Treatment Strategies: Why, How, What?



How to do

What it does

Head Back Poor oral control
Must have normal pharyngeal phase
Tilt head back during swallow Uses gravity, duration of UES relaxation decreases with increased head extension
Chin Tuck Premature loss
Reduced airway closure
Touching chin to chest before & during swallow widens valleculae
narrows airway
Pushes tongue base to pharyngeal wall
Head rotation Unilateral pharyngeal
Paralysis, reduced PES
Turn head to weak side before & during swallow Direct bolus to stronger side
Increases VC closure
Reduce pyriform retention
Head Tilt Unilateral pharyngeal
Tilt head to stronger side before & during the swallow Directs to stronger side with use of gravity
Thermal Stim or Cold Bolus Delayed swallow
Reduced sensory recognition
Cold laryngeal mirror & rub anterior facial arches Decrease delay
Supraglottic Swallow Reduced or late
VC closure
Delayed swallow
Inhale, hold breath, swallow, cough, swallow Protect airway
improves coordination
Effortful Swallow Reduced tongue base
(vallecular retention)
Swallow hard, push & squeeze all muscles in mouth and throat Effort increases posterior tongue base mvmt.
Mendelsohn Reduced laryngeal elev.
Reduced PES
As you swallow, hold it in mid opening swallow for several secs. Increases duration & width of PES, strengthens & retrains muscles of laryngeal elev.
Shaker Reduced PES opening Lay flat on back, raise head high to see toes without raising shoulders.
Hold 1 min, rest 1 min 30X
Strengthens Suprahyoid musculature Decreasing pressure above UES
E-Stim Reduced laryngeal elevation Stim of submandibular area Retrains laryngeal musculature for laryngeal elevation
Thick liquids Delayed swallow
Decreased laryngeal elev.
Reduced VC closure
Thickener Thinner liquids penetrate more easily & are more difficult to control orally
Puree Diets Delayed swallow
Reduced closure
Reduced elevation
Reduced mastication
Foods blended
Does not require chewing
Do not flow as quickly as thin
Easier to control
Mechanical Soft Reduced mastication Ground meats; fruits
Soft cooked vegetables
Soft enough to be chewed easily

Any alteration to the neurological system has the potential to cause dysphagia. It is important for the SLP to explore the neuroanatomical level of the disease process by conducting an MBSS. This will determine the motor and sensory etiologies and signs and symptoms of the presenting dysphagia. The results of the MBS will guide the choice of treatment strategies that are chosen according to the anatomic/physiologic rationale. An MBSS will allow you to evaluate ALL phases of the swallow: Oral Phase, Pharyngeal Phase, and Esophageal Phase.