Methods for Controlling Aspiration

Question 1

10 Methods for controlling aspiration include:

Answer 1

• Oral motor exercises + VF closure exercises
• Head Position maneuvers
• Postural maneuvers
• Swallowing retraining
• Diet modification
• NPO
• Bolus control techniques
• Pooled oral secretion management
• Thermal tactile stimulation
• Surgical management

Question 2

Oral motor exercises:

+

VF closure exercises:

Answer 2

• OM exercises: lip seal, tongue retraction, tongue strengthening, vocal fold closure, LSVT)
• VF closure exercises: practice coughing, increase loudness, hard glottal attack, sustain phonation and increase duration while maintaining voice quality, sustain phonation at various pitches, LSVT

Question 3

Head position maneuvers include:

Answer 3

• Chin tuck
• Head tilt
• Rotate to side

Question 4

Postural maneuvers include:

Answer 4

• Sitting upright *Important to sit upright for 30min after meal (clear residue/ mitigate risk of reflux)
• Lying on side

Question 5

Swallowing retraining exercises include:

Answer 5

-Supraglottic swallow/ super-supraglottic swallow
[How are they different? Super-supraglottic swallow= add bearing down while holding breath (Valsalva Maneuver)]

• Mendelsohn maneuver
• Multiple swallows
• Frequent throat clearing

Question 6

Diet Modifications include:

Answer 6

• Bolus size
• Food consistency
• Temperature
• Taste

Question 7

Bolus control techniques

Answer 7

• Lingual sweep
• Cyclic ingestion (ON TEST)
• 3 second prep
• dry swallows
• adaptations of intake (thicken liquids to slow them, sippy cup)
• Slurp and swallow

Question 8

Techniques for pooled oral secretions:

Answer 8

• Pulmonary toilet (cough training and augmentation aka pulmonary hygiene)
• Increased frequency of dry swallow
• Independent oral suction
• Hard swallow

Question 9

Surgical management if aspiration before pharyngeal stage:

Answer 9

Horizontal epiglottoplasty
Tongue base flaps
Laryngeal suspension

Question 10

Surgical management if aspiration during the swallow (least common type - due to VF paralysis, palsy, incoordination):

Answer 10

Conservative mgmt - VF adduction exercises

Surgical mgmt - augment paralyzed VF

Question 11

Surgical management if aspiration after the swallow (inhale residue):

Answer 11

-Conversative mgmt: thinning diet, alternate liquds, liquid wash, mendelsohn, head rotation

Surgical mgmt - translaryngeal resection of cricoid lamina, cricopharyngeal myotomy or botox, laryngotracheal separation

Question 12

*Risk factors for aspiration pneumonia!

Answer 12

Oral care
Feeding techniques (19x more likely if dependent for feeding!)
Positioning
Antibiotic use
Diet Manipulation
Hand washing by staff
Physical activity/mobility
Bed elevation/alertness