Oral Care

Oral Care

The First Thing.... When I assess a patient with dysphagia, my first plan of attack is to teach the patient about oral care and start an oral care plan with that patient! Aspiration Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways, that is, the act of taking [...]

Respiratory Muscle Strength Training

Respiratory Muscle Strength Training

Inspiratory Muscle Strength Training  Inspiratory strength training works on the muscles of inspiration the diaphragm, the intercostals. Inspiration involves contractions of the diaphragm and external intercostals, which increase intrathoracic volume and decreased volume in pressure.  Respiration is a recoil from inspiration. Exhalation involves relaxation of the inhalation muscles, recruitment of abdominal and internal intercostals to force [...]

Lingual Strengthening Using Resistance

Lingual Strengthening Using Resistance

Research  Research by Dr. Lazarus and Dr. Robbins has focused heavily on lingual strengthening. Many of these research articles have proven to us that lingual strengthening using resistance such as an IOPI does increase not only tongue strength and at times, tongue mass, but also improves the overall swallow.  This same research has also shown us that using [...]

Exercise

Exercise

Recent and some previous dysphagia literature emphasizes the use of exercise physiology. Researchers such Lazarus et. al, Robbins et.al, Burkhead et. al and Clark have published the need for incorporating exercise physiology into dysphagia therapy. They emphasize the need to understand the muscles involved in the swallowing mechanism, understand their function so that you can [...]

CTAR (Chin Tuck Against Resistance)

CTAR (Chin Tuck Against Resistance)

Way back in 2014...... Way back in 2014, an article was published describing Chin Tuck Against Resistance. When we look at patients with dysphagia from Pharyngoesophageal Segment (PES) dysfunction, we look at strengthening the suprahyoid muscles. These muscles assist in hyolaryngeal excursion and therefore play a part in esophageal opening. Isokinetic vs. Isometric CTAR vs [...]

FEES Following Extubation

FEES Following Extubation

The 1998 Paper Leder, Cohn and Moller investigated the incidence of aspiration following extubation in critically ill trauma patients. The study looked at 20 patients who required oropharyngeal intubation for at least 48 hours.   All FEES were completed around 24 hours following extubation. Remember, aspiration is when the bolus enters the airway, below the level [...]

Why the Dye?

Why the Dye?

The many colors of FEES You've maybe witnessed a FEES exam.   It can sometimes be quite colorful. Often, green food coloring is used during the exam.   This helps to make the bolus "stand out" in the pharynx.   You may also see blue food coloring used or even white food coloring or naturally white foods such [...]