Compensatory & Rehab Practices Dysphagia Quiz

Compensatory Strategies: Posture Techniques

chin up/down

head rotation

chin down w/ head rotation

head tilt

side laying down

Compensatory Strategies: Increasing Sensory

temperature

sour

viscosities

Compensatory Strategies: Modified Volume/Speed (Presentation)

pipette

syringe

spoon

straw

cup

Compensatory Strategies: Food Consistency

SOLIDS:

regular

mechanical

chopped

ground

puree

pudding

LIQUIDS:

honey

nectar

thin nectar

thin

What are the traditional approaches to therapy/rehab

oral motor

range of motion

resistance

Oral Motor Control Exercises

lingual lateralization (difficulty during chewing)

tongue elevation

tongue cupping of bolus

anterior-posterior movement of midline of tongue midline

Range of Motion Exercises can

improve coordination, oral motor control, and movement of lips jaw, oral tongue, tongue base, and vocal folds

Range of Motion Exercises … 

lingual ROM

jaw ROM (spasticity → therabite)

ROM for Pharyngeal Structures: Vocal Folds

VF adduction (push-pull builds glottal pressure)

Repeating “ah” with hard glottal attack

ROM for Pharyngeal Structures: Tongue Base

gargling

lingual retraction

yawn-sigh (opens larynx)

effortful swallow

masako (swallowing while you bite your tongue → stretches BOT and PPW)

ROM for Pharyngeal Structures: Laryngeal Elevation

hold falsetto (elevates pitch and raises larynx)

jaw depression against resistance (ball under neck and open jaw)

mendelsohn (mandel has a hold → holds larynx at peak of swallow)

CTAR (jaw resistance opening)

shaker (laying down & look at toes → UES movement & hyolaryngeal elevation)

Resistance Exercises

pushing tongue against tongue blade to improve motion and strength

IOPI/MOST quantifies and measures this pressure and resistance!!!

Swallow Maneuvers: Supraglottic Swallow

Compensatory: protects airway BEFORE the swallow, targets VF closure

Rehab: used for VF weakness

When would you use a supraglottic swallow

delayed pharyngeal swallow

Swallow Maneuvers: Super-supraglottic swallow

closes airway BEFORE AND DURING swallow

targets closing VFs AND entrance to laryngeal vestibule

When would you use a super-supraglottic swallow

when there’s no hyolaryngeal elevation nor forward movement of the arytenoids to the epiglottis

Swallow Maneuvers: Effortful swallow

increased BOT motion & strengthens pharyngeal muscles

When/why would you use an effortful swallow

to increase pharyngeal contraction to clear residue

Swallow Maneuvers: Mendelsohn

improves hyolaryngeal elevation & improves duration of UES opening

Why would you use the mendelsohn

it improves airway protection and bolus

Principles of training that makes an exercise effective

specificity (does it mimic the target outcome)

muscle overload (needs to be fatigued)

frequency

progression

adherence

New Therapy Approach: LSVT

voice therapy

only Parkinson’s

strict, most researched

VF closure & sub glottal pressure

New Therapy Approach: IOPI/MOST/Swallow STRONG

targets lingual strength

goal is to increase oral pressure

change resistance

measures improvement

New Therapy Approach: CTAR/Jaw Opening Against Resistance

increase hyolaryngeal elevation (supra hyoid muscles)

New Therapy Approach: Expiratory Muscle Strength Training (EMST)

expiration & airway muscles

goal = airway clearance

cough to clear?

New Therapy Approach: McNeill Dysphagia Therapy

gatekeepers

want to get NPO eating

improving strength by changing viscosities

New Therapy Approach: Neuromuscular Electrical Stimulation

electrodes stimulate muscle contractions through electrical pathways

unsure effectiveness bc of placement & does it actually do what it’s supposed to

Consistency for reduced tongue coordination

applesauce (does not require a lot of coordination)

Consistency for reduced tongue strength

thin (does not need pressure to push it back)

Consistency for delayed pharyngeal swallow

thicker (moves slower)

Consistency for reduced laryngeal movement & UES dysfunction

thinner to go down faster

Consistency for reduced airway closure

thicker - less likely to get stuck in the gap

Consistency for reduced lingual ROM

medium (too thin races and too thick gets stuck)

What can you do with a delay in swallow initiation (pharyngeal issue)

Compensatory (SENSORY):

viscosity

volume

temperature (cold)

sour

carbonated

Rehab (MOTOR):

IOPI

super-supraglottic swallow

head tilt

chin tuck

thicken liquid

What can you do with base of tongue issue where material is getting stuck in vallecula (pharyngeal issue)

Compensatory:

head turn rotation

mendelsohn

masako

effortful swallow

Rehab:

masako

effortful swallow

mendelsohn

What can you do when there is residue in the vallecula due to poor BOT movement due to poor hyolaryngeal elevation

Compensatory:

chin tuck

head turn

effortful swallow

Rehab:

effortful swallow

What can you do when you get residue/material getting stuck in the pyriform sinuses

Compensatory & Rehab:

mendelsohn

effortful swallow

masako

shaker

thin liquids

What can you do when there is decreased hyolaryngeal elevation and residue throughout, and decrease in UES opening and airway exposure/aspiration

Compensatory:

chin tuck

Rehab:

mendelsohn

super-supraglottic swallow

neuromuscular electrical stumulation

CTAR (resistance ball under chin)

What can you do when there is upper esophageal sphincter dysfunction and therefore residue in the pyriform sinuses

Compensatory:

head turn

volume (lighter)

viscosity (thinner)

Rehab:

mendelsohn

shaker

effortful swallow