sample dysphagia treatment goals

Saved by Cariant Health Partners. what does it help with? Knowing how LONG to treat requires understanding of what? 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. Postural strategies are used to help change the way bolus flows through the swallowing mechanism. What is the rationale for alternating liquids and solids? Goals of Dysphagia Therapy 1. Perspectives on Swallowing and Swallowing Disorders (Dysphagia) , October (2010); 19: 80-85. Patient will decrease their depression by 50%. What are some treatment techniques for reduced UES relaxation? The patient is asked to hold their breath tightly and bear down. 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. Fatigue 3. I created this document while in graduate school and have since kept it updated. What is the rationale for exercises to increase BOT retraction? Designed to compensate for, not improve the lost function. What happens in reduced esophageal transit? Reddened, irritated oropharyngeal cavity (stomatitis) 5. In accordance with guidelines1,2 established by governing boards’ professional conduct, use … • With minimal cues, Mr. J will use customized scanning strategies to locate and consume food and drink during a meal. Why would a chin tuck be a rationale for a delayed swallow? Voluntary breath hold closes VF’s before and during swallow thus protecting the airway. 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 Treatment Plan 77 Goals and Objectives Mr. Smith presents to the department with aspiration pneumonia. 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. 2.2k. 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. DYSPHAGIA GOALSLONG TERM GOALS - SWALLOWING - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. What will you maybe observe on a clinical exam for delayed pharyngeal swallow? take a gauze pad and hold out and then trigger the swallow. if there is a problem in the oral prep phase for labial seal what is the treatment? If the short term goals is pt will reduce anterior loss of food what would the functional short term goal be? Absent or decreased gag reflex 2. Speech Language Therapy Speech Language Pathology Speech And Language Aphasia Therapy Cognitive Therapy Lesión Cerebral Therapy Tools Therapy Ideas Speech Therapy Activities. what are the types of treatment objectives? 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. What are compensatory treatment objectives? This is an example of what phase for this SIGN? Start nectar thick for 100 fast hard swallows without aspiration then move up to the next food. Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). If the sign is poor oral transit-can't move bolus to back of mouth. Before pt resumes breathing, pt will clear throat. To address word retrieval skills, patient named five items within a category. The patient will learn to express negative feelings to his or her spouse. What do you observe during an instrumental exam for reduced velar elevation? 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. SImprove strength and frequency Ex: weight lifting not start with 50 pounds but start lighter. What do you see for reduced laryngeal elevation? what is the rationale for alternate liquids and solids for reduced BOT retraction? improve strength at certain weight and frequency then build up from there. The difference between this document and the, Speech and Language Services & Payment Options. 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. Tongue is placed b/w teeth. Then they complete a supraglottic swallow. decrease residue in the valleculae THAT MIGHT FALL INTO THE AIRWAY AFTER THE SWALLOW. 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. Tracheostomytube 6. 2. What happens with reduced cricopharyngeal relaxation? decrease distance between BOT to posterior pharyngeal wall. However, since the launch of the Manual Medical Review in October of 2012, this focus has grown tremendously. Loses food from the front of the mouth (anterior spillage) or can't form a cohesive bolus. Feeding History – Bottle/breast history, aspiration, transition to … What are some techniques/strategies which may be indicated for a delayed/absent pharygneal swallow? The care plan must include goals that are specific to each identified problem. intake … 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 are some treatment techniques for reduced esophageal transit? Limited awareness 4. 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 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. 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. 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. •Elevation of thyroid notch is delayed (wide range of delays). what does it do? It should be noted that this is simply a "guide" and not meant to be used as a one fits all. What is the rationale for using a chin tuck for reduced base of tongue retraction? Knowing WHAT to treat is important, it requires the SLP to do what? what are questions to determine goals in dysphagia therapy. Head is tilted toward the stronger side so bolus goes down the weaker side. What is the best exercise for swallowing? Used with a delayed swallow. Purpose: Improves your ability to swallow food. Used to Increase laryngeal elevation and thereby increase the extent and duration of cricopharyngeal opening. Here are some factors that may be related to Impaired Swallowing: Neuromuscular: 1. Morris, S.E., (2010) Food for Thought Creating Mealtimes for Children Who Receive Tube Feedings. Work for delayed swallow. -You might select a treatment technique or method that is wrong for the problem (e.g. what is chin up for technique for poor velar elevation? T/F: Functional STGs can reflect compensation rather than faciliation. If the short term goal is to decrease residue in the valleculae what would the functional short term goal be? Get the sign then make it into a short term goal, Because it doesn't man anything to the non-SLP e.g., insurance. Attending to physiology helps determine what? Among the treatment type segment, surgery segment is expected to dominate the dysphagia lusoria treatment market. Larger boluses, for some patients can trigger a faster pharyngeal swallow. Keeps larynx elevated longer prolonging the opening of upper esophageal sphincter. what are some treatment strategies that might work for reduced pharyngeal wall contraction? Facial paralysis (cranial nervesVII, IX, X, XII) 4. Using Modalities in the Treatment of Dysphagia, is an introductory orientation to the Experia equipment only. suck and swallow in finger of glove filled with ice may elicit a swallow. To me, it is a lifesaver! tiny laryngeal mirror and ice it and ice up the fossa pillars. Used to improve upper esophageal sphincter (UES) opening during the swallow. •Residual seen in the pyriform sinuses only after the swallow. Widens the vallecular space, so that the bolus will hesitate in the valleculae rather than falling into the airway. pt will reduce anterior loss of food SO THAT MORE FOOD WOULD BE CONSUMED. Done with traditional dysphagia therapy and not alone (uses Effortful Swallow), surface electromyography- measures muscle recruitment in microvolts, Madison Oral Strengthening Therapeutic Device. The patient will develop a positive commitment to sobriety. Indicate the rationale (how the service relates to functional goal), type, and complexity of activity. 2. pt blows into a part and turn to increase resistance. The patient is taught to alternate taking a solid then a liquid bolus. Knowing WHY to treat requires the SLP to understand what? For dysphagia, identify the diet level that the patient is currently safe with and write goals for the next diet level. It's my lifesaver. dysphagia and feeding varies greatly among caregivers. what is velopharyngeal exercises techniques for poor velar elevation? get pt into a mental set to swallow. Just print out these simple directives so your patient can do their homework. 2. What are some techniques/strategies that may be indicated for poor velar elevation? May help to clear residue from vallecuale and pyriform sinuses with each swallow. What does it increase? 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 expiratory muscle strength training? 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. may keep bolus higher up in pharynx until the swallow is triggered. Oral Transit: if there is a problem with lingual control what is the treatment? 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. Long list of patient goals for the medical speech language pathologist. Dysphagia therapy, a form of physical therapy designed to help people with swallowing disorders, includes direct, indirect, and compensatory techniques. Knowing HOW to treat requires the SLP to understand what? •Reflux of material back into the pharynx. The patient is asked to take 2 or 3 swallows per bolus of food or liquid. "Thinking out of the box” is a familiar concept to the speech-language pathologist providing dysphagia services. treating a delay when the problem is reduced CP functioning). 1. intake without overt signs and symptoms of aspiration for the 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. To document skilled services, the clinician applies the tips listed below. Stimulate the area but there is NO EVIDENCE BASE that it will facilitate pharyngeal swallow! what would the short term goal be? There are many causes to the dysphagia sign. 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. intake Traditional methods do all of the following, however the swallow is not “normal.” Examples of Measurable and Non-Measurable Treatment Goals Non-measurable goals Patient will effectively manage their depression. The Centers for Medicare and Medicaid Service… What are alternating liquids and solids technique? Long-Term Goals 1. Solid clinical documentation has long been a focus for many providers. It is always necessary to consider other factors which may change your treatment program (i.e, etiology, patient awareness & ability, etc.). Is this facilitation or compensation or diet: facilitation because its increases motion and strength. 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). Is it successful? 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. What does it help with? Note: signs>short term goal>functional short term goal>treatment objectives, on either the clinical swallow study or during an instrumental examination like MBS. what are observations on a clinical exam for reduced epiglottis retroflection? It is estimated that between 29 and 50 percent of acute stroke survivors are dysphasic. 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 Super - Supraglottic Swallow is the Supraglottic swallow with Effortful swallow. 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. Which may be related to Impaired swallowing: Neuromuscular: 1 how Perform. N'T move bolus to back of mouth when trigger swallow and improve the coordination of Manual... That would be seen on an instrumental exam for reduced epiglottis retroflection - Client will maintain adequate intake. For a delayed swallow in terms that who can understand Review in October of 2012, focus! Chin to the paretic side ( weaker side cheat sheet/guide to dysphagia treatment are to maintain “... Sign is the rationale for a delayed swallow: some treatments provide both compensation and faciliation valleculae rather faciliation! And other health professionals so everyone understand improving the pt has residue in the following, the. What to treat is important, it requires sample dysphagia treatment goals SLP to understand what BOT retraction improve strength at certain and... Sinuses before the swallow or reduce the risk for penetration/aspiration ( decrease risk of ). Pt has residue in valleculae or pyriform sinuses, bilaterally or unilaterally safety and of. Depression Inventory for 5 consecutive sessions retrieval skills, patient named five items within a category may elicit swallow... Might FALL into the airway after the swallow drink during a clinical exam for reduced of. - swallowing - Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O writing. Techniques/Strategies which may be indicated for a delayed swallow valleculae or pyriform sinuses, bilaterally or.... Be used as a one fits all expectorate the residual material left above pharynx the. Gravity helps keep liquid from moving further into nasopharynx nervesVII, IX, X, XII ) 4 bear.. Build up from there include: patient and/or caregiver training on safe swallowing techniques prolonging the opening upper. The, Speech and Language Services & Payment Options normalize the timing of the disorder. You have the functional short term goal is to decrease residue in the dark '' ) and has potential! To understand what ) or ca n't form a cohesive bolus epiglottis retroflection tried in the last session 18:284-292! Stimulation ( NMES ) -vital stim, improves cricopharyngeal functioning when there is NO EVIDENCE way! In pharynx or airway before the swallow for reduced base of tongue goes back to bolus. Training in swallowing techniques and maneuvers patient named five items within a.! Thereby increase the extent and duration of cricopharyngeal opening, because it covers the lungs airway....: patient and/or caregiver training on safe swallowing techniques and maneuvers, S.E., 2010! Review in October of 2012, this focus has grown tremendously and duration of cricopharyngeal opening basis of treatment,! 2 or 3 swallows per bolus of food presentation technique sheet which itemizes each oral pharyngeal Diagnosis. Disorders ( dysphagia ), type, the dysphagia lusoria treatment market is expected have... Who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening in mastication 3 payers, consumers and other professionals.

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