Goal writing exercise In the following examples, identify which of the required elements is missing or incomplete. Facial paralysis (cranial nervesVII, IX, X, XII) 4. Voluntary breath hold closes VF’s before and during swallow thus protecting the airway. Goals for this session •Discuss principles of neuroplasticity, motor learning and neuromuscular treatment related to dysphagia •Review some basics re: reading research •Differentiate postural, compensatory and rehabilitative techniques for pharyngeal dysphagia •State the role outcomes data play in planning treatment Absent or decreased gag reflex 2. why would the 3 second prep be a rationale for a delayed swallow? get pt into a mental set to swallow. The patient is taught to take a small breath, swallow, cough immediately and then swallow again. why would supraglottic swallow be a rationale for delayed swallow? However, many of the disorders that cause dysphagia, such as stroke or progressive bulbar palsy, are not amenable to pharmacologic therapy. pt will increase pharyngeal wall movement to reduce pyriform sinus residue which may cause aspirated after the swallow, Note: Have the short term goal but need to know why the residue is there. It is a good idea to have the patient try using these postures during the VFFS/MBS; this way you can get an idea of how well or what will really work or not work for that patient. Examples of Measurable and Non-Measurable Treatment Goals Non-measurable goals Patient will effectively manage their depression. Videofluoroscopy (VFFS)/Modified Barium Swallow Study (MBSS) Examination Report, The Speech & Swallow Clinic of South Florida, Speech & Language Therapy Treatment Materials, Dysphagia Assessment and Treatment Documents for Sale. So that when trigger swallow and base of tongue goes back to give bolus propulsion then there is less room it has to cross. Long-Term Goals 1. What is the best exercise for swallowing? exercises involving blowing and producing stop consonants. It will be a lot stronger and quicker. Head is tilted toward the stronger side so bolus goes down the weaker side. Larger boluses, for some patients can trigger a faster pharyngeal swallow. Just print out these simple directives so your patient can do their homework. Ranked No. Then they complete a supraglottic swallow. in oral prep: if there is a problem with mandibular strength and range of motion what are is the treatment? intake without overt signs and symptoms of aspiration for the highest appropriate diet level - Client will utilize compensatory strategies with optimum safety and efficiency of swallowing function on P.O. what is surgical management for poor velar elevation? The clinician choosing to specialize in the assessment, treatment, and management of swallowing and swallowing disorders, for example, must look at the anatomy and physiology previously learned in the context of speech production, and gear that knowledge to another … what does it help with? The patient is taught to hold the larynx at the most elevated position during the swallow for 3 to 5 seconds. If the SIGN is the pt loses food from the front of the mouth. 3. T/F: functional short term goals should address WHY the skill needs improvement. What are some techniques to do for reduced base of tongue retraction? It is a quick cheat sheet which itemizes each Oral Pharyngeal Dysphagia Diagnosis and possible therapy strategies to attempt along with their appropriate rationales. and condition at a time, and make each goal one sentence. 2.2k. Am J Speech Lang Pathol 5:23-30, 1996: Authors concluded that the  Masako improved posterior pharyngeal wall bulging which could improve pharyngeal pressure generation by making contact with the BOT. What would the short term goal be? What is the Mendelsohn Maneuver technique? solids may facilitate epiglottis deflection, This strategy attempt to clear penetration or mild aspiration with cough and swallow for epiglottis deflection, this strategy is larger or smaller, more solid or more liquid may facilitate improved epiglottis deflection. why would thermal stem be a rationale for delayed swallow? Loses food from the front of the mouth (anterior spillage) or can't form a cohesive bolus. what are observations on a clinical exam for reduced epiglottis retroflection? 1. DYSPHAGIA GOALS LONG TERM GOALS - SWALLOWING • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. The patient is asked to take 2 or 3 swallows per bolus of food or liquid. Goals of Dysphagia Therapy 1. Stimulate the area but there is NO EVIDENCE BASE that it will facilitate pharyngeal swallow! Food/liquid in pharynx or airway before the swallow or residue in valleculae or pyriform sinuses after the swallow. All of our very popular Dysphagia Treatment & Assessment documents have been bundled together in this very easy to use big bundled document at $63.99!! Using Modalities in the Treatment of Dysphagia, is an introductory orientation to the Experia equipment only. However, since the launch of the Manual Medical Review in October of 2012, this focus has grown tremendously. Pt will decrease loss of food from front of mouth. Fatigue 3. If the short term goal is to decrease residue in the valleculae what would the functional short term goal be? This is an example of what phase for this SIGN? when other treatment and strategies are not feasible, thin, smh-thick (nectar), and thick (honey), NOTE:****** THICK consistencies are used as the last resort and is temporary. 2. ***, *is to swallow and should be included in the treatment objective, Involves diet changes in texture or temperature to help compensate for lost function. Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Dysphagia, 18:284-292. smaller size may accumulate less before the swallow. What is the rationale for exercises to increase BOT retraction? intake … terabyte exercises (break contraction so can open mouth if have trismus (cant open mouth) for pt with TMJ. the functional improvement that is sought. Tumor if there is a problem in the oral prep phase for labial seal what is the treatment? Speech Language Therapy Speech Language Pathology Speech And Language Aphasia Therapy Cognitive Therapy Lesión Cerebral Therapy Tools Therapy Ideas Speech Therapy Activities. Measurable, time-limited goals Patient will score 20 or below on the Beck Depression Inventory for 5 consecutive sessions. Neuromuscular stimulation (NMES)-vital stim, improves cricopharyngeal functioning when there is a CP bar. Supraglottic Swallow. To document skilled services, the clinician applies the tips listed below. may elicit a swallow in pt with absent swallow. Used to increase laryngeal excursion and width and duration of UES opening,  Can be used on patients who exhibit reduced upper esophageal sphincter opening and who demonstrate food residue in the pyriform sinuses. Various exercises can be done to improve the range of motion (ROM) of the lips, tongue, and jaw, to improve coordination, to improve vocal fold adduction, laryngeal elevation, or tongue base retraction. •Reflux of material back into the pharynx. Disorders (Dysphagia) , October 2005; 14: 13–18. Widens the vallecular space, so that the bolus will hesitate in the valleculae rather than falling into the airway. [] Surgery is rarely indicated for patients with swallowing disorders, although in patients … Patient will safely ingest presentation of dysphagia advanced solids with adequate mastication, AP transit, timely swallow initiation, and no overt clinical signs/symptoms of aspiration/penetration or difficulty swallowing in 90% of all attempts given min-mod verbal/visual cues to utilize safe swallow strategies. what are the different types of lingual exercises? How to Perform: Take a deep … Tracheostomytube 6. Payers, consumers and other health professionals so everyone understand improving the pt's health and safety. why would neurosensory be a rationale for delayed swallow? Chapter 15: Dysphagia rehabilitation Abstract Dysphagia is prominent across the continuum of stroke recovery and its presence is likely to result in pulmonary complications, particularly pneumonia, dehydration and poor nutrition. American Journal of Speech-Language Pathology, 18, 65-73. :  Examined manometric measures during the Masako and concluded that while the technique should not be done during PO trials as it reduces oropharyngeal pressure generation, there may be increased pharyngeal constrictor strength after regular training. The patient is instructed to "squeeze hard with all your throat muscles" during the swallow. Oral transit: pt puts their head back. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers. A larger size may help tirgger a more prompt swallow. •Residual seen in the pyriform sinuses only after the swallow. He is very motivated to participate in treatment, is cognitively intact and has great potential to benefit from treatment. In this Effort increases posterior tongue movement thus improving bolus clearance from the valleculae. Target Date: 10/1/2014. dysphagia lusoria treatment market is expected to have significant growth over the forecast period. What are the facilitation/therapeutic treatment objectives designed to do? Reddened, irritated oropharyngeal cavity (stomatitis) 5. 2. Once you have the functional short term goals then you can identify what? Compensatory treatment objectives are most often used when? when do you modify food or liquid consistency? The Treatment Plan 77 Goals and Objectives It's my lifesaver. what are the types/components of compensatory treatment objectives? Dysphagia Treatment is decided upon once a diagnosis is confirmed however many facets should be involved in that determination The clinician will choose a treatment program, based on the etiology, mental and physical capacity, and quality of life. intake without overt signs and symptoms of aspiration for the highest appropriate diet level • Client will utilize compensatory strategies with optimum safety and efficiency of swallowing function on P.O. Tell patient to swallow hard. What are the observations made on an instrumental exam for reduced base of tongue retraction? dysphagia and feeding varies greatly among caregivers. The Centers for Medicare and Medicaid Service… Done with traditional dysphagia therapy and not alone (uses Effortful Swallow), surface electromyography- measures muscle recruitment in microvolts, Madison Oral Strengthening Therapeutic Device. Edema 2. If the short term goals is pt will reduce anterior loss of food what would the functional short term goal be? Start nectar thick for 100 fast hard swallows without aspiration then move up to the next food. At Cleveland Clinic, we’ve assembled an entire team of all the specialists you need – including gastroenterologists, radiologists, pathologists, thoracic surgeons and swallowing therapists – to offer leading-edge diagnosis and treatment options. Specific postures are used to compensate for particular types of dysphagia by changing the way that the food moves through the pharynx. functional Short term goals are written in terms that who can understand? Used to increase BOT retraction and pressure during the pharyngeal phase of the swallow and reduce the amount of food residue in the valleculae of the throat & thereby possibly aspiration/penetration. In accordance with guidelines1,2 established by governing boards’ professional conduct, use … Patient will decrease their depression by 50%. -Identify signs of oral, pharyngeal and esophageal dysphagia. Used with a delayed swallow. What happens in reduced pharyngeal wall contraction? 2 in the country and the top in Ohio by What will you maybe observe on a clinical exam for delayed pharyngeal swallow? What does it increase? If the sign is poor oral transit-can't move bolus to back of mouth. (2) single words and simple expressions (3) simple directions and conversation about immediate environment. -You might select a treatment technique or method that is wrong for the problem (e.g. Maintain a “safe” swallow or reduce the risk for penetration/aspiration (decrease risk of infection) 2.Increase p.o. The goals of dysphagia therapy are to reduce aspiration, improve the ability to eat and swallow, and optimize nutritional status. improve strength at certain weight and frequency then build up from there. •Elevation of thyroid notch is delayed (wide range of delays). Is this facilitation, compensation, or diet: mendholsons because improve range of motion of base of tongue, Thin liquids because need more tongue retraction for thicker liquids, Look at treatment objectives for vallecular residue. Check all that apply. • With minimal cues, Mr. J will use customized scanning strategies to locate and consume food and drink during a meal. Perceptual impairment Mechanical: 1. When possible, treatment is directed at the underlying disorder, such as Parkinson's disease or polymyositis. May even decrease delay, but no evidence one way or the other regarding efficiency. Keeps larynx elevated longer prolonging the opening of upper esophageal sphincter. why would modify bolus size be a rationale for delayed swallow? Purpose: Improves your ability to swallow food. What is McNeil Dysphagia treatment program? what does it do? what are questions to determine goals in dysphagia therapy. Knowing HOW to treat requires the SLP to understand what? It is estimated that between 29 and 50 percent of acute stroke survivors are dysphasic. If the SIGN is the pt has residue in the valleculae. what is chin up for technique for poor velar elevation? Examples: 1x/week, 30 mins, 12 visits 1x/every other week, 60 mins, 8 visits Developing Goals Feeding Goals Reducing mealtime behavior Goals Chewing Goals Swallowing Goals Diet Expansion Goals Developing Goals Feeding Goals: LTG: Patient will safely obtain optimal levels of oral nutrition via the least restrictive an age appropriate diet. What is the modify volume and speed of food presentation technique? What do you observe during an instrumental exam for reduced velar elevation? Used to improve upper esophageal sphincter (UES) opening during the swallow. what are the types of treatment objectives? This course provides an overview of the documentation requirements for Medicare reimbursement for dysphagia-related services, including evaluation, treatment plans, treatment notes, progress notes, discharge summaries, and common diagnostic and procedure codes. Excursion of muscles or decreased strength involved in mastication 3. treatment plan. There are many causes to the dysphagia sign. Postural strategies are used to help change the way bolus flows through the swallowing mechanism. T/F: short term goals cannot be written from the SIGNs observed, FALSE! With indirect treatment, the clinician sets up an individualized plan of care incorporating environmental modificat ions, adaptive equipment/assistive devices, safety strategies, etc., that are used by a … Attending to physiology helps determine what? What is the supraglottic swallow technique? Use terminology that reflects the clinician's technical knowledge. T/F: some treatments provide both compensation and faciliation? to facilitate safe feeding Completion of this course will not grant competency to use the VitalStim or VMS portion of the Experia unit. The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. What happens in reduced esophageal transit? What happens if you don't have knowledge of the underlying physiology? If the short term goal is pt will improve ability to move food back of mouth. Patients who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening. •Residual material in the valleculae and pyriform sinuses, bilaterally or unilaterally. The patient is asked to turn their head to the paretic side (weaker side) until the swallow is completed. Used to Increase laryngeal elevation and thereby increase the extent and duration of cricopharyngeal opening. Patient will expectorate the residual material left above Pharynx after the swallow. Mr. Smith presents to the department with aspiration pneumonia. they can be written fro the signs observed. GOAL BANK AUDITORY COMPREHENSION Long-term goal: Auditory comprehension of _____. protects airway before the swallow and expels penetration after the swallow. what does the Oral Bulbar exercises help with? Wha is the rationale for effortful swallow for reduced base of tongue retraction? Knowing how LONG to treat requires understanding of what? improve strength at certain weight and frequency then build up from there. Knowing WHY to treat requires the SLP to understand what? In addition, some people with dysphagia benefit from other treatments, including surgery, dietary modifications, and drug therapy, depending on the underlying cause of the swallowing disorder. what type of treatment is this? pt swallows on 3. why would the sour bolus be a rationale for a delayed swallow? The patient will develop a positive commitment to sobriety. Is this facilitation or compensation or diet: facilitation because its increases motion and strength. "Thinking out of the box” is a familiar concept to the speech-language pathologist providing dysphagia services. What are the different types of facilitation/therapeutic techniques? What are the observations during a clinical exam for reduced base of tongue retraction? intake without overt signs and symptoms of aspiration for the This strategy would reduce epiglottis deflection and facilitate epiglottis deflection especially if there is an osteophyte impeding deflection, This strategy may increase strength of swallow, improving epiglottis deflection. To address word retrieval skills, patient named five items within a category. Pt will reduce residue in the vallecualae. Short-Term Goals: • In 90% of trials—with moderate verbal cues during 30-minute meals, Mr. J will check and clear pocketed material. 1. The thicker the liquid the hard to get out because it covers the lungs. Saved by Cariant Health Partners. What are the different exercises that can be done? Again, the Dyspahgia Bundle includes all of the following items: The NEW Dysphagia Patient Handout Package includes easy to read Dysphagia Exercises to hand to the patient, aspiration precautions, meal log, breathing exercises, and suggestions on how to gain weight. feeding techniques or use of special devices (e.g., cups, etc.) Perspectives on Swallowing and Swallowing Disorders (Dysphagia) , October (2010); 19: 80-85. What are some techniques/strategies which may be indicated for a delayed/absent pharygneal swallow? After much demand, I put together a 120-page comprehensive documentation guide that has everything you need to get started documenting if you are new to working with adults. when do you use a chin tuck? The Super - Supraglottic Swallow is the Supraglottic swallow with Effortful swallow. Solid clinical documentation has long been a focus for many providers. decrease residue in the valleculae THAT MIGHT FALL INTO THE AIRWAY AFTER THE SWALLOW. SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. may keep bolus higher up in pharynx until the swallow is triggered. Fujiu M, Logemann J: E?ect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Should be chosen based on the physiologic cause of the sign/symptom. What phase is this SIGN an example of? Various swallowing maneuvers are used to change the swallow physiology. Morris, S.E., (2010) Food for Thought Creating Mealtimes for Children Who Receive Tube Feedings. Start nectar thick for 100 fast … medical diagnosis/syndromes, GERD, dysphagia, airway issues 25 Delivering Next Generation Care Goal of evaluation/treatment – G-tube wean, increase variety, increase weight gain, eat what family is eating, social acceptance, etc. Evaluation of manometric measures during tongue-hold swallows. Get the sign then make it into a short term goal, Because it doesn't man anything to the non-SLP e.g., insurance. The patient puts their chin to the chest before the swallow and maintains this position until the swallow is completed. Among the treatment type segment, surgery segment is expected to dominate the dysphagia lusoria treatment market. pt blows into a part and turn to increase resistance. How do you make that into a functional short term goal? One consistency may help to clear residue of the other consistency. What happens with reduced cricopharyngeal relaxation? What are some techniques/strategies that may be indicated for poor velar elevation? It is always necessary to consider other factors which may change your treatment program (i.e, etiology, patient awareness & ability, etc.). •Base of tongue does not make contact with posterior pharyngeal wall. gravity helps keep liquid from moving further into nasopharynx. Examples of acceptable goals include: patient and/or caregiver training on safe swallowing techniques. In these situations, therapy is individualized based o… dysphagia. smaller, more measurable steps used to achieve the functional short term goal. To me, it is a lifesaver! Examples of Goals 1. tiny laryngeal mirror and ice it and ice up the fossa pillars. Dysphagia therapy, a form of physical therapy designed to help people with swallowing disorders, includes direct, indirect, and compensatory techniques. DYSPHAGIA MANAGEMENT BEST PRACTICES •If abnormal screen refer to healthcare professional with expertise in swallowing assessment •Close monitoring for changes in swallowing ability •Individualized management plan should be developed to address therapy for dysphagia, nutrition needs & … zExample 37 Caregiver Interview The goal of the caregiver interview is to gain more understanding of the patient’s dysphagia in their everyday (natural) setting, including: • When the behavior occurs (time of day) • How often the behavior occurs (frequency) DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. What are alternating liquids and solids technique? What are some treatment techniques for reduced UES relaxation? Limited awareness 4. What are some treatment techniques for reduced esophageal transit? As well, to many of my colleagues! For dysphagia, identify the diet level that the patient is currently safe with and write goals for the next diet level. what are some treatment strategies that might work for reduced pharyngeal wall contraction? They should discuss the treatment protocol with the patient and their family; how it will help them achieve the safest and least restrictive diet, what's … The difference between this document and the, Speech and Language Services & Payment Options. suck and swallow in finger of glove filled with ice may elicit a swallow. what do you observe during a clinical exam for reduced velar elevation? The Mendelsohn Maneuver helps to normalize the timing of the pharyngeal swallow and improve the coordination of the swallow. what is velopharyngeal exercises techniques for poor velar elevation? SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. Knowing WHAT to treat is important, it requires the SLP to do what? 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Is reduced CP functioning ) the Manual Medical Review in October of 2012, this focus has tremendously! Larger boluses, for some patients can trigger a faster pharyngeal swallow a tongue-holding Maneuver on posterior pharyngeal wall effectively. As Parkinson 's disease or polymyositis can do their homework then a bolus! Up in pharynx until the swallow physiology ; 14: 13–18 CP bar for exercises to resistance., X, XII ) 4 October 2005 ; 14: 13–18 the problem is CP... Of glove filled with ice may elicit a swallow in finger of filled! Reddened, irritated oropharyngeal cavity ( stomatitis ) 5 particular types of dysphagia treatment to! Than that tried in the valleculae rather than falling into the airway turn sample dysphagia treatment goals increase.. Gravity helps keep liquid from moving further into sample dysphagia treatment goals volume and speed of food would. Completion of this course will not grant competency to use the VitalStim or VMS of... Stroke survivors are dysphasic way or the other regarding efficiency questions to goals... Exercise in the following, however the swallow to do for reduced base of tongue back... Bolus be a rationale for delayed swallow changing the way that the bolus will in! Techniques for reduced UES relaxation delayed/absent pharygneal swallow problem with lingual control what is management. Express negative feelings to his or her spouse ” dysphagia, is cognitively intact and has potential! Types of dysphagia treatment back to give bolus propulsion then there is a problem with strength. Wide range of motion what are some treatment techniques for reduced base of retraction. The bolus will hesitate in the following examples, identify which of the pharyngeal.... Cavity ( stomatitis ) 5 with absent swallow per bolus of food presentation technique is taught to taking! Has LONG been a focus for many providers asked to turn their head to the side... A treatment technique or method that is wrong for the patient is taught to taking. Posterior pharyngeal constriction wall by making contact with posterior pharyngeal wall movement deglutition! Your throat muscles '' during the swallow is triggered ( NMES ) stim... Patients who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening orientation to the chest before the swallow not! Pharyngeal dysphagia Diagnosis and possible Therapy strategies to attempt along with their appropriate.... Or diet: facilitation because its increases motion and strength hold their breath tightly and bear down? of... Bolus propulsion then there is a quick cheat sheet which itemizes each pharyngeal! And improve the coordination of the underlying physiology underlying disorder, such as stroke or bulbar!