Dysphagia

Bad signs of dysphagia

• Wet gurgle voice

• Delayed swallow/slow oral transit

• Hypotonicity

• Poor positioning

Dysphagia Good things

• Chin tuck

• Double swallow

• Mendelssohn

• Thicken liquids

• Puréed foods

Dysphagia Interventions

• Hemiplegia: Turn head to weaker side

• Trunk weakness: Upright, midline, supportive positioning

• Oral motor: ROM, exercises of tongue, jaw, check

• Pocketing (tongue issues): Sensory stimulation or exercises of tongue

• Cognition: Quiet environment, pacing

Problems w/ Dysphagia can be address with:

• Positioning

• Oral motor exercises

• Use of AE

• Modified swallow techniques

• Changes in diet consistency

Dysphagia Interventions: Positioning

• WE encourage an upright seated position:

  • Chin tuck: constrains airway

  • Head turn: closes off weaker side

  • Mendelssohn: opens pathway

Dysphagia Interventions: Exercises

• ROM of tongue, jaw, cheeks

• Motor task like blowing bubbles or sucking through straw

Dysphagia Interventions: Visual neglect

• Present food within the client’s visual field

• Help the client to scan the plate

Dysphagia Interventions: Decreased Postural Control

• Leaning to one side, ataxia, poor body awareness

  • Interventions:

    • Trunk ex, supportive positioning, and AE

• Increased Tone:

  • Interventions:

    • Promote hip flexion, leaning on table, ROM ex

• Decreased Tone, pocketing, oral transit:

  • Interventions:

    • Vibration, lip and tongue ex, straws, place food to unimpaired side, cold food or liquids, stroke cheek

Dysphagia Interventions: Decreased Cognition

• Quiet areas such as the client’s room

• Introduce one piece of adaptive equipment at a time

• Suggest placing fork down after each bite (impulsive)