Dysphagia 3

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What does the evaluation for dysphagia include? Hx, chart review, hx of pneumonia, fevers/respiratory infections, psychosocial factors, nutritional status (oral, NG tube, G tube, TPN/IV drip, know %), respiratory status (independent, ventilator, tracheostomy), suctioning needs, mental status, general physical status  
What should the therapist evaluate for mental status? Level of alertness, ability to follow instructions, cognitive level, impulsivity, judgment and safety  
What should the therapist evaluate for general physical status? Gross asymmetries in positioning, drooling, motor control, head/neck control (ROM, muscle tone), trunk control, endurance, supported vs. unsupported sitting, effects of positioning on swallowing  
What should the outer oral evaluation include? facial muscles, lips, jaw, sensation (hot/cold, light touch), ROM of facial musculature, lips, jaw control, tone, motor coordination  
*What should the inner oral status evaluation include? Oral structures and dentition, tongue musculature (ROM , strength), sensation, reflexes  
*What should the evaluation on reflexes include? Cough (voluntary or reflexive), gag, palatal (closes nasal passage, trigger swallow response), swallow (1-3 sec), primitive reflexes (rooting, biting, suck, prevent isolated motor control), tongue thrust (interferes with mouth closure)  
What should a swallowing trial include? Sample of pureed, soft, & ground food, thick, semi-thick, and thin liquid  
Give examples of pureed food. Pudding, applesauce  
Give examples of soft food. Bananas, macaroni and cheese  
Give examples of ground food. Ground meat, tuna with mayo  

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