables the recovery of muscle function. It allows you to target CN and muscles that are difficult to treat with conventional treatment. Provide 2 examples of how they facilitate cortical reorganization.
What is the basic function of EMG?
What is the basic function of EMG?
The treatment must match an understanding of the mechanism of dysfunction. When developing a treatment plan you must remember to ask yourself, what is our goal? Please list these four goals.
The treatment must match an understanding of the mechanism of dysfunction. When developing a treatment plan you must remember to ask yourself, what is our goal? Please list these four goals.
According to EBP who is suitable to use compensatory strategies?
According to EBP who is suitable to use compensatory strategies?
This maneuver is used to augment UES opening via sustained laryngeal elevation
This maneuver is used to augment UES opening via sustained laryngeal elevation
Rehabilitative swallowing therapy involves exercises and techniques that aim to achieve long-term improvement in the ____________ of swallowing.
Rehabilitative swallowing therapy involves exercises and techniques that aim to achieve long-term improvement in the ____________ of swallowing.
What is biofeedback? What is the benefit of biofeedback?
What is biofeedback? What is the benefit of biofeedback?
Why is ultrasound a powerful tool to use during articulation therapy?
Why is ultrasound a powerful tool to use during articulation therapy?
Provide 3 examples of the consequences of dysphagia.
Provide 3 examples of the consequences of dysphagia.
Who is not suitable for the use of compensatory strategies?
Who is not suitable for the use of compensatory strategies?
This maneuver is utilized for laryngeal protection. The patient holds breath before & during the swallow & exhales afterwards.
This maneuver is utilized for laryngeal protection. The patient holds breath before & during the swallow & exhales afterwards.
_________ targets the suprahyoid muscles, to facilitate the opening of the upper esophageal sphincter and improving bolus transfer. A flexible object (ball, towel) is required.
_________ targets the suprahyoid muscles, to facilitate the opening of the upper esophageal sphincter and improving bolus transfer. A flexible object (ball, towel) is required.
The external measurement of muscle recruitment via microvolts:
The external measurement of muscle recruitment via microvolts:
Uses sound waves to produce pictures of the inside of the body
Uses sound waves to produce pictures of the inside of the body
This is a treatment modality that uses elasticity of cotton tapes on the skin to affect muscle and nerve. It can enhance postural control for neural position and stability.
This is a treatment modality that uses elasticity of cotton tapes on the skin to affect muscle and nerve. It can enhance postural control for neural position and stability.
How can neuromuscular taping benefit patients?
How can neuromuscular taping benefit patients?
What are the four types of treatment options?
What are the four types of treatment options?
Provide 3 examples of compensatory maneuvers that are utilized to better protect the airway immediately before, during and after swallows.
Provide 3 examples of compensatory maneuvers that are utilized to better protect the airway immediately before, during and after swallows.
Oral motor exercises are designed to increase the range of movement in your tongue, lips, and jaw and can improve the strength of the swallowing musculature.
Oral motor exercises are designed to increase the range of movement in your tongue, lips, and jaw and can improve the strength of the swallowing musculature.
This head-life exercise strengthens the suprahyoids and increases the opening of the UES.
This head-life exercise strengthens the suprahyoids and increases the opening of the UES.
When utilizing ultrasound for swallowing, the most common application for observing the tongue, larynx, and hyoid-bone movement.
When utilizing ultrasound for swallowing, the most common application for observing the tongue, larynx, and hyoid-bone movement.
What are the benefits of submental taping?
What are the benefits of submental taping?
When developing a treatment plan, you should only include one type of therapy.
When developing a treatment plan, you should only include one type of therapy.
Evidence shows this maneuver produces high pharyngeal pressure and results in reduction or elimination of pharyngeal residue. It’s the most common, easiest maneuver for patients to understand.
Evidence shows this maneuver produces high pharyngeal pressure and results in reduction or elimination of pharyngeal residue. It’s the most common, easiest maneuver for patients to understand.
What makes a patient suitable for rehabilitative swallowing therapy?
What makes a patient suitable for rehabilitative swallowing therapy?
Although _______ is a “non-swallow” exercise, there is evidence of transference in which respiratory strength training facilitates improvements in deglutition
Although _______ is a “non-swallow” exercise, there is evidence of transference in which respiratory strength training facilitates improvements in deglutition
This modality uses of electrical pulses that are modified and manipulated to excite peripheral nerves and evoke an action potential through a transcutaneous medium i.e. surface electrodes.
This modality uses of electrical pulses that are modified and manipulated to excite peripheral nerves and evoke an action potential through a transcutaneous medium i.e. surface electrodes.
The only accessible swallowing muscles for external electrode placement are the suprahyoids.
The only accessible swallowing muscles for external electrode placement are the suprahyoids.
What is the primary goal of Evidence-Based Practice (EBP) in dysphagia treatment?
What is the primary goal of Evidence-Based Practice (EBP) in dysphagia treatment?
What is a critical aspect of developing a treatment plan for dysphagia?
What is a critical aspect of developing a treatment plan for dysphagia?
What are the four goals of a treatment plan in dysphagia rehabilitation?
What are the four goals of a treatment plan in dysphagia rehabilitation?
What is the primary focus of rehabilitative swallowing therapy?
What is the primary focus of rehabilitative swallowing therapy?
What is a key principle of rehabilitation in dysphagia treatment?
What is a key principle of rehabilitation in dysphagia treatment?
What is the primary goal of compensatory management strategies in dysphagia treatment?
What is the primary goal of compensatory management strategies in dysphagia treatment?
What is the main limitation of conventional swallowing treatment?
What is the main limitation of conventional swallowing treatment?
What is a crucial factor to consider when developing a treatment plan for dysphagia?
What is a crucial factor to consider when developing a treatment plan for dysphagia?
What is the main benefit of using modalities in dysphagia treatment?
What is the main benefit of using modalities in dysphagia treatment?
What is the primary goal of compensatory swallowing maneuvers?
What is the primary goal of compensatory swallowing maneuvers?
What is the primary goal of rehabilitative swallowing therapy?
What is the primary goal of rehabilitative swallowing therapy?
Which maneuver is used to augment UES opening via sustained laryngeal elevation?
Which maneuver is used to augment UES opening via sustained laryngeal elevation?
What is the problem associated with the supraglottic swallow maneuver?
What is the problem associated with the supraglottic swallow maneuver?
What is a common consequence of dysphagia?
What is a common consequence of dysphagia?
What is the purpose of the 'buffet table philosophy' in dysphagia treatment?
What is the purpose of the 'buffet table philosophy' in dysphagia treatment?
Which of the following is a therapeutic exercise that can be used to strengthen swallowing muscles?
Which of the following is a therapeutic exercise that can be used to strengthen swallowing muscles?
What is the purpose of the head rotation/turn maneuver?
What is the purpose of the head rotation/turn maneuver?
What is a key factor in determining the effectiveness of compensatory management strategies?
What is a key factor in determining the effectiveness of compensatory management strategies?
Which of the following is NOT a compensatory swallowing posture?
Which of the following is NOT a compensatory swallowing posture?
What is the primary goal of therapeutic exercises in dysphagia treatment?
What is the primary goal of therapeutic exercises in dysphagia treatment?
What is the most important consideration when selecting a treatment approach for dysphagia?
What is the most important consideration when selecting a treatment approach for dysphagia?
What is the goal of rehabilitative swallowing therapy?
What is the goal of rehabilitative swallowing therapy?
Which of the following is a benefit of using compensatory strategies?
Which of the following is a benefit of using compensatory strategies?
What is the rationale behind the super-supraglottic swallow maneuver?
What is the rationale behind the super-supraglottic swallow maneuver?
What is the purpose of the consecutive throat clear and swallow maneuver?
What is the purpose of the consecutive throat clear and swallow maneuver?
What is the primary goal of the Chin Tuck Against Resistance (CTAR) exercise?
What is the primary goal of the Chin Tuck Against Resistance (CTAR) exercise?
What is the main benefit of the Thermal Tactile Oral Stimulation (TTOS) modality?
What is the main benefit of the Thermal Tactile Oral Stimulation (TTOS) modality?
What is the primary goal of the Shaker Exercise?
What is the primary goal of the Shaker Exercise?
Which of the following is a contraindication for the Shaker Exercise?
Which of the following is a contraindication for the Shaker Exercise?
What is the primary cause of morbidity and mortality in patients with advanced neurogenic conditions?
What is the primary cause of morbidity and mortality in patients with advanced neurogenic conditions?
What is the primary effect of muscle weakness and incoordination on respiratory function in neurogenic patients?
What is the primary effect of muscle weakness and incoordination on respiratory function in neurogenic patients?
Which of the following is NOT a characteristic of neurogenic patient populations?
Which of the following is NOT a characteristic of neurogenic patient populations?
What is the primary benefit of exercises that target the suprahyoid muscles?
What is the primary benefit of exercises that target the suprahyoid muscles?
What is the primary goal of neuromuscular rehabilitation?
What is the primary goal of neuromuscular rehabilitation?
Which of the following principles of neuromuscular rehabilitation is MOST relevant to the treatment of swallowing disorders?
Which of the following principles of neuromuscular rehabilitation is MOST relevant to the treatment of swallowing disorders?
What is the primary benefit of using EMST in improving cough and airway protection?
What is the primary benefit of using EMST in improving cough and airway protection?
How often should the resistance be increased during Breather Training for Swallowing Protocol?
How often should the resistance be increased during Breather Training for Swallowing Protocol?
What is the total number of reps completed by the end of each day during Breather Training for Swallowing Protocol?
What is the total number of reps completed by the end of each day during Breather Training for Swallowing Protocol?
What is the frequency of Breather Training for Swallowing Protocol?
What is the frequency of Breather Training for Swallowing Protocol?
What is the primary benefit of respiratory strength training in EMST?
What is the primary benefit of respiratory strength training in EMST?
What is the primary consequence of respiratory muscle dysfunction?
What is the primary consequence of respiratory muscle dysfunction?
What is the term for breathing that is too shallow or too slow to meet the needs of the body?
What is the term for breathing that is too shallow or too slow to meet the needs of the body?
What is the most common type of pneumonia that occurs due to aspiration event?
What is the most common type of pneumonia that occurs due to aspiration event?
What is the primary goal of Respiratory Muscle Strength Training (RMST)?
What is the primary goal of Respiratory Muscle Strength Training (RMST)?
What is the term for the shrunken, infected, airless state of the lungs?
What is the term for the shrunken, infected, airless state of the lungs?
What is the benefit of Expiratory Muscle Strength Training (EMST) in swallow function?
What is the benefit of Expiratory Muscle Strength Training (EMST) in swallow function?
What is the suggested duration of EMST training for improving swallow safety and/or cough?
What is the suggested duration of EMST training for improving swallow safety and/or cough?
What is the term for the temporary decrease in oxygen concentration in the blood during sleep?
What is the term for the temporary decrease in oxygen concentration in the blood during sleep?
What is the primary benefit of using resistive trainers in RMST?
What is the primary benefit of using resistive trainers in RMST?
What is the term for the respiratory failure that occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body?
What is the term for the respiratory failure that occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body?
What is the primary benefit of using modalities in speech and dysphagia rehabilitation?
What is the primary benefit of using modalities in speech and dysphagia rehabilitation?
What is the primary function of neuromuscular electrical stimulation (NMES) in swallowing treatment?
What is the primary function of neuromuscular electrical stimulation (NMES) in swallowing treatment?
What is the primary benefit of repetitive transcranial magnetic stimulation (rTMS) in speech and dysphagia rehabilitation?
What is the primary benefit of repetitive transcranial magnetic stimulation (rTMS) in speech and dysphagia rehabilitation?
What is the primary goal of using ultrasound in swallowing treatment?
What is the primary goal of using ultrasound in swallowing treatment?
What is the primary benefit of biofeedback in speech and dysphagia rehabilitation?
What is the primary benefit of biofeedback in speech and dysphagia rehabilitation?
What is the primary goal of neuromuscular taping?
What is the primary goal of neuromuscular taping?
What is the benefit of submental taping?
What is the benefit of submental taping?
What is the limitation of neuromuscular taping?
What is the limitation of neuromuscular taping?
What is the basis of neuromuscular learning?
What is the basis of neuromuscular learning?
What is the benefit of neuromuscular taping for muscle function?
What is the benefit of neuromuscular taping for muscle function?
What is the primary goal of neuromuscular rehabilitation?
What is the primary goal of neuromuscular rehabilitation?
What is the purpose of using surface EMG in swallowing therapy?
What is the purpose of using surface EMG in swallowing therapy?
What is the benefit of using EMG in dysphagia treatment?
What is the benefit of using EMG in dysphagia treatment?
What is the role of neuromuscular taping in dysphagia management?
What is the role of neuromuscular taping in dysphagia management?
What is the primary function of electromyography?
What is the primary function of electromyography?
What is the benefit of using ultrasound in dysphagia management?
What is the benefit of using ultrasound in dysphagia management?
What is the effect of muscle weakness and incoordination on respiratory function in neurogenic patients?
What is the effect of muscle weakness and incoordination on respiratory function in neurogenic patients?
What is the purpose of the CTAR exercise in dysphagia treatment?
What is the purpose of the CTAR exercise in dysphagia treatment?
What is the benefit of using biofeedback in dysphagia treatment?
What is the benefit of using biofeedback in dysphagia treatment?
What is the purpose of the 'buffet table philosophy' in dysphagia treatment?
What is the purpose of the 'buffet table philosophy' in dysphagia treatment?
What is the contraindication of the Shaker Exercise in dysphagia treatment?
What is the contraindication of the Shaker Exercise in dysphagia treatment?
What is the advantage of using surface electromyography (sEMG) in biomechanics?
What is the advantage of using surface electromyography (sEMG) in biomechanics?
What is the importance of accuracy in collecting and interpreting sEMG data?
What is the importance of accuracy in collecting and interpreting sEMG data?
What is the purpose of collecting sEMG readings every 5 sessions or 9 sessions?
What is the purpose of collecting sEMG readings every 5 sessions or 9 sessions?
What is the rationale behind placing electrodes on the suprahyoid muscles?
What is the rationale behind placing electrodes on the suprahyoid muscles?
What is the benefit of combining sEMG with adjunctive swallowing therapies?
What is the benefit of combining sEMG with adjunctive swallowing therapies?
What is the principle of maximal effort in sEMG treatment?
What is the principle of maximal effort in sEMG treatment?
What is the importance of controlling for bolus size and viscosity in sEMG data collection?
What is the importance of controlling for bolus size and viscosity in sEMG data collection?
What is the purpose of the 'open display' feature in some sEMG devices?
What is the purpose of the 'open display' feature in some sEMG devices?
What is the role of games in sEMG treatment?
What is the role of games in sEMG treatment?
Why is it essential to remember to only target the suprahyoid muscles in sEMG treatment?
Why is it essential to remember to only target the suprahyoid muscles in sEMG treatment?
What is the primary benefit of using ultrasound in swallowing assessment?
What is the primary benefit of using ultrasound in swallowing assessment?
During the oropharyngeal phase, what is essential for effective and safe swallowing?
During the oropharyngeal phase, what is essential for effective and safe swallowing?
What is the main advantage of ultrasound over VFSS in assessing oropharyngeal dysphagia?
What is the main advantage of ultrasound over VFSS in assessing oropharyngeal dysphagia?
What is the purpose of the transducer in ultrasound imaging?
What is the purpose of the transducer in ultrasound imaging?
What is the primary application of submental ultrasonography in swallowing assessment?
What is the primary application of submental ultrasonography in swallowing assessment?
Why is ultrasound a valuable tool in articulation therapy?
Why is ultrasound a valuable tool in articulation therapy?
What is the benefit of using ultrasound in combination with other therapies for comprehensive habilitation/rehabilitation?
What is the benefit of using ultrasound in combination with other therapies for comprehensive habilitation/rehabilitation?
What is the primary characteristic of liquids on sonography imaging?
What is the primary characteristic of liquids on sonography imaging?
What is the primary benefit of using real-time biofeedback in articulation therapy?
What is the primary benefit of using real-time biofeedback in articulation therapy?
What is the primary advantage of using ultrasound in swallowing assessment compared to other imaging modalities?
What is the primary advantage of using ultrasound in swallowing assessment compared to other imaging modalities?
What is the primary benefit of using ultrasound in swallowing therapy?
What is the primary benefit of using ultrasound in swallowing therapy?
What is the goal of NMES treatment in swallowing therapy?
What is the goal of NMES treatment in swallowing therapy?
What is the primary mechanism of action of neuromuscular taping?
What is the primary mechanism of action of neuromuscular taping?
What is the typical duration of an NMES treatment session?
What is the typical duration of an NMES treatment session?
What is the primary benefit of using NMES in swallowing therapy?
What is the primary benefit of using NMES in swallowing therapy?
What is the primary goal of neuromuscular taping in swallowing therapy?
What is the primary goal of neuromuscular taping in swallowing therapy?
What is the primary effect of NMES on motor units?
What is the primary effect of NMES on motor units?
What is the primary benefit of using ultrasound in speech therapy?
What is the primary benefit of using ultrasound in speech therapy?
What is the primary goal of NMES treatment in swallowing therapy?
What is the primary goal of NMES treatment in swallowing therapy?
What is the primary mechanism of action of NMES?
What is the primary mechanism of action of NMES?
Study Notes
Dysphagia and Swallowing Disorders
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Dysphagia is likely the result of multiple contributing factors, including: • Decreased neural drive to the swallowing musculature • Insufficient sensory feedback for efficient motor control • Myofascial restrictions as a result of disuse • Disruption of air flow gradients • Anatomical changes to the swallowing musculature • Muscle atrophy as a result of disuse
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Consequences of Dysphagia: • Aspiration: respiratory distress, pneumonia, death • Choking: airway compromise • Tracheostomy • Malnutrition/dehydration: weight loss, chronic respiratory illness • Artificial feeding: PEG, NG, OG, or G Tube/J Tube Placement
Effective Dysphagia Management
- The "buffet table philosophy" involves considering four areas of available treatments and determining what the patient needs to improve swallowing: • Compensatory strategies • Therapeutic exercises • Medical management • Modalities
Compensatory Strategies
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Modify or manage symptoms, but do not strengthen muscles: • Head turn • Chin tuck • Modified diet • Supra- and super-supra-glottic swallows • Effortful swallow • Volitional breath hold
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Compensatory management strategies: • Proceed with caution, as they are not technically therapeutic and have limited evidence • Should be proven to be effective for the client under instrumental evaluation • May not be suitable for all patients, especially those with severe cognitive impairments
Therapeutic Exercises
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Oromotor exercises: • Designed to increase the range of movement in the tongue, lips, and jaw • Do not improve strength and should be used minimally
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Rehabilitative swallowing therapy: • Goal: Achieve long-term improvement in the neuromuscular control of swallowing • Suitable for patients with adequate cognitive skills, motivation, and willingness to practice independently • Not suitable for patients with severe cognitive impairments
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4 general principles of neuromuscular rehabilitation: • Use it or lose it (Taub's principle of non-use) • Use it and improve it • Specificity: targeting the mechanism of dysfunction • Transference and carryover to deglutition
Respiratory Muscle Strength Training (RMST)
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Targets muscles essential for ventilation and airway protective functions of cough and swallow
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Types of resistive trainers: • Airport devices • General mechanism: different sized ports that increase or lessen resistance
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Benefits of RMST: • Improves both ventilatory and non-ventilatory functions • Improves strength of cough and decreases penetration-aspiration scale
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Suggested EMST training protocol: • 5 weeks, 40 reps a day, 20 AM and 20 PM, 6 days a week • Use a pressure-threshold device
Evidence-Based Practice (EBP)
- Definition: The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
- Promotes the use of best available research evidence, clinical expertise, and client's/caregiver's values and perspectives in making clinical decisions
Respiratory Dysfunction in Neurogenic Patient Populations
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Neurogenic patient populations often have respiratory dysfunction, including: • Muscle weakness, spasticity, motor incoordination, and postural abnormalities • Reduced activity due to fatigue, further reducing respiratory muscle function • Impaired ventilation, which is a major cause of morbidity and mortality in patients with advanced neurogenic conditions
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Breather training for swallowing protocol: • 2 sets, each consisting of 20 reps per set, 6 days a week, for 4 weeks • Increase resistance every week### Management of Dysphagia
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Customized treatment plan includes:
- Stopping at each treatment table to create a customized "plate" with sEMG/Biofeedback paired with CTAR exercise
- Electrical stimulation to the suprahyoid paired with effortful swallow
- Neuromuscular taping to support laryngeal elevation
- EMST paired with dietary modifications/positioning while eating/drinking
- Non-oral feeding options, if medically necessary, paired with Ultrasound
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Modalities do not work in isolation
Introduction to Biofeedback
- Biofeedback: the use of an external tool to provide the patient with a representation of their physical effort
- sEMG: the external measurement of muscle recruitment via microvolts, measuring the amount of muscle recruited
- Benefits: provides clear, objective, numerical data to measure baseline and results of intervention
Fundamentals of sEMG
- Electromyography (EMG): the non-invasive study of muscle function through analysis of electrical signals produced during muscular contractions
- EMG involves:
- Detection, amplification, recording, analysis, and interpretation of electrical signals
- Measures muscle firing
- Surface EMG uses:
- 2 bipolar surface electrodes placed on the surface of the skin to detect voltage differences due to asynchronous activation of motor units
- Small signals detected by the active pair of electrodes on the surface of the skin over the muscle are compared to the signal detected by a reference electrode ("ground") placed over connective tissues
- The basic function of EMG is to see how well a muscle is activated
- Maximal voluntary contraction (MVC) of the muscle is used to determine muscle force
Literature
- Surface EMG (sEMG) has been successfully used for:
- Identifying the presence of swallowing activity
- Analyzing swallowing functions (timing and amplitude)
- As a biofeedback training strategy in the treatment of swallowing disorders
- Studies:
- Ashida (2010): analyzed the pattern of suprahyoid muscle activity during pharyngeal swallowing of foods by healthy young subjects
- Vaiman (2007): determined that sEMG was a statistically reliable assessment tool for children, adults, and older adults
- Deluca (1997): discussed the use of surface electromyography in biomechanics
Clinical Responsibility
- Data collection and interpretation:
- Accuracy is imperative with sEMG
- Reliability and validity of the data are essential
- Inaccurate data is worthless because the practitioner (and patient) may draw incorrect conclusions
SEMG Advantages
- Validates the effectiveness of interventions
- Provides objective quantification of the energy of a muscle
- Allows the observer to see the muscle energy at rest and changing continuously over the course of a moment
- Blends valuable information concerning how the nervous system participates in the orchestration of muscle movement
SEMG Protocol
- Clean and prepare the skin with an ESTIM prep pad
- Place two new electrodes on the suprahyoid muscles (for initial and re-evaluation data collection)
- Place the black ground electrode on the back of the neck or collar bone
- Exercise: skill specific (salience), coordination, endurance, and speed
Daily Application
- sEMG can be used as part of the daily treatment plan
- Should be used in conjunction with other therapies
- Patient should attempt anywhere from 5-10 of their maximal effortful swallows, or attempt to perform a swallow maneuver per trial
Electrode Placement
- Suprahyoids and Thyrohyoid
- Rationale: the only accessible swallowing muscles for external electrode placement are the suprahyoids
Ultrasound
- Introduction: provides clinicians with non-invasive opportunities to study the dynamics of the oral pharyngeal system and the muscles of the oropharynx during swallowing
- Uses: visualization of essential swallowing structures in real-time, observation of tongue motion and hyoid bone displacement, and assessment of VF function
Neuromuscular Electrical Stimulation (NMES)
- Definition: the use of electrical pulses that are modified and manipulated to excite peripheral nerves and evoke an action potential through a transcutaneous medium
- History: dates back to Hippocrates and the Romans and Greeks
- Common uses: reduce joint swelling and inflammation, tissue healing, muscle re-education, improve circulation, and pain management
NMES and Swallowing Function
- Maintains and strengthens muscle mass during inactive periods
- Maintains and gains ROM for optimal hyolaryngeal excursion and airway closure
- Facilitates voluntary motor control for swallowing maneuvers
- Increases sensory awareness
- Restores normal balance to the system as ascending sensory information is reintegrated into movement patterns
NMES "Ingredients"
- Parameters: pulse rate, pulse duration, amplitude, and ramp up
- Typical NMES treatment session: 30 minutes, 3-4 times a week, for 6 weeks
Neuromuscular Taping
- Definition: a treatment modality that uses the elasticity of cotton tapes on the skin to affect muscle and nerve
- Mimics the qualities of the skin, aka "functional taping"
- Provides outside-in, bottom-up, superficial to deep stimuli
- Can assist in normalization of physiological functions when applied appropriately on the target tissues
- Can be worn for extended periods with continued therapeutic effect with little or minimal negative side effects
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