Dysphagia Quiz 5 👅

Compensation techniques are…

short-term adjustments that facilitate swallowing but do not have a lasting effect

Rehabilitation techniques are….

long term techniques that cause lasting changes in swallowing - even after a technique is discontinued.

Compensation technique example

chin-tuck strategy. Patient’s head is tilted forward, narrowing the throat to reduce the risk of anything entering the airway

Rehabilitation technique example

Mendelsohn Maneuver. A swallowing technique where the larynx is held at its peak position during the swallow to improve coordination.

Prevention techniques are…

a way of preemptively avoiding negative outcomes in people who are at higher risk for dysphagia

Prevention technique example

teaching swallowing strategies to those who may develop dysphagia later, even if they currently do not have dysphagia

Dysphagia management is made up of three parts:

Compensation, Rehabilitation, and Prevention

Head Turn Strategy

a type of Compensation technique. Patient tucks the chin toward the chest to narrow the throat and reduce the risk of bolus entering the airway (not really effective in patients with dementia or Parkinson's disease).

Head extension strategy

A compensatory technique. Patient tilts their head back to widen the throat and let gravity help move bolus from the mouth into the throat.

helpful when the tongue isn't working well, but dangerous if the airway can't close properly during the swallow

Effortful Swallow

A compensatory strategy. Patient swallows as hard as possible, which builds up more pressure in the throat leaving less leftover residue behind.

Supraglottic Swallow strategy

a Compensatory strategy. Patient holds their breath, swallows, and coughs to clear any residue from vocal folds. This works because the glottis (space between vocal folds) closes horizontally when someone holds their breath.

Super-Supraglottic Swallow Strategy

A compensatory strategy. Patient holds their breath while straining, swallows, then coughs gently. The extra effort causes even better airway protection than the regular supraglottic swallow. Should NOT be used in patients with heart disease.

Head-Lift Exercise (Shaker)

A rehabilitative technique. Patient lies on their back and lifts their head up to see their toes without lifting their shoulders. Strengthens the muscles that help open the upper esophagus during swallowing. Many patients struggle to practice this regularly.

Tongue-Hold Maneuver (Masako)

A rehabilitative technique where the patient holds the tip of their tongue between their teeth while swallowing, which causes the back of the throat to move forward more. Meant to strengthen muscles. Should NOT be done with actual food or liquid. Evidence is weak and it carries some risk

Frazier Water Protocol

Protocol that allows patients to drink water between meals. Excessive oral care is important. Does not significantly increase the risk of lung infection (most of the time).

National Dysphagia Diet (NDD) – 4 levels

An outdated system for modifying food textures. Level 1: Pureed; Level 2: Mechanically Altered; Level 3: Advanced (soft solids); Level 4: Regular.

IDDSI levels

International Dysphagia Diet Standardisation Initiative. A newer system that replaced NDD, providing clearer labels and simple tests for modified foods.

Medialization Thyroplasty

A surgical option to improve glottal closure. A small implant is placed behind one vocal fold to push it toward the middle, helping the airway close better during swallowing. The patient stays awake so the surgeon can check their voice during the procedure.

Botox (PES)

A surgical option for ppl w dysphagia. Botox is injected into the muscle that controls the PES, to relax it. makes it easier for food to pass through. Should not be used in patients with significant acid reflux.

sEMG Biofeedback technique

An adjunctive modality. Sensors on the skin pick up muscle activity and display it on a screen, so patients can see in real time how hard their swallowing muscles are working. Especially useful for learning the Mendelsohn maneuver.

adjunctive modality

technique that supports therapy but is not a treatment on its own.

NMES (Neuromuscular Electrical Stimulation)

An adjunctive modality. Therapy where small electrical currents are placed on skin to stimulate weakened swallowing muscles. Evidence is mixed, not fully proven to work yet.

Clinical Swallowing Examination (CSE)

A thorough bedside evaluation done by an SLP. Includes reviewing medical history, checking the mouth and throat, assessing speech and cognition, and observing swallows.

Screening vs. Assessment

Screening doesn't diagnose anything. Assessment is the full evaluation diagnoses someone.

Sensitivity vs. Specificity (screening)

Sensitivity = how good a test is at identifying people who DO have a disease. Sometimes flags people who are actually fine (false alarms).

Specificity = how good a test is at identifying people who DON'T have a disease. sometimes misses people who actually do have the disease (missed cases).

Higher sensitivity means more _______ _______. higher specificity means more ______ _______.

false alarms, missed cases.

Case-Finding

A type of screening done on people who are already known to be at high risk.

Parallel vs. Serial Testing

Within a CSE, there are multiple subtests the SLP can run.

Parallel: run all the subtests at the same time and combine all the results together to form one overall impression.

Serial: you run one test at a time. If the patient passes the first test, you stop.

CSE tests come ___ instrumental testing, and aren’t reliable for catching _______ ____________.

before,silent aspiration

Parallel/Serial Testing pros and cons

Parallel

• Pro: Better at catching people who have a problem

• Con: More false alarms

Serial

• Pro: Better at clearing people who don't have a problem

• Con: More missed cases

Treatment Burden

The total cost hat a treatment plan puts on a patient and their caregiver. Good therapy has to be doable outside of the clinic, not just during a therapy session.

Exercise Principle, Specificity

Principle: Exercise should directly match your goal. The best exercise for improving swallowing is practicing swallowing itself.

Exercise Principle, Reversibility

If you stop practicing, you lose the progress you made. Patients need a maintenance plan to avoid losing their progress.