Quiz 2 Part C One More Time

Front 1

Pharyngeal Delay

Back 1

X-Ray:
1)Chin Down
2)Sensory - Thermal Tactile Stim, suck-swallow, sour bolus
Therapy:
1) Thermal Tactile Stim
2) Suck Swallow

Hint 1

Posture and then sensory heightening. For posture - think about how to protect the patient from aspirating before the swallow. Remember this disorder is SENSORY in nature.

Front 2

Reduced Pharyngeal Contraction Bilaterally

Back 2

X-Ray:
1) Lying down
2) Effortful Swallow
(You can also try having the patient follow thicker bolus with thin liquid wash to clear residue)
Therapy:
1) Masako
2) Effortful Swallow (double counts!)

Hint 2

Posture and then maneuver. Sensory heightening will not help because this is a motor issue. For posture - how can you protect the patient from aspirating residue after the swallow? For maneuver - how can you increase muscular contraction?

Front 3

Reduced UES opening

Back 3

X-Ray:
1) Head Rotated
2) Lying Down
3) Mendelsohn Maneuver
Therapy:
1) Mendelsohn Maneuver (double counts)
2) Shaker Exercises
3) Falsetto

Hint 3

Postures and then voluntary maneuvers. For posture - what makes UES opening easier? What will protect the patient from aspirating after the swallow? For maneuvers - how can you increase UES opening?

Front 4

Cricopharyngeal Dysfunction

Back 4

X-Ray:
1) Nothing we can do really
Therapy:
1) Surgical procedures including myotomy and dilation.

Hint 4

In a true CP dysfunction, what can a swallowing therapist actually do?

Front 5

Reduced Airway Entrance Closure

Back 5

X-Ray:
1) Chin down
2) Super supraglottic swallow
Therapy:
1) Super supraglottic swallow

Hint 5

Posture first, then maneuver. Sensory won't help here. For the posture - what makes closing airway entrance easier? For the maneuver - don't forget the importance of having the patient BEAR DOWN.

Front 6

Reduced airway closure throughout

Back 6

X-Ray
1) Head rotation if you have a unilateral issue (to bring damaged fold to midline)
2) Head rotation + chin down - best airway closure
3) Super supraglottic swallow
Therapy:
1) Super supraglottic closure
2) Vocal fold adduction exercises
3) Surgical options (bulk up or medialize fold)

Hint 6

Postures and then maneuvers. What if the problem was unilateral?

Front 7

Reduced lingual elevation

Back 7

X-Ray:
1) Chin up
2) Supraglottic swallow
3) Suck swallow
(These don't really make sense to me but it was what Nicole listed in the review??)
Therapy:
1) Range of Motion exercises
2) Palatal Augmentation prosthesis

Hint 7

Posture, then maneuver, then POSSIBLY sensory choice (according to Nicole). Therapy includes exercise and a different option if elevation doesn't improve.

Front 8

Reduced Tongue Base Retraction

Back 8

X-Ray:
1) Chin down
2) Lying down
3) Effortful Swallow
Therapy:
1) Masako
2) Gargle
3) Yawn
4) Effortful Swallow
5) Super supraglottic swallow

Hint 8

Two postures and then a manuever. For postures - how can you reduce residue? How can you protect the patient if residue IS left over? For therapy - what can you do to improve tongue base function?

Front 9

Unilateral Pharyngeal Wall Weakness

Back 9

X-Ray:
1) Head Rotation
2) Lying Down
3) Effortful Swallow
Therapy:
1) Masako
2) Effortful Swallow

Hint 9

For posture - how can you avoid the damaged area? For maneuvers - what will increase muscle effort?

Front 10

Reduced Laryngeal Elevation

Back 10

X-Ray
1) Lying down
2) Head Rotation
3) Mendelsohn Maneuver
4) Super supraglottic swallow
Therapy:
1) Mendelsohn Maneuver
2) Shaker exercises
3) Falsetto

Hint 10

This is a motor issue so use postures and maneuvers. You need to protect the patient from aspirating after the swallow. Also, in therapy use techniques to increase laryngeal elevation.

Front 11

Apraxia of Swallow

Back 11

X-Ray:
1) Increase downward pressure on the tongue
2) Thermal Tactile Stim
3) Sour Bolus
Therapy:
1) Thermal Tactile Stim

Hint 11

This is NOT A MOTOR issue

Front 12

Unilateral Tongue Paralysis

Back 12

X-Ray:
1) Head Tilt
2) Chin Up
3) (Maybe suck-swallow)
4) Supraglottic swallow
Therapy:
1) Range of Motion Exercises
2) Resistance Exercises
3) Palatal Augmentation

Hint 12

This is MOTOR but there is one sensory technique Nicole mentioned. For therapy - what will you do if exercises don't work?

Front 13

Delayed Oral Onset

Back 13

X-Ray:
1) Increase downward pressure on the tongue
2) Thermal Tactile Stim
3) Sour Bolus
Therapy:
1) Thermal Tactile Stim

Hint 13

This is not a motor issue. It is the same procedures you would use for apraxia of swallow.

Front 14

Reduced Velopharyngeal Closure

Back 14

X-Ray:
1) Nothing because we can't fix it
Therapy:
1) Prosthetics

Hint 14

Is there anything the swallowing therapist can do?

Front 15

Unilateral Oral/Pharyngeal Weakness

Back 15

X-Ray:
1) Head Tilt
Therapy:
1) Masako
2) Effortful Swallow
3) Effortful breath hold

Hint 15

How does the posture differ from only pharyngeal weakness? Therapy - what can you do to increase muscular effort?