|Anterior loss of food or liquids||Decreased lip, jaw strength||Oral|
|Can not suck through straw||Decreased lip, jaw strength
Decreased lip sensation
|Pocketing||Decreased tongue strength and sensation||Oral|
|Reduced mastication||Decreased tongue strength||Oral|
|Oral hold||Decreased tongue strength & sensation||Oral|
|Loses food prematurely over back of tongue||Decreased base of tongue control||Oral|
|Penetration BEFORE the swallow||Decreased base of tongue control||Oral|
|Penetration DURING the swallow||Delayed reflex||Pharyngeal|
|Penetration AFTER the swallow from retention in the pyriforms||Decreased laryngeal elevation||Pharyngeal|
|Penetration from retention in the valleculae||Decreased base of tongue or laryngeal pressure||Pharyngeal|
Treatment Objectives for Short Term Goals
Anterior loss – Patient will be able to keep PO in the mouth while eating without losing bolus anteriorly.
- Patient will eliminate loss of PO when clinician provides jaw support on ___ of ___ trails
- Pt. will achieve lip closure around object ( Lifesaver on string, popsicle, ice cube) for ___ sec on ___ of ___ trails
- Pt will increase sensitivity to cold when clinician rubs lips with cold spoon on __ of __ trials.
- Patient will pucker lips as if to blow a kiss on ___ of ___ trails
- Pt. will hold tongue depressor between closed lip, not teeth) for count of 10 on ___ of ___ trails
- Patient will puff cheek and keep lips tightly sealed on ___ of __ trails
Bolus Propulsion – Patient will move bolus to back of mouth in coordinated fashion to be able to propel PO safely through hypopharynx and reduced risk of it falling into the airway.
- Patient will move lemon swab placed between tongue and hard palate from front to back on __of __ trials.
- Patient will sweep tongue from alveolar ridge to junction of hard and soft palate on __ of ___ trails
- Patient will pop tongue against hard palate on __ of __ trails
Premature Loss – Pt will be able to keep food from falling over the back of the tongue into the airway.
- Patient will produce a forceful /K/ at end of words on __ of __trails
- Patient will exert pressure with base of tongue up against a tongue depressor on __ of __ trials
- Patient will use effort swallow with/without cues on __ of __trials
- Patient will use chin down posture (if loss is not to pyriforms) for ___ consistencies with/without cues on __ of __ trails
Laryngeal Closure – Patient will achieve closure of larynx during the swallow sufficient to keep PO from entering the airway
- Pt will use a supraglottic swallow for ___ consistencies with/without cues on __ of __ trials
- Patient will demonstrate Valsalva maneuver (breath hold) on ___ of ____trails.
- Patient will produce /a/ while pulling/pushing against resistance on ___ of __ trails
- Pt will use multiple swallows for each bolus with/without cues on __ of __ trails.
- Pt will control bolus size to __ with/without cues on __ of __ trials
- Pt will empty mouth before next bite with/without cues on __ of __ trials
Laryngeal Elevation – Pt will reduced change of penetration by increasing laryngeal elevation and reducing retention in the pyriforms
- Patient will use Mendelsohn Maneuver for ___ consistencies with/without cues on ___of ___trials
- Patient will produce /i/ in a continuous fashion, including falsetto on ___ of __ trials
- Patient will trigger volitional swallow in timely conjunction with E-Stim with/without PO, with/without cues on ___ of ___ trials