Procedures: Esther Goldstein

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  • 1. Therapy Procedures Esther Goldstein
  • 2. Who can Administer Thermal Stimulation?
    • Certification is required for Speech-Language Pathologists or Registered Occupational Therapists to administer Thermal stimulation.
  • 3. Process
    • Prior to Thermal stimulation therapy the SLP, OT or certified clinician should:
    • Review patient history.
    • Completed functional assessment of swallowing
    • Develop a treatment plan, which may include Thermal Stimulation.
  • 4. Materials To Use……
    • The three most commonly used materials are:
    • Ice Finger
    • Thermo-stim
    • Laryngeal Mirror
  • 5. Ice finger
    • The ice finger is a thermal stimulator that remains cold throughout the entire therapy session. The Ice Finger is 4 inches long below the handle and is 5/8" in diameter.
    • It Helps improve oral motor and oropharyngeal strength and sensation for feeding and swallowing impairments in clients with dysphagia. The malleable gel core is frozen and totally-sealed, so that appropriate thermal stimulation can occur. Additionally, its long lasting cold temperature enables the SLP to use one for the entire duration of therapy.
    • For additional stimulation, it can be dipped into sour substances.
    • The small grip located at the top of the ice finger, makes it easy to evoke mouth opening, insert for sucking, or to overcome a hypersensitive gag reflex. The ice finger is easy to use with clients who oppose intraoral stimulation or have difficulty following one-step commands.
  • 6. Thermo-Stim
    • Thermo-stim is specifically designed, for application of thermal stimulation. It is glass-free and made of spun stainless steel with a baked thermal handle protector. Has good cold retention. 
    • An optional Bite Guard cushion slides over the Thermo-Stim shaft, and helps protect the teeth from damage. The thermo-stim comes in two sizes- Adult is 9" long and Pediatric/Geriatric is 5 ¼" long.
  • 7. Laryngeal Mirrors
    • The One-piece Laryngeal mirror allows safe, easy cleaning and icing. It is safe to use on patients with a bite reflex as ,being that pieces cannot come apart.Laryngeal mirrors should retains cold and accommodates liquid (sour stimuli) for enhancing thermal stimulation. Laryngeal mirrors come in two sizes, 00 mirror(10 mm) facilitates light touch and 0 mirror (12mm) is appropriate for exams of the oral cavity.
  • 8. What is the common procedure?
    • Thermal stimulation is usually administered by a clinician, where stimulation (tapping/rubbing) of the tonsillar fossa -anterior facial arches/pillar is stimulated using a cold medium to elicit the onset of swallowing. Traditionally, a size 00 laryngeal mirror is used to stimulate the arches 4-5 times on each arch before introducing a bolus.In each treatment "set" the tapping/rubbing is done about five times.
    • The swallow reflex should be generated when the head of the bolus reaches the anterior facial arches, speculating that when a bolus passes the arches, the swallow will be stimulated in a timely manner following thermal stimulation. once a set is completed, the patient is then instructed to swallow and may be given a small dosage of liquid through a straw, even carbonated. The extra stimulation from the iced mirror should alert the nervous system, and allow the swallow response to occur more rapidly. Often substances such as lemon is added to the ice and mirror as sour boluses tend to initiate a more rapid reflexive response.
    • Logemann (1989) suggests administering thermal stimulation three times per day per client. Additionally, she also recommends stimulating only the anterior faucial pillar on the patient's stronger side. While these traditional methods are usually effective for treating dysphagia, these methods often require that the patient endure weeks or months of therapy.
  • 9. References:
    • Thermal Stimulation (Logemann, 1989, 1997)
    • www.csuchico.edu/~pmccaffrey/syllabi/SPPA342/342unit7.html - 24k -
    • Alimed.com