1. Types of Treatment:  Compensatory Strategies

 a. Postural changes
 b. Improving oral sensory awareness
 c. Modification of volume and speed of food presentation
 d. Food consistency/diet changes
 e. Intraoral prosthetics

 a. Oral motor control exercises
 b. Oral and Pharyngeal ROM Exercises
 c. Sensory-Motor Integration Procedures
 d. Swallow maneuvers

 a. Increases vallecular space; narrows airway entrance
 b. Pushes epiglottis posteriorly into more protective position over airway
 c. Pushes tongue base backward toward pharyngeal wall
 d. Used if there is a delay in triggering the pharyngeal swallow
     (increased duration of stage transition); reduced posterior movement
     of tongue base; unilateral laryngeal dysfunction

 a. Turning to weaker (damaged) side eliminates the damaged side from the bolus path,
     allows the bolus to pass through the intact side.
 b. Pulls cricoid cartilage away from posterior pharyngeal wall, reducing resting pressure in UES
 c. Increases vocal fold closure by applying extrinsic pressure, narrows laryngeal entrance
 d. Used if there is unilateral pharyngeal paresis; cricopharyngeal dysfunction; unilateral laryngeal dysfunction

 a. Tilt the head to the stronger side directs bolus down the most intact side.
 b. Usually appropriate for problems caused by unilateral oral weakness or
     unilateral oral and pharyngeal weakness (on same side)

 a. Facilitates drainage of the food out of the oral cavity by taking advantage of gravity
 b. Helpful for patients with reduced tongue control resulting in reduced posterior propulsion of the bolus
 c. May also aid patients with reduced lip closure - tilting head slightly back and
     toward stronger side keeps food in the mouth
 d. Only used for patients with adequate laryngeal closure or who can utilize the supraglottic swallow

 a. Eliminates the effects of gravity on pharyngeal residue
 b. Useful for patients with reduced pharyngeal contraction resulting in residue
      spread throughout the pharynx
 c. Reverses gravitational pull on the residue effectively keeping it on the pharyngeal
     wall until subsequent swallows clear it
 d. Not indicated if residue builds after each swallow or pt has history of reflux

 a. Increasing downward pressure with spoon on the tongue
 b. Presenting sour or cold bolus
 c. Presenting a bolus requiring chewing
 d. Presenting a larger volume bolus
 e. Thermal-tactile stimulation
 f. Suck-swallow

 a. For reduction in tongue elevation - position food posteriorly with straw or syringe
 b. For oral tongue dysfunction and/or delayed pharyngeal swallow -
     use thickened liquids/purees
 c. For patients with poor pharyngeal contraction - take smaller boluses at a slower rate
 d. For patients with significant tongue resections or bilateral tongue paralysis -
     use palatal augmentation or reshaping prosthesis

 a. Include voluntary swallow maneuvers and exercises to improve neuromuscular strength
 b. May be direct or indirect
 c. Typically require cognition and ability to follow directions
 d. Also require increased energy on the part of the patient; can be fatiguing for many patients
 e. If a compensatory technique can alleviate the swallowing problem, use that first

 a. Directions for exercise regimens should be written for patients/family
 b. Specify number of repetitions, time to complete, number of practice sessions/day
 c. Continuously monitor and increase/decrease exercise demands as needed
 d. Examples given in text pp.  206 - 210

 a. Can be considered compensatory or therapeutic
 b. May need to be part of a maintenance program for some patients
     e.g. motor neuron diseases, Alzheimer’s
 c. Useful for patients with reduced recognition of food in the mouth, extremely
     slow oral transit (apraxia) or delay in triggering the swallow
 d. Include arm and hand motion of self-feeding and thermal-tactile stimulation

 a. Supraglottic swallow - reduced or late vocal fold closure, delayed pharyngeal swallow
 b. Super-supraglottic swallow - reduced closure of airway entrance
 c. Effortful swallow - reduced posterior movement of the tongue base
 d. Menselsohn maneuver - reduced laryngeal movement, discoordinated swallow