Ask the patient to drink 30m of water as usual, observe and record the drinking time, whether there is choking, drinking status, etc., and record whether the patient has the following symptoms, such as slurping, slurping, water flowing out of the corner of the mouth, and asking for food while eating. Continue to drink reluctantly, drink cautiously, etc., and grade and judge them.

Grading

judge

Operation steps: Take a sitting position, the examiner places the index finger transversely on the upper edge of the patient's thyroid cartilage, and instructs him to make swallowing movements. When it is confirmed that the larynx rises with the swallowing movement, passes over the index finger and then resets, it is judged that a swallowing reflex has been completed. When the patient complains of dry mouth and difficulty in swallowing, a little water can be poured on the tongue to facilitate swallowing. Swallow repeatedly as quickly as possible and record the number of completed swallows

Assessment criteria: Swallowing dysfunction is abnormal if the number of swallows is less than 3 times within 30 seconds.

Suitable for bedridden people

Determine whether the patient has aspiration. If there is aspiration, a swallowing imaging examination should be performed.

Considered the "ideal method" for dysphagia examination and the "gold standard" for diagnosis

Main observations

VFSS manifestations of dysphagia

It uses a laryngoscope to observe the anatomical structures of the pharynx and larynx such as the epiglottis cartilage, spoon-shaped cartilage, and vocal cords under direct vision, as well as the functional status of saliva retention, saliva flow into the larynx, and glottis atresia.

Lateral movements of tongue muscles Practice actions such as raising the tip of the tongue and the tongue body toward the back of the mouth, inhaling the cheek, curling the tongue body, and resisting resistance.

It uses frozen lemon sticks to stimulate the reflex function of the throat, focusing on three reflex areas: the soft base of the tongue, the upper pharyngeal constrictor muscles and the middle pharyngeal constrictor muscles, so as to strengthen the oral muscle function and throat reflexes and improve the swallowing function.

Use modified vibrator, fingers, ice cotton swabs to stimulate lips, cheeks, tongue, throat wall, soft tissue and other parts

Specific method: When swallowing, fix a small part of the tongue body behind the tip of the tongue between the teeth or the therapist pulls out a small part of the tongue body by hand, and then ask the patient to make swallowing movements to make the patient's pharyngeal wall contract forward.

This method is mainly used in patients with dysphagia who have weak forward movement of the posterior pharyngeal wall.

Specific method: Let the patient lie on his back on the bed, raise his head as much as possible so that his eyes can look at his toes, but his shoulders cannot leave the bed, repeat several times

This action can make the suprahyoid muscle and other muscles such as the myoglossus muscle, thyrohyoid muscle, and digastric muscle move the hyoid bone and larynx joint upward and downward, and exert an upward and forward pulling force on the pharyngeal esophageal segment. The upper esophageal sphincter is opened, thereby reducing the occurrence of food residue and aspiration after swallowing due to poor opening of the upper esophageal sphincter.

Practice pronunciation of the sound flute with your mouth in your mouth

voice training

Hyoid-laryngeal complex training

Operation method: Take a deep breath and then hold your breath - keep your breath closed, and at the same time eat a mouthful of food - swallow - after exhaling a breath, cough immediately - swallow again - breathe normally through your mouth.

Inhale and hold the breath tightly, pressing down firmly. Hold your breath while swallowing and press down, then cough immediately when swallowing is completed

(1) For patients whose larynx can be raised, when swallowing, ask the patient to press the tongue against the hard object and hold his breath. Hold this position for a few seconds. At the same time, let the patient place his index finger above the thyroid cartilage and his middle finger on the cricoid cartilage to feel the Adam's apple. Lift up

(2) For patients who are unable to lift, the therapist pushes their throat with hands to promote swallowing. That is, as soon as the larynx starts to rise, the therapist places the thumb and index finger under the cricoid cartilage, gently pinches the larynx and pushes up the larynx, and then fixes it. It is important to first let the patient feel the larynx rising. After the larynx is gradually induced, the patient can then consciously maintain the raised position.

The patient sits on a chair, relaxes the body, straightens the body, relaxes the shoulders, relaxes the body, swallows saliva hard, and feels the force in the throat area. Practice 5 to 10 times each time. During the process of swallowing saliva, the patient needs to Use your fingers to feel the movement of the throat, and control your fingers to help the throat move. After the exercise, the patient needs to perform deep breathing and relaxation exercises.