Postural Adjustments

Question 1

• pushes the anterior pharyngeal wall posteriorly
• BOT & epiglottis pushed closer to PPW
• widens vallecular space in order to hold more food/liquid before swallow
• airway entrance is narrowed

Answer 1

Chin Tuck

Question 2

Who can benefit from the chin tuck?

Answer 2

if pt has delay in trigger for pharyngeal swallow, premature spillage, reduced tongue base retraction, and reduced airway entrance closure

Question 3

• “Look up”
• Eliminates vallecular space
• To clear oral cavity by gravity

Answer 3

Head tilt back

Question 4

Who can benefit from head tilt back?

Answer 4

if pt has poor oral transport BUT good airway protection

Question 5

-Tilt to the better/stronger side
-Uses gravity to drain food down to the stronger
side to have beoer control
-“Tilt your head like you are trying to touch your ear
to your shoulder.”

Answer 5

Lateral Head Tilt

Question 6

Who can benefit from lateral head tilt?

Answer 6

If pt has both unilateral oral impairment and unilateral pharyngeal impairment on the same side

Question 7

• Head rotation to the damaged side
• Twists the pharynx and closes the damaged side of the pharynx, and then directs food to most intact side
• “Turn your head to the side as though you are looking over your shoulder.”
• Increases vocal fold closure by applying extrinsic pressure, narrows laryngeal entrance

Answer 7

Head turn/rotation

Question 8

Who can benefit from head turn?

Answer 8

• Unilateral pharyngeal paresis
• Unilateral laryngeal dysfunction
• Most open used when there is pyriform sinus and pharyngeal wall residue, particularly when some asymmetry in residue collection is noted

Question 9

Upright posture (or head-of-bed elevation) after feeding

Answer 9

for pts with esophageal dysfunctions

Question 10

Lying Down on the Side or Back

Answer 10

Eliminates effects of gravity on pharyngeal residue, useful for pts with reduced pharyngeal contraction resulting in residue spread throughout the pharynx, and gravity pulls residue effectively to keep it on the stronger side of pharyngeal wall until subsequent swallows clear it.

Not indicated if:
• Pt has poor airway protec1on
• Residue builds after each swallow
• Pt has history of reflux