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. gravity helps keep liquid from moving further into nasopharynx. when do you modify food or liquid consistency? Examples of Goals 1. In these situations, therapy is individualized based o… why would supraglottic swallow be a rationale for delayed swallow? What happens in reduced pharyngeal wall contraction? 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. Should be chosen based on the physiologic cause of the sign/symptom. more effort may facilitate increased BOT retraction. 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. The patient will develop a positive commitment to sobriety. Purpose: Improves your ability to swallow food. DYSPHAGIA GOALS LONG TERM GOALS - SWALLOWING • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. 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. functional Short term goals are written in terms that who can understand? Facial paralysis (cranial nervesVII, IX, X, XII) 4. Keeps larynx elevated longer prolonging the opening of upper esophageal sphincter. 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 … 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. tiny laryngeal mirror and ice it and ice up the fossa pillars. Morris, S.E., (2010) Food for Thought Creating Mealtimes for Children Who Receive Tube Feedings. -the physiology of the swallow (otherwise it's "shooting in the dark"). Before pt resumes breathing, pt will clear throat. why would modify bolus size be a rationale for delayed swallow? What will you maybe observe on a clinical exam for delayed pharyngeal swallow? what is velopharyngeal exercises techniques for poor velar elevation? Then they complete a supraglottic swallow. 1. 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 … •Residual material in the valleculae and pyriform sinuses, bilaterally or unilaterally. Limited awareness 4. 2. The Treatment Plan 77 Goals and Objectives Principal treatments for selected disorders that affect swallowing are listed in Table 4. The patient is asked to turn their head to the paretic side (weaker side) until the swallow is completed. What are some techniques/strategies which may be indicated for a delayed/absent pharygneal swallow? Attending to physiology helps determine what? 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. 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. Neuromuscular stimulation (NMES)-vital stim, improves cricopharyngeal functioning when there is a CP bar. Get the sign then make it into a short term goal, Because it doesn't man anything to the non-SLP e.g., insurance. Dysphagia therapy, a form of physical therapy designed to help people with swallowing disorders, includes direct, indirect, and compensatory techniques. Examples of direct dysphagia treatment interventions include sensory stimulation, di et modification, muscle strengthening, ROM exercises, and caregiver training in feeding assistance. Dysphagia, 18:284-292. It is a quick cheat sheet which itemizes each Oral Pharyngeal Dysphagia Diagnosis and possible therapy strategies to attempt along with their appropriate rationales. why would the 3 second prep be a rationale for a delayed swallow? When possible, treatment is directed at the underlying disorder, such as Parkinson's disease or polymyositis. The patient is asked to hold their breath tightly and bear down. Tumor 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. 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. 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. Various swallowing maneuvers are used to change the swallow physiology. T/F: short term goals cannot be written from the SIGNs observed, FALSE! Is it successful? Food/liquid in pharynx or airway before the swallow or residue in valleculae or pyriform sinuses after the swallow. the functional improvement that is sought. GOAL BANK AUDITORY COMPREHENSION Long-term goal: Auditory comprehension of _____. What are the observations made on an instrumental exam for reduced base of tongue retraction? What are some techniques/strategies that may be indicated for poor velar elevation? Excursion of muscles or decreased strength involved in mastication 3. improve strength at certain weight and frequency then build up from there. Used with a delayed swallow. The patient puts their chin to the chest before the swallow and maintains this position until the swallow is completed. If the short term goal is to decrease residue in the valleculae what would the functional short term goal be? Among the treatment type segment, surgery segment is expected to dominate the dysphagia lusoria treatment market. For dysphagia, identify the diet level that the patient is currently safe with and write goals for the next diet level. Short-Term Goals: • In 90% of trials—with moderate verbal cues during 30-minute meals, Mr. J will check and clear pocketed material. 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!! what are the types of treatment objectives? One consistency may help to clear residue of the other consistency. Fatigue 3. T/F: some treatments provide both compensation and faciliation? What is McNeil Dysphagia treatment program? dysphagia and feeding varies greatly among caregivers. What is the rationale for exercises to increase BOT retraction? What is the supra-superglottic swallow technique? treating a delay when the problem is reduced CP functioning). However, since the launch of the Manual Medical Review in October of 2012, this focus has grown tremendously. Designed to compensate for, not improve the lost function. It will be a lot stronger and quicker. The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. What would the short term goal be? Knowing how LONG to treat requires understanding of what? Knowing HOW to treat requires the SLP to understand what? Indicate the rationale (how the service relates to functional goal), type, and complexity of activity. Reddened, irritated oropharyngeal cavity (stomatitis) 5. Supraglottic Swallow. pt blows into a part and turn to increase resistance. Compensatory treatment objectives are most often used when? what are observations that would be seen on an instrumental exam for reduced epiglottis retroflexion? Speech Language Therapy Speech Language Pathology Speech And Language Aphasia Therapy Cognitive Therapy Lesión Cerebral Therapy Tools Therapy Ideas Speech Therapy Activities. dysphagia lusoria treatment market is expected to have significant growth over the forecast period. Voluntary breath hold closes VF’s before and during swallow thus protecting the airway. Widens the vallecular space, so that the bolus will hesitate in the valleculae rather than falling into the airway. Evaluation of manometric measures during tongue-hold swallows. If the SIGN is the pt loses food from the front of the mouth. what does the Oral Bulbar exercises help with? What would the short term goal be? In accordance with guidelines1,2 established by governing boards’ professional conduct, use … How do you make that into a functional short term goal? What are some techniques to do for reduced base of tongue retraction? T/F: Functional STGs can reflect compensation rather than faciliation. What are the different types of facilitation/therapeutic techniques? For example, if your patient with aphasia answered yes/no questions at 80% accuracy but open-ended questions at 50% accuracy, write a goal for open-ended questions. Payers, consumers and other health professionals so everyone understand improving the pt's health and safety. Edema 2. Solid clinical documentation has long been a focus for many providers. Larger boluses, for some patients can trigger a faster pharyngeal swallow. To address word retrieval skills, patient named five items within a category. Used to improve upper esophageal sphincter (UES) opening during the swallow. What are alternating liquids and solids technique? what is surgical management for poor velar elevation? Oral Transit: if there is a problem with lingual control what is the treatment? What is the modify volume and speed of food presentation technique? If the short term goals is pt will reduce anterior loss of food what would the functional short term goal be? 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. and condition at a time, and make each goal one sentence. The goals of dysphagia therapy are to reduce aspiration, improve the ability to eat and swallow, and optimize nutritional status. 2.2k. Why would a chin tuck be a rationale for a delayed swallow? Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Wha is the rationale for effortful swallow for reduced base of tongue retraction? It should be noted that this is simply a "guide" and not meant to be used as a one fits all. Knowing WHY to treat requires the SLP to understand what? what are the different types of lingual exercises? Done with traditional dysphagia therapy and not alone (uses Effortful Swallow), surface electromyography- measures muscle recruitment in microvolts, Madison Oral Strengthening Therapeutic Device. Goals of Dysphagia Therapy 1. The difference between this document and the, Speech and Language Services & Payment Options. Oral transit: pt puts their head back. As well, to many of my colleagues! Many of my CFs and mentees have stated what helped them the most in learning how to document for adult medical patients was reading and looking at my sample reports for wording ideas. If the sign is poor oral transit-can't move bolus to back of mouth. 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. 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. Note: signs>short term goal>functional short term goal>treatment objectives, on either the clinical swallow study or during an instrumental examination like MBS. The Centers for Medicare and Medicaid Service… What happens in reduced esophageal transit? if there is a problem in the oral prep phase for labial seal what is the treatment? To me, it is a lifesaver! what is prosthetic management technique for poor velar elevation? Tell patient to swallow hard. to facilitate safe feeding may keep bolus higher up in pharynx until the swallow is triggered. The patient is taught to take a small breath, swallow, cough immediately and then swallow again. What does it help with?  Surgery is rarely indicated for patients with swallowing disorders, although in patients … This is an example of what phase for this SIGN? Once you have the functional short term goals then you can identify what? 1. SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. What are some treatment techniques for reduced esophageal transit? •Base of tongue does not make contact with posterior pharyngeal wall. What will you observe on instrumental exam for delayed pharyngeal swallow? •Residual seen in the pyriform sinuses only after the swallow. Long list of patient goals for the medical speech language pathologist. Patient will expectorate the residual material left above Pharynx after the swallow. Target Date: 10/1/2014. What are some treatment techniques for reduced UES relaxation? May even decrease delay, but no evidence one way or the other regarding efficiency. Postural strategies are used to help change the way bolus flows through the swallowing mechanism. Note: Treatment requires understanding the relationship between signs to short term goals, based on physiology that determines what is wrong or impaired which will then determine functional short term goals. Tracheostomytube 6. Pt will reduce residue in the vallecualae. If the short term goal is pt will improve ability to move food back of mouth. Using Modalities in the Treatment of Dysphagia, is an introductory orientation to the Experia equipment only. what are the types/components of compensatory treatment objectives? The patient is instructed to "squeeze hard with all your throat muscles" during the swallow. Just print out these simple directives so your patient can do their homework. terabyte exercises (break contraction so can open mouth if have trismus (cant open mouth) for pt with TMJ. they can be written fro the signs observed. Start nectar thick for 100 fast … -You might select a treatment technique or method that is wrong for the problem (e.g. 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. Examples of Measurable and Non-Measurable Treatment Goals Non-measurable goals Patient will effectively manage their depression. 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 is expiratory muscle strength training? There are many causes to the dysphagia sign. Opposite of head rotation. Effort increases posterior tongue movement thus improving bolus clearance from the valleculae. What are compensatory treatment objectives? Disorders (Dysphagia) , October 2005; 14: 13–18. What is the rationale for multiple swallows for reduced BOT retraction? DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. How to Perform: Take a deep … in oral prep: if there is a problem with mandibular strength and range of motion what are is the treatment? It is always necessary to consider other factors which may change your treatment program (i.e, etiology, patient awareness & ability, etc.). •Reflux of material back into the pharynx. Fujiu M, Logemann J: E?ect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. what is the rationale for alternate liquids and solids for reduced BOT retraction? What does it increase? intake Traditional methods do all of the following, however the swallow is not “normal.” A larger size may help tirgger a more prompt swallow. It has everything you need from our bedside swallow evaluation, to both of our very well known treatment guides to help choose the right strategies to utilize with patients as well as our new patient handout package, the videoflouroscopy form, and of course the Bedside Dysphagia Evaluation. •Puree or liquids enter the valleculae and/or pyriform sinuses before the swallow is triggered (n/a to foods requiring mastication). What are the observations during a clinical exam for reduced base of tongue retraction? Mr. Smith presents to the department with aspiration pneumonia. diet recommendations and modifications. Head is tilted toward the stronger side so bolus goes down the weaker side. what do you observe during a clinical exam for reduced velar elevation? 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. Feeding History – Bottle/breast history, aspiration, transition to … The Mendelsohn Maneuver helps to normalize the timing of the pharyngeal swallow and improve the coordination of the swallow. Start nectar thick for 100 fast hard swallows without aspiration then move up to the next food. get pt into a mental set to swallow. Respiration and Swallowing Hardemark Cedborg Al, Sundman E, Boden K, Hedstrom HW, Kuylenstierna R, Ekberg O, Eriksson LI (2009) Coordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans. The patient will learn to express negative feelings to his or her spouse. intake … SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. In this The care plan must include goals that are specific to each identified problem. Can't move the bolus to the back of mouth or loses bolus over back of tongue while trying to move bolus back (premature spillage). What is the rationale for using a chin tuck for reduced base of tongue retraction? dysphagia. Saved by Cariant Health Partners. Measurable, time-limited goals Patient will score 20 or below on the Beck Depression Inventory for 5 consecutive sessions. It's my lifesaver. 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. May help clear residue, This strategy is to facilitate clearing or reduce residue from the valleculae and pyriform sinuses which might be aspirated after the swallow when there is reduced epiglottis deflection, This strategy: one may help clear residue of other. Examples of acceptable goals include: patient and/or caregiver training on safe swallowing techniques. pt swallows on 3. why would the sour bolus be a rationale for a delayed swallow? •Penetration and/or aspiration DURING the swallow. If the SIGN is the pt has residue in the valleculae. Here are some factors that may be related to Impaired Swallowing: Neuromuscular: 1. "Thinking out of the box” is a familiar concept to the speech-language pathologist providing dysphagia services. Perceptual impairment Mechanical: 1. What is the Mendelsohn Maneuver technique? I created this document while in graduate school and have since kept it updated. This is an example of what phase for this SIGN? protects airway before the swallow and expels penetration after the swallow. smaller, more measurable steps used to achieve the functional short term goal. He is very motivated to participate in treatment, is cognitively intact and has great potential to benefit from treatment. It is estimated that between 29 and 50 percent of acute stroke survivors are dysphasic. take a gauze pad and hold out and then trigger the swallow. may elicit a swallow in pt with absent swallow. 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. Used to improve posterior pharyngeal constriction wall by making contact with the BOT. 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. The patient is taught to hold the larynx at the most elevated position during the swallow for 3 to 5 seconds. What happens with reduced cricopharyngeal relaxation? DYSPHAGIA GOALS LONG TERM GOALS – SWALLOWING • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. 2 in the country and the top in Ohio by To document skilled services, the clinician applies the tips listed below. improve strength at certain weight and frequency then build up from there. For only $10.99 you can purchase this wonderful cheat sheet/guide to dysphagia treatment. Rationale: Poor bolus propulsion for solids but liquids help wash it OR he has liquid residue in the valleculae that is washed away or taken away with a solid bolus of food because muscles put more effort for the solid bolus. T/F: functional short term goals should address WHY the skill needs improvement. What is the best exercise for swallowing? What do you observe during an instrumental exam for reduced 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 … smaller size may accumulate less before the swallow. On the basis of treatment type, the dysphagia lusoria treatment market is classified into surgery and medications. -Identify signs of oral, pharyngeal and esophageal dysphagia. Specific postures are used to compensate for particular types of dysphagia by changing the way that the food moves through the pharynx. 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. 1. Check all that apply. What is the effortful swallow technique? Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers. 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. feeding techniques or use of special devices (e.g., cups, etc.) Pt will decrease loss of food from front of mouth. what would the short term goal be? May help to clear residue from vallecuale and pyriform sinuses with each swallow. exercises involving blowing and producing stop consonants. Use terminology that reflects the clinician's technical knowledge. what does it do? 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. Ranked No. Patient will decrease their depression by 50%. • With minimal cues, Mr. J will use customized scanning strategies to locate and consume food and drink during a meal. what is chin up for technique for poor velar elevation? 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. The patient will learn the skills necessary to maintain a sober lifestyle. The instance of denials for therapy services has grown exponentially and our single greatest weapon in recouping payment for skilled and dedicated services remains strong clinical documentation. what does it help with? Similarly, chapters address-ing special populations, including neu-rogenic disease (Chapter 15) and head and neck cancer (Chapter 16), provide details regarding the unique features of these pathologies, as well as incorpo-rating the latest information regarding dysphagia and approaches to treatment pertinent to each group. What are the different exercises that can be done? what type of treatment is this? pt will reduce anterior loss of food SO THAT MORE FOOD WOULD BE CONSUMED. What are the facilitation/therapeutic treatment objectives designed to do? What do you see for reduced laryngeal elevation? What is the supraglottic swallow technique? Work for delayed swallow. suck and swallow in finger of glove filled with ice may elicit a swallow. 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 & … The thicker the liquid the hard to get out because it covers the lungs. why would neurosensory be a rationale for delayed swallow? The Super - Supraglottic Swallow is the Supraglottic swallow with Effortful swallow. This is when the head of bolus is going beyond the head of the mandible to the pyriform sinuses, Rationale: helps bolus propulsion because narrows the space between the base of tongue and the posterior pharyngeal wall (oropharygneal space).