THERAPY and STRATEGIES for Pharyngeal Disorders

It is very important to understand WHY the dysphagia is occurring before initiating treatment for it.

Velopharyngeal insufficiency

1. raise and lower velum during the production of  /a/ to produce nasal and oral contrasts, as in /ng-a, ng-a/
   
2. Pretend to be “stopped up” and then gradually eliminate denasality to more oral resonance
   
3. Raise the velum mechanically with a tongue blade while producing vowel sounds.
   
4. Yawn technique
   
5. Pinch nostrils during production of pressure sound
   

Valleculae/Tongue Base

1. Yawn
   
2. Prolong /i/ or “eeeee” with a high pitch quality
   
3. Pretend to gargle
   
4. /k/ and /g/ words/sounds. Say “guh”
   
5. Pull/hump tongue base posteriorly
   
6. Head tilt or turn as appropriate
   
7. Chin tuck if appropriate
   

PES/UES/Cricopharyngeal sphincter if related to laryngeal elevation!

1. Effortful/dry/hard swallow
   
2. Alternate solids and liquids if appropriate
   
3. Head turn or tilt if appropriate
   
4. Chin thrust (not chin tuck!)
   
5. Hyolaryngeal exercises if it is a neurological involvement (see below)
   
6. Mendelsohn Maneuver or E-Stim
   
7. Myotomy as a least resort
   

Pharyngeal Posterior wall

1. Masaka (protrude tongue between teeth  – hold – swallow hard
   
2. Repeat and increase rate of swallow
   
3. Thermal Stim
   
4. Alternate solids and liquids if appropriate
   
5. Expectoration
   

Delayed or absent triggering of the pharyngeal swallow

There are no documented standards to date that tell us what is considered a mild, moderate or severe, delay. FYI – Perlman et.al, 1994 suggest that a delay of less than 2 sec is mild and a delay greater than 5 sec is severe.

1. Thermal Stim, multiple times during the day for 10-15 minutes
   
2. Tactile Stim
   
3. Suck-Swallow
   
4. Bolus with sensory characteristics such as sour or cold.
   

Pharyngeal Pyriform

1. Head turn to damaged side if appropriate
   
2. Tilt head to stronger side if appropriate
   
3. Alternate solid and liquids if appropriate
   
4. Push against mandible while swallowing
   
5. Successive swallow
   

Laryngeal or Hyolaryngeal exercises

1. Lie flat – raise head – look at toes/feet – hold
   
2. Mendelsohn Maneuver or E-Stim to submandibular area
   
3. Falsetto exercises
   
4. Adduction ex while lifting or pushing
   
5. Supraglottic swallow if appropriate
   
6. Effortful swallows
   
7. Mandibular protrusion – hold
   
8. Posterior lingual elevation
   
9. Valsalva maneuver (breath hold)
   
10. Resistive jaw opening and closing exercises
    

References: Perlman, A. L., Booth, B. M., & Grayhack, J. P. (1994). Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia, 9, 90–95