swallowing stratiges

What do swallowing strategies do

• immediately but typically transiently

• Change the flow and gravitational direction of the bolts to allow for passage into the stomach with improved laryngeal/airway protection

• If the strategy is not used, the swallow will return to the prior status

• No longer term affects on physiological improvement

Swallow stratigraphic can be used in two ways

• in combo with rehabilitative exercises

• Alone

Postural strategies

• body posturing - to support self-feeding and swallowing. Provides a foundation for all interventional efforts

• Phragneal posturing to facilitate bogus transfer during swallowing

Body posturing

• sit upright with the pelvis as far back as possible in solid chair with solid arms

• “ sitting at 90 degrees or 90-90-90

• State eat/drink as upright as possible

Pharyngeal posturing do

Redirect bonus in a specific way to compensate for identified physiological problems

Chin tuck

PT instructed to take sip/bit into mouth, then tuck chain down to chest, and swallow

What it does

• widens vallecula and slows flow to prevent the bolus from entering the airway ( useful for delayed pharyngeal swallow, posterior spillage

• Chin tuck also pushes tongue base backward towards pharyngeal wall ( useful for reduced tongue base retraction and residue in the vallecula

• And narrows laryngeal entrance closure. Can eliminate aspiration during the swallow

Head rotation

• patient rotates head to left or right and then swallows ( looking over shoulder)

What is does

• twists the pharynx and closes off the side to which the person is rotated and the bolus will flow primarily down the other side

• Provides external pull on the PES and facilitates it’s opening

Used for

• unilateral pharyngeal wall paralysis or paresis ( you observe pharyngeal residue only on one side of the pharynx in A-P view) turn head to damaged side to close it off

• Makes the pharynx smaller + increased pressures

• Improving pes opening

Head tilt

• patient tilts head to one side

• Uses gravity to pull food to stronger side wher it can be better controlled

What it’s used for

• unilateral oral impairment, will tilt head towards stronger side

• Unilateral pharyngeal impairment, will tilt head towards the stronger side

Neck extension or chin up

• patient chin is elevated and then she swallows

• Uses gravity to drain food from oral cavity

Used for

• patients’s with reduced tongue control to move the bolus from the anterior oral cavity to the back of the oral cavity

• May cause airway protection with airway protection strategies such as supraglottic swallow to close off the airway

Slurp and swallow

• slurp or suck the bolus into the pharynx using aerodynamic pressure as opposed to lingual control to transfer the bolus

• Circumvents the oral phase and rapidly transfers the bolus into the pharynx, similar to neck extension

• Oral cancer pt with partial glossectomy

Lingual sweep

• actively using the tongue to clear residual from oral recesses and redirecting to tongue blade for swallowing

• A cued or volitional lingual sweep is particularal useful when decreased oral sensitivity is associated with weakness and the patient is unaware of the residue

• If the the tongue is too weak to sweep in certain spots a finger sweep may be substituted

Alternating liquids and solids

• utilize increased flow rate of the liquid to clear residue in the oral and pharyngeal cavity

• If patient does not have problems with premature spillage then “swishing” to clear the oral recesses may also be effective

• Should be evaluated during exam to determine needed ratio and safety with liquids

• May be contraindicated for pts with liquid restrictions

• Patient must be able to recall the task

Dry swallows

• pt is instructed to dry swallow (swallow spit) after every X number of food swallows as needed

• Depends on how full the pharynx is with residual and how at risk it puts the patient

• Anchor way to phrase it

  • Swallow each bolus X times

  • Used to clear oral and pharyngeal residue secondary to any reason

Supraglottic swallow

How to

• take deep breath and hold it

• Place food in mouth

• Swallow, cough , swallow

Why

• provides volitional airway protection, the airway should be closed before the bolus enters the oropharynx

• The volitional cough will clear any laryngeal coating/residue to be potentially aspirated

• Second swallow will hopefully clear any coughed out material and cleared residual