Compensatory

Question 1

Compensatory strategies

Answer 1

Changes that affect the swallow in size of bolus, flow, method/rate, sequence of delivery
limitations: pt must always use the technique, might not work, only limited improvement

Question 2

postural changes

Answer 2

head back
head tilt to strong side
chin down
head rotated to damaged side with chin down
head rotation

Question 3

head back/extension

Answer 3

used for: oral transit dysfunction

rationale: gravity helps clear oral cavity

Question 4

chin tuck

Answer 4

used for: delayed onset of pharyngeal swallow, reduced BOT retraction, decreased airway protection, aspiration during swallow
rationale: pushed BOT back towards PPW, expands vallecular recess, narrows entrance to laryngeal vestibule by moving epiglottis posteriorly

Question 5

head turn

Answer 5

to weak side

• used for: unilateral pharyngeal or laryngeal weakness, cricopharyngeal dysfunction
  rationale: blocks bolus from traveling down weak side, applies pressure to vocal fold to increase approximation, reduces resting pressure on cricpharyngeal by pulling larynx away from PPW

Question 6

head tilt

Answer 6

to stronger side
used for: unilateral oral or pharyngeal weakness
rationale: directs bolus to stronger side of oral/pharyngeal cavities

Question 7

swallow maneuvers

Answer 7

S/SSGS
Mendelsohn maneuver
effortful swallow

Question 8

Supraglottic swallow

Answer 8

• used for: reduced airway protection (at VF level), aspiration during swallow
• instruction: inhale first then hold breath, hold breath and swallow, cought immediately after you swallow and then swallow again before inhaling
• rationale: voluntarily closing off VFs during and before swallow to prevent aspiration

Question 9

Super-supraglottic swallow

Answer 9

• used for: reduced airway protection at Laryngeal Vestibule level, aspiration BEFORE or DURING swallow
• instructions: hold breath tightly while bearing down… then same as previous
• rationale: effortful breath hold causes artyenoids to tilt forward which closes laryngeal vestibule before and during swallow

Question 10

mendelsohn maneuver

Answer 10

used for: decreased range/duration of hyolaryngeal excursion and/or cricopharyngeal opening, decreased pharyngeal swallow coordination
-rationale: increased laryngeal movement stretches/opens CP, prolonging hyolaryngeal elevation keeps CP open longer

Question 11

effortful swallow

Answer 11

used for: residue in vallecula, reduced BOT retraction

-rationale: increased effort increases BOT retraction, clears residue through pharynx

Question 12

behavioral strategies

Answer 12

liquid wash
larger bolus
multiple swallows/bolus

Question 13

liquid wash

Answer 13

used for: residue after swallow (oral, vallecular, pharyngeal, or pyriforms)

Question 14

larger bolus:

Answer 14

used for: delayed triggering of pharyngeal swallow

-rationale: may enhance sensory input in some patients

Question 15

multiple swallows per bolus

Answer 15

used for: significant oropharyngeal residue

rationale: decrease risk for aspiration by clearing residue before additional bolus attempts

Question 16

sesnory stimulation

Answer 16

enhance sensory property of food

thermal-tactile stimulation

Question 17

enahnce sensory properties

Answer 17

• hot/cold (change temp)
• taste (sour, bitter)
• texture

Question 18

thermal tactile stim

Answer 18

(Lazarra, 86)

• wipe anterior faucial pillars with cold laryngeal mirror then ask pt to swallow
• swallow gets faster/stronger but only immediate effects

Question 19

behavioral compensation

Answer 19

cut up food/ slow patient down if compulsive eater

• alter taste, temp, massage muscles if they hold food in mouth
• give another mode of delivery (straw, rationed straw/cup) if they cant control amount…take too much at once