gravity helps keep liquid from moving further into nasopharynx. What is the rationale for alternating liquids and solids? 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. what are questions to determine goals in dysphagia therapy. What is the modify volume and speed of food presentation technique? What are some techniques to do for reduced base of tongue retraction? smaller, more measurable steps used to achieve the functional short term goal. -Identify signs of oral, pharyngeal and esophageal dysphagia. 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. Long list of patient goals for the medical speech language pathologist. 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. T/F: some treatments provide both compensation and faciliation? Voluntary breath hold closes VF’s before and during swallow thus protecting the airway. Is this facilitation or compensation or diet: facilitation because its increases motion and strength. In this dysphagia. 1. What will you maybe observe on a clinical exam for delayed pharyngeal swallow? It is estimated that between 29 and 50 percent of acute stroke survivors are dysphasic. 2 in the country and the top in Ohio by Patients who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening. Various swallowing maneuvers are used to change the swallow physiology. 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 & … Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Mr. Smith presents to the department with aspiration pneumonia. 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. treatment plan. decrease residue in the valleculae THAT MIGHT FALL INTO THE AIRWAY AFTER THE SWALLOW. improve strength at certain weight and frequency then build up from there. Patient will expectorate the residual material left above Pharynx after the swallow. What is the Mask Maneuver? Target Date: 10/1/2014. Check all that apply. pt swallows on 3. why would the sour bolus be a rationale for a delayed swallow? What is the rationale for exercises to increase BOT retraction? Should be chosen based on the physiologic cause of the sign/symptom. Knowing HOW to treat requires the SLP to understand what? 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. smaller size may accumulate less before the swallow. T/F: short term goals cannot be written from the SIGNs observed, FALSE! Food/liquid in pharynx or airway before the swallow or residue in valleculae or pyriform sinuses after the swallow. treating a delay when the problem is reduced CP functioning). 2.2k. suck and swallow in finger of glove filled with ice may elicit a swallow. feeding techniques or use of special devices (e.g., cups, etc.) 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. What is the rationale for multiple swallows for reduced BOT retraction? Examples of Goals 1. What are the different exercises that can be done? A limit of 12 seconds made the activity more complex than that tried in the last session. Indicate the rationale (how the service relates to functional goal), type, and complexity of activity. dysphagia and feeding varies greatly among caregivers. what are observations that would be seen on an instrumental exam for reduced epiglottis retroflexion? 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. If the SIGN is the pt has residue in the valleculae. may keep bolus higher up in pharynx until the swallow is triggered. This is an example of what phase for this SIGN? Feeding History – Bottle/breast history, aspiration, transition to … Examples of Measurable and Non-Measurable Treatment Goals Non-measurable goals Patient will effectively manage their depression. Payers, consumers and other health professionals so everyone understand improving the pt's health and safety. "Thinking out of the box” is a familiar concept to the speech-language pathologist providing dysphagia services. What is the best exercise for swallowing? •Base of tongue does not make contact with posterior pharyngeal wall. Neuromuscular stimulation (NMES)-vital stim, improves cricopharyngeal functioning when there is a CP bar. What are alternating liquids and solids technique? get pt into a mental set to swallow. what is surgical management for poor velar elevation? What are some techniques/strategies that may be indicated for poor velar elevation? Fujiu M, Logemann J: E?ect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. 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. improve strength at certain weight and frequency then build up from there. Use terminology that reflects the clinician's technical knowledge. Speech Language Therapy Speech Language Pathology Speech And Language Aphasia Therapy Cognitive Therapy Lesión Cerebral Therapy Tools Therapy Ideas Speech Therapy Activities. 1. May help to clear residue from vallecuale and pyriform sinuses with each 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). •Puree or liquids enter the valleculae and/or pyriform sinuses before the swallow is triggered (n/a to foods requiring mastication). Excursion of muscles or decreased strength involved in mastication 3. why would thermal stem be a rationale for delayed swallow? 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 the rationale for using a chin tuck for reduced base of tongue retraction? Completion of this course will not grant competency to use the VitalStim or VMS portion of the Experia unit. What would the short term goal be? What is the supra-superglottic swallow technique? For only $10.99 you can purchase this wonderful cheat sheet/guide to dysphagia treatment. pt blows into a part and turn to increase resistance. What phase is this SIGN an example of? -the physiology of the swallow (otherwise it's "shooting in the dark"). Used with a delayed swallow. Tongue is placed b/w teeth. DYSPHAGIA GOALS LONG TERM GOALS - SWALLOWING • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. It is a quick cheat sheet which itemizes each Oral Pharyngeal Dysphagia Diagnosis and possible therapy strategies to attempt along with their appropriate rationales. 2. What happens in reduced esophageal transit? The patient is taught to alternate taking a solid then a liquid bolus. 2. 2. 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. 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. if there is a problem in the oral prep phase for labial seal what is the treatment? Opposite of head rotation. The patient will learn the skills necessary to maintain a sober lifestyle. Loses food from the front of the mouth (anterior spillage) or can't form a cohesive bolus. Larger boluses, for some patients can trigger a faster pharyngeal swallow. in oral prep: if there is a problem with mandibular strength and range of motion what are is the treatment? Solid clinical documentation has long been a focus for many providers. 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. The Super - Supraglottic Swallow is the Supraglottic swallow with Effortful swallow. What is McNeil Dysphagia treatment program? Supraglottic Swallow. One consistency may help to clear residue of the other consistency. The patient will learn to express negative feelings to his or her spouse. When possible, treatment is directed at the underlying disorder, such as Parkinson's disease or polymyositis. The goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. The goals of dysphagia therapy are to reduce aspiration, improve the ability to eat and swallow, and optimize nutritional status. what is prosthetic management technique for poor velar elevation? tiny laryngeal mirror and ice it and ice up the fossa pillars. This is an example of what phase for this SIGN? what are the types/components of compensatory treatment objectives? The Mendelsohn Maneuver helps to normalize the timing of the pharyngeal swallow and improve the coordination of the swallow. The patient will develop a positive commitment to sobriety. Edema 2. 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. what would the short term goal be? 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. •Penetration and/or aspiration DURING the swallow. Measurable, time-limited goals Patient will score 20 or below on the Beck Depression Inventory for 5 consecutive sessions. How do you make that into a functional short term goal? Short-Term Goals: • In 90% of trials—with moderate verbal cues during 30-minute meals, Mr. J will check and clear pocketed material. Why would a chin tuck be a rationale for a delayed swallow? Stimulate the area but there is NO EVIDENCE BASE that it will facilitate pharyngeal swallow! Reddened, irritated oropharyngeal cavity (stomatitis) 5. what is velopharyngeal exercises techniques for poor velar elevation? Work for delayed swallow. why would neurosensory be a rationale for delayed swallow? Then they complete a supraglottic swallow. they can be written fro the signs observed. 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. what are the types of treatment objectives? what are observations on a clinical exam for reduced epiglottis retroflection? Perceptual impairment Mechanical: 1. improve strength at certain weight and frequency then build up from there. Dysphagia therapy, a form of physical therapy designed to help people with swallowing disorders, includes direct, indirect, and compensatory techniques. Here are some factors that may be related to Impaired Swallowing: Neuromuscular: 1. intake … What will you observe on instrumental exam for delayed pharyngeal swallow? 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. What is expiratory muscle strength training? What are some treatment techniques for reduced esophageal transit? What are the observations during a clinical exam for reduced base of tongue retraction? Pt will decrease loss of food from front of mouth. Saved by Cariant Health Partners. 1. and condition at a time, and make each goal one sentence. Tell patient to swallow hard. may elicit a swallow in pt with absent swallow. Knowing WHY to treat requires the SLP to understand what? Used to Increase laryngeal elevation and thereby increase the extent and duration of cricopharyngeal opening. Fatigue 3. Ranked No. pt will reduce anterior loss of food SO THAT MORE FOOD WOULD BE CONSUMED. 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. Head is tilted toward the stronger side so bolus goes down the weaker side. Before pt resumes breathing, pt will clear throat. If the short term goal is to decrease residue in the valleculae what would the functional short term goal be? • With minimal cues, Mr. J will use customized scanning strategies to locate and consume food and drink during a meal. 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. 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. 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. In these situations, therapy is individualized based o… 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. when do you modify food or liquid consistency? 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 … intake Traditional methods do all of the following, however the swallow is not “normal.” •Residual material in the valleculae and pyriform sinuses, bilaterally or unilaterally. On the basis of treatment type, the dysphagia lusoria treatment market is classified into surgery and medications. Absent or decreased gag reflex 2. Purpose: Improves your ability to swallow food. what does it help with? decrease distance between BOT to posterior pharyngeal wall. Examples of acceptable goals include: patient and/or caregiver training on safe swallowing techniques. intake without overt signs and symptoms of aspiration for the Principal treatments for selected disorders that affect swallowing are listed in Table 4. How to Perform: Take a deep … Keeps larynx elevated longer prolonging the opening of upper esophageal sphincter. what do you observe during a clinical exam for reduced velar elevation? what does the Oral Bulbar exercises help with? What techniques are used for reduced laryngeal elevation? Effort increases posterior tongue movement thus improving bolus clearance from the valleculae. 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. The care plan must include goals that are specific to each identified problem. Evaluation of manometric measures during tongue-hold swallows. Maintain a “safe” swallow or reduce the risk for penetration/aspiration (decrease risk of infection) 2.Increase p.o. Compensatory treatment objectives are most often used when? It is always necessary to consider other factors which may change your treatment program (i.e, etiology, patient awareness & ability, etc.). dysphagia lusoria treatment market is expected to have significant growth over the forecast period. 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, 18:284-292. However, many of the disorders that cause dysphagia, such as stroke or progressive bulbar palsy, are not amenable to pharmacologic therapy. Goal writing exercise In the following examples, identify which of the required elements is missing or incomplete. What do you observe during an instrumental exam for reduced velar elevation? Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers. It's my lifesaver. The Treatment Plan 77 Goals and Objectives 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. Knowing how LONG to treat requires understanding of what? Patient will decrease their depression by 50%. 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. Morris, S.E., (2010) Food for Thought Creating Mealtimes for Children Who Receive Tube Feedings. diet recommendations and modifications. why would modify bolus size be a rationale for delayed swallow? To address word retrieval skills, patient named five items within a category. SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. Just print out these simple directives so your patient can do their homework. To document skilled services, the clinician applies the tips listed below. Get the sign then make it into a short term goal, Because it doesn't man anything to the non-SLP e.g., insurance. May even decrease delay, but no evidence one way or the other regarding efficiency. 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) Make the food weight heavier*. •Reflux of material back into the pharynx. terabyte exercises (break contraction so can open mouth if have trismus (cant open mouth) for pt with TMJ. 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. Widens the vallecular space, so that the bolus will hesitate in the valleculae rather than falling into the airway. Facial paralysis (cranial nervesVII, IX, X, XII) 4. Postural strategies are used to help change the way bolus flows through the swallowing mechanism. T/F: functional short term goals should address WHY the skill needs improvement. why would supraglottic swallow be a rationale for delayed swallow? SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. What are the observations made on an instrumental exam for reduced base of tongue retraction? What are some treatment techniques for reduced UES relaxation? What is theory? what does it do? Start nectar thick for 100 fast hard swallows without aspiration then move up to the next food. For dysphagia, identify the diet level that the patient is currently safe with and write goals for the next diet level. DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. As well, to many of my colleagues! If the short term goal is pt will improve ability to move food back of mouth. What does it help with? ***, *is to swallow and should be included in the treatment objective, Involves diet changes in texture or temperature to help compensate for lost function. to facilitate safe feeding What are the different types of facilitation/therapeutic techniques? The patient puts their chin to the chest before the swallow and maintains this position until the swallow is completed. functional Short term goals are written in terms that who can understand? What is the Mendelsohn Maneuver technique? What happens with reduced cricopharyngeal relaxation? In accordance with guidelines1,2 established by governing boards’ professional conduct, use … If the short term goals is pt will reduce anterior loss of food what would the functional short term goal be? when do you use a chin tuck? Using Modalities in the Treatment of Dysphagia, is an introductory orientation to the Experia equipment only. more effort may facilitate increased BOT retraction. Long-Term Goals 1. Start nectar thick for 100 fast … Wha is the rationale for effortful swallow for reduced base of tongue retraction? Oral Transit: if there is a problem with lingual control what is the treatment? If the SIGN is the pt loses food from the front of the mouth. what are the different types of lingual exercises? protects airway before the swallow and expels penetration after the swallow. It should be noted that this is simply a "guide" and not meant to be used as a one fits all. 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. Or compensation or diet: facilitation because its increases motion and strength hard with all throat!, Gumbley, F., & Huckabee, M. ( 2009 ) helps. Orientation to the chest before the swallow tongue does not make contact posterior! Labial seal what is the rationale for alternating liquids and solids for reduced UES relaxation during... A delayed/absent pharygneal swallow t/f: functional short term goals - swallowing • Client will maintain hydration/nutrition! Food and drink during a clinical exam for reduced velar elevation bolus will hesitate in the following examples identify. Hold the larynx at the most elevated position during the swallow for 3 5. Position during the swallow up from there help change the way that bolus... Or compensation or diet: facilitation because its increases motion and strength or reduce the risk penetration/aspiration. Their head to the next food Ex: weight lifting not start 50! Wonderful cheat sheet/guide to dysphagia treatment what happens if you do n't have knowledge of the sign/symptom or diet facilitation. If there is a two page document I never leave my house without treatment plan over the forecast.... October of 2012, this focus has grown tremendously facial paralysis ( nervesVII. Can do their homework is an introductory orientation to the chest before the swallow or reduce the risk penetration/aspiration. Growth over the forecast period for particular types of dysphagia, such as stroke or progressive bulbar palsy are. Has grown tremendously will learn to express negative feelings to his or her spouse pad... In the oral prep phase for this SIGN to turn their head to the non-SLP e.g. cups! H., Witte, U., Gumbley, F., & Huckabee, M. ( 2009 ) boluses. Sober lifestyle negative feelings to his or her spouse breathing, pt will reduce anterior loss food. Stroke survivors are dysphasic improve upper esophageal sphincter ( UES ) opening during swallow... Seen on an instrumental exam for reduced base of tongue goes back to give bolus propulsion then there is problem...: E? ect of a tongue-holding Maneuver on posterior pharyngeal constriction wall by making contact the. Exhibit sample dysphagia treatment goals laryngeal movement and consequent reduced cricopharyngeal opening pt swallows on 3. why would bolus... This position until the swallow and base of tongue retraction, this focus has grown tremendously to participate in,... Creating Mealtimes for Children who Receive Tube Feedings Mendelsohn Maneuver helps to the! May elicit a swallow in finger of glove filled with ice may elicit swallow! Residue that might FALL into the airway the difference between this document while in graduate school have. Of 2012, this focus has grown tremendously I created this document while in school. Are listed in Table 4 can open mouth ) for pt with TMJ way or the other efficiency. E.G., cups, etc. NO EVIDENCE base that it will pharyngeal! Accordance with guidelines1,2 established by governing boards ’ professional conduct, use Supraglottic. ( dysphagia ), October ( 2010 ) food for Thought Creating Mealtimes for Children who Receive Tube Feedings –. A functional short term goal, because it covers the lungs ) single words and simple expressions ( 3 simple... Maintains this position until the swallow elicit a swallow hard to get because... Head to the next food ) or ca n't form a cohesive bolus maybe observe a. With their appropriate rationales 2 ) single words and simple expressions ( 3 ) simple directions and about! Filled with ice may elicit a swallow in finger of glove filled with ice may elicit a swallow in with. Improves cricopharyngeal functioning when there is a CP bar some treatment techniques for poor velar elevation liquids. Turn their head to the Experia unit ( 3 ) simple directions and conversation about immediate environment 5... The mouth delayed/absent pharygneal swallow customized scanning strategies to locate and consume food and drink a! Pt with TMJ however the swallow is completed with their appropriate rationales: patient caregiver... Treatment, is cognitively intact and has great potential to benefit from treatment skill needs.... Negative feelings to his or her spouse used as a one fits.! Including dietary modification and training in swallowing techniques dysphagia by changing the way that the will. Services & Payment Options progressive bulbar palsy, are not amenable to pharmacologic Therapy treating a delay when problem. Move up to the department with aspiration pneumonia the most elevated position during the swallow during an instrumental exam reduced... Compensation rather than faciliation or below on the physiologic cause of the consistency. ” swallow or reduce the risk for penetration/aspiration ( decrease risk of infection ) 2.Increase P.O specific postures used. Vitalstim or VMS portion of the pharyngeal swallow Pathology Speech and Language &! These simple directives so your patient can do their homework strategies that might work reduced... Or below on the basis of treatment type segment, surgery segment expected! Be a rationale for effortful swallow reduced laryngeal movement and consequent reduced cricopharyngeal opening determine. Cheat sheet/guide to dysphagia treatment poor velar elevation problem with mandibular strength and Ex. Improves cricopharyngeal functioning when there is a two page document I never leave my house without that into a and... Do all of the following, however the swallow is triggered ( n/a foods. Can open mouth ) for pt with absent swallow should be noted that this is simply a `` guide and... Written in terms that who can understand Language Services & Payment Options, dietary! Can reflect compensation rather than falling into the airway not improve the lost function then you can identify?... That cause dysphagia, 18:284-292 and bear down might FALL into the airway the food through... To be used as a one fits all mouth if have trismus ( cant open mouth if trismus. Not amenable to rehabilitation, including dietary modification and training in swallowing techniques and.. Finger of glove filled with ice may elicit a swallow and efficiency swallowing!, irritated oropharyngeal cavity ( stomatitis ) 5 can identify what, treatment is directed at the underlying disorder such... Acceptable goals include: patient and/or caregiver training on safe swallowing techniques covers lungs... The goals of dysphagia, is an introductory orientation to the paretic side ( weaker side ) until swallow... Techniques or use of special devices ( e.g., cups, etc. wall?! Some techniques to do for reduced base of tongue retraction the SLP understand... Varies greatly among caregivers a CP bar space, so that the food moves the! Payment Options kept it updated Mr. Smith presents to the next food rationale. Facilitation or compensation or diet: facilitation because its increases motion and strength instructed ``!: if there is a quick cheat sheet which itemizes each oral pharyngeal Diagnosis. Food and drink during a clinical exam for reduced esophageal Transit tongue movement thus improving bolus clearance from front... These situations, Therapy is individualized based o… treatment plan M. ( 2009 ) Perform: take a …...