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Speech Pathologist Reference Sheet

Dec 19, 2006 Posted by: DiagnosTEX Evaluation of Dysphagia,  Treatment and Strategies

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CN 5 – Trigeminal – sensation of face/ motor of palate and pharynx

Primary interest to SLP’s are Maxillary and mandibular branches

1. Test with a wisp of cotton gently to the nostrils which should resulting the wrinkling of the nose

2. Bulk of masseter and temporalis muscle is tested by palpation of the muscles while pt. clenches their teeth

3. After bulk is determined, strength of muscles should be tested by attempting to open the jaw. Jaw will deviate to one side

4. Inside mouth, weakness of tensor vili palatini may manifest itself as tilting of the uvula to the weak side.

CN 7 – Facial – tongue and face muscles

Test by inspection of facial symmetry and then individual muscle for strength

CN 9 – Glossopharyngeal – tongue, soft palate, pharynx

Testing this muscle is accomplished by testing the gag reflex

CN 10 – Vagus – motor to larynx, pharynx

1. Test by inspecting palate, it will be lower and less arched. Say /a/ and you will see deviation to the normal side

2. Gag reflex will be reduced

3. Bilateral weakness – hypernasal and nasal regurgitation

4. Unilateral – hoarse voice

CN11 – Accessory – motor to larynx, chest, and shoulder

Muscle strength can be tested by a shoulder shrug

CN 12 – Hypoglossal – tongue

Test tongue motor function by protruding tongue, push tongue against cheek

ALS has good bulk but plegic with attempted volitional movement

 

One muscles and/or one nerve involvement can affect the normal swallow function.
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Food and Drug Interactions important for Speech Pathologist to know;

Coumadin (Anticoagulant) – No salad, broccoli, cauliflower, spinach, brussel sprouts, turnip greens, or liver.

Theophylline (Bronchial Dilator) – No Caffeninated Beverages

Lasix (Diuretic) – send oranges, OJ, bananas, potatoes

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C-1 – Hard Palate, Soft Palate, Velum

C-2 – Base of tongue, valleculae

C-3 – Base of Tongue, Retropharyngeal space, valleculae, epiglottis

C-4 – Hyoid Bone, Pyriform Sinuses

C-5 – Vocal cords

C-6 – Vocal Cords, Pyriform Sinuses, Cricopharyngeal muscle

C-7 – Cricopharyngeal muscle

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Valleculae/Tongue Base

  1. Yawn
  2. Prolong /i/ or “eeeee” with a high pitch quality
  3. Pretend to gargle
  4. /k/ and /g/ words/sounds. Say “guh”
  5. Pull/hump tongue base posteriorly
  6. Head tilt or turn as appropriate
  7. Chin tuck if appropriate
PES/UES/Cricopharyngeal sphincter
  1. Effortful/dry/hard swallow
  2. Alternate solids and liquids if appropriate
  3. Head turn or tilt if appropriate
  4. Chin thrust (not chin tuck!)
  5. Hyolaryngeal exercises if it is a neurological involvement
  6. Mendelsohn
  7. Myotomy as a last resort
Pharyngeal Posterior wall
  1. Masaka (protrude tongue between teeth – hold – swallow hard)
  2. Repeat and increase rate of swallow
  3. Thermal stimulation/application
  4. Alternate solids and liquids if appropriate
  5. Expectoration
Pharyngeal Pyriform
  1. Head turn to damaged side if appropriate
  2. Tilt head to stronger side if appropriate
  3. Alternate solid and liquids if appropriate
  4. Push against mandible while swallowing
  5. Successive swallow
Laryngeal or Hyolaryngeal exercises
  1. Lie flat – raise head – look at toes/feet – hold
  2. Mendelsohn
  3. Falsetto exercises
  4. Adduction ex while lifting or pushing
  5. Supraglottic swallow if appropriate
  6. Effortful swallows
  7. Mandibular protrusion – hold
  8. Posterior lingual elevation
  9. Valsalva maneuver (breath hold)
  10. Resistive jaw opening and closing exercises

 

GERD Precautions

  1. Always eat in a relaxed setting
  2. Eat small meals throughout the day instead of one large meal
  3. Try separating solids and liquids. Do not drink during meals.
  4. Always include protein items like lean meat, poultry, cottage cheese, or low-fat cheese in each meal
  5. Avoid:
  • Caffeine (found in coffee, tea, cola)
  • Mint
  • Alcohol
  •   Chocolate or cocoa
  •   Chili powder or other spices
  •   Cured or spiced meats like sausage and hot dogs
  •   Pepper
  •   Citrus juices (Orange, lemon, tomato)
  • Pickled Items
  1. Keep Fat content low
  2. Do not eat right before you lie down to rest, go to sleep at night, or recline in a chair. Allow 30-45 minutes after eating before lying down
  3. Elevate the head of you bed six inches. This is best done with blocks under the legs at the head of the bed. It’s not effective to add extra pillows.
  4. Other things to change: if overweight, lose weight, avoid tight clothing, stoop, and do not bend, avoid lifting heavy objects, and stop smoking.

 

Normal Changes in Advance Age:

Decreased salivation

Decreased taste

Decreased smell

Decreased pliability of the epiglottis

Decreased elasticity and strength of lung muscles

Decreased muscle tone of the laryngeal & pharyngeal muscles

Increased threshold for a cough reflex

Increased threshold for a swallow reflex

Incidence of esophageal disease and reflux

Increased chest wall stiffness

Changes in ossification of cartilages

Degeneration of bony structures

Changes in dentition

Larynx lowers to level of 6-7 of the cervical spine

Fatigue

10% reduction in brain weight

30% decline in the speed of action

 

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