Treatment Strategies: Why, How, What?
Strategy |
Why? |
How to do |
What it does |
| Head Back | Poor oral control Must have normal pharyngeal phase |
Tilt head back during swallow | Uses gravity, duration of UES relaxation decreases with increased head extension |
| Chin Tuck | Premature loss Reduced airway closure |
Touching chin to chest before & during swallow | widens valleculae narrows airway Pushes tongue base to pharyngeal wall |
| Head rotation | Unilateral pharyngeal Paralysis, reduced PES |
Turn head to weak side before & during swallow | Direct bolus to stronger side Increases VC closure Reduce pyriform retention |
| Head Tilt | Unilateral pharyngeal Paralysis |
Tilt head to stronger side before & during the swallow | Directs to stronger side with use of gravity |
| Thermal Stim or Cold Bolus | Delayed swallow Reduced sensory recognition |
Cold laryngeal mirror & rub anterior facial arches | Decrease delay |
| Supraglottic Swallow | Reduced or late VC closure Delayed swallow |
Inhale, hold breath, swallow, cough, swallow | Protect airway improves coordination |
| Effortful Swallow | Reduced tongue base Retraction (vallecular retention) |
Swallow hard, push & squeeze all muscles in mouth and throat | Effort increases posterior tongue base mvmt. |
| Mendelsohn | Reduced laryngeal elev. Reduced PES |
As you swallow, hold it in mid opening swallow for several secs. | Increases duration & width of PES, strengthens & retrains muscles of laryngeal elev. |
| Shaker | Reduced PES opening | Lay flat on back, raise head high to see toes without raising shoulders. Hold 1 min, rest 1 min 30X |
Strengthens Suprahyoid musculature Decreasing pressure above UES |
| E-Stim | Reduced laryngeal elevation | Stim of submandibular area | Retrains laryngeal musculature for laryngeal elevation |
| Thick liquids | Delayed swallow Decreased laryngeal elev. Reduced VC closure |
Thickener | Thinner liquids penetrate more easily & are more difficult to control orally |
| Puree Diets | Delayed swallow Reduced closure Reduced elevation Reduced mastication |
Foods blended Does not require chewing |
Do not flow as quickly as thin Easier to control |
| Mechanical Soft | Reduced mastication | Ground meats; fruits Soft cooked vegetables |
Soft enough to be chewed easily |
Any alteration to the neurological system has the potential to cause dysphagia. It is important for the SLP to explore the neuroanatomical level of the disease process by conducting an MBSS. This will determine the motor and sensory etiologies and signs and symptoms of the presenting dysphagia. The results of the MBS will guide the choice of treatment strategies that are chosen according to the anatomic/physiologic rationale. An MBSS will allow you to evaluate ALL phases of the swallow: Oral Phase, Pharyngeal Phase, and Esophageal Phase.