Pharyngeal Stage Management

Question 0

What technique can be used to reduce a delay in triggering a swallow?

Answer 0

Increase sensation using:

Chilled bolus

Fizzy drinks (Nixon 1997)

Sour bolus

Question 1

What techniques can be used to buy time for client with a delayed swallow?

Answer 1

Increasing cohesion of the bolus: using thickener

Using flexed head posture: provides wider vallecular space to hold bolus

Narrows airway entrance by bringing tongue base closure to pharyngeal wall and pushing epiglottis posteriorly

Increases length of cricopharyngeal opening

Question 2

Who is most likely to suffer from reduced laryngeal elevation?

Answer 2

Brainstem CVA patients

Question 3

What techniques may be used to improve laryngeal elevation?

Answer 3

Falsetto: client can also monitor this with hand

Mendelsohn manoeuvre

Question 4

What is the Mendelsohn manoeuvre?

Answer 4

Aim: accentuate and prolong laryngeal elevation which results in an increase of the extent and duration of cricopharyngeal opening

How:
Logemann (1998)
Client asked to swallow with hand held to larynx and feel elevation
Next asked to swallow again but this time to hold larynx up for a few seconds and not to allow it to lower
This prolongs time larynx is most elevated, tongue is most retracted in contact with pharyngeal wall and airway is closed