Lecture 3

Speech Language Pathology Spa6565 with Plowman at University of South Florida

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By: Diana Rosero
Created: 2010-10-11
Size: 28 flashcards
Views: 9

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Clinical Evaluation Intends to Assess:
List them (1st 5)

Medical Dx, Medical Hx, Swallowing Hx
Medical Status
Oral Anatomy
Respiratory function in relation to swallow
Labial control

Clinical Evaluation Intends to Assess:
List them (2nd 5)

Lingual control
Palatal Function
Pharyngeal wall contraction
Laryngeal control
Ability to follow directions

What are the RED flags that indicate evaluation?

Recurrent pneumonia
Unplanned weight loss
Coughing with medications and/or meals
Vocal paralysis
Labored breathing
Difficulties chewing
Dehydration
Changes in eating
Non-oral feeding
Abnormal oral feeding

Sign
Define

objective measurement/ observation noted by clinician during physical exam

Symptom
Define

Any perceptible change in body function the patient notices

What are some important historical variables reviewed from the medical history?

Congenital disease
Neurological disease
Previous test results
Surgical procedures
Esophageal disorders
Respiratory impairment
Systematic & metabolic disorders
Advanced directive

Common complaints
Food sticking

Most frequently have esophageal motility disorder

Common complaints
Difficulty with solids

Most frequently have esophageal obstruction disorder

Common complaints
Difficulty with liquids

Most frequently is of oropharyngeal origin

Common complaints
Difficulty with solids and liquids

Most frequently have esophageal motility disorder

Common complaints
Choking vs. no choking

Choking= Pharyngeal origin
No choking= Esophageal origin

Mental status screen
Determines what?

Appropriate alertness
Appropriate attention
Orientation
Memory
Appropriate decision making
Impulsivity

Components of ORAL MECH EXAM for
TONGUE-
CN ______
List 4 components

Strength
Tone
Range
Speed

Components of ORAL MECH EXAM for
LIPS-
CN ______
List 5 components

Strength
Range
Speed
Spread
Seal

Components of ORAL MECH EXAM for
JAW-
CN ______
List 3 components

Strength
Range
Speed

Components of ORAL MECH EXAM for
LARYNX-
CN ______
List 3 components

Cough
Pitch
Phonation

Swallow trials are only proceeded to when patient can...

manage own secretions
is alert
cognitively able

What are 6 general rules for swallow trials?

Start with smaller volumes, easiest textures
As tolerated proceed to larger volumes
Proceed to more complex textures
Clinician controls feeding
Allow patient, if appropriate, to control delivery
Minimize distractions

Some important observations are:

Chewing and bolus prep
Pre- and post- swallowing respiratory rate
Fatigue
Patients ability to self feed
Feeding rate
Bite size posture
Dentures

Other test to detect aspiration
List them (5)

3 oz. water test
Cervical Auscultation
Modified Evans blue test
MASA
Oxygen saturation test

Evidence based predictors of dysphagia
List them (6)

Dysphonia
Wet gurgly voice
Dysarthira
Poor management of secretions
Cough on oral trials
Decreased laryngeal elevation

Trigeminal Nerve CN V
5 observations

Jaw open and close without resistance
Jaw lateralization
Jaw strength, rate, range of motion
Jaw coordination, trismus
Pathologic bite reflex

Facial Nerve CN VII
6 observations

Facial muscles at rest
Raise eyebrows
Lips closed against resistance, smacking, pucker, smile
Lip spread /i/; lip rounding /u/; bilabial closure on articulation
didactic tasks (/p//p//p/) and alternating (/i//u//i//u/)
Puff cheeks, blowing

Glossopharyngeal and Vagus Nerve CN IX & X
6 observations

Uvula/ velum at rest
Palatal movement on phonation
Gag reflex: afferent (IX), efferent (X)
Voice
Cough
Dry swallow

Hypoglossal Nerve XII
4 observations

Tongue at rest (atrophy, fasiculations, tremor)
Movement with and without resistance (protrusion, retraction, elevation, depression, lateralization, rotation)
Rapid tongue movement
Strength, speed, ROM, accuracy, coordination

Testing materials
List liquids:

Ice chips
Water
Nectar thick
Honey thick

Testing materials
List solids:

puree
mechanical
regular
mixed

Testing materials
List viscosities:

Volume
Texture and consistency
Medium (cup, straw)
Feed vs. self feed

About this deck

By: Diana Rosero
Created: 2010-10-11
Size: 28 flashcards
Views: 9

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis