Table 1.9-1. Compensatory techniques used in patients with dysphagia

Compensatory technique


Texture modification of food or liquid

– Food: Regular, soft and bite-sized, minced and moist, pureed, liquidized

– Liquid: Extremely thick, moderately thick, mildly think, slightly thick, thin

Regular foods and fluids require exceptional muscle control and accurate coordination between swallowing-respiratory systems. Thickened fluids slow the act of swallowing, thus enhancing safe swallowing. Modified diets use alterations to food texture to reduce the need to orally prepare food

Food/liquid sensory adjustments (eg, temperature, flavor, tactile)

– Cold bolus; sour bolus; carbonated bolus

Sensory stimulation may prime the swallow system for subsequently presented bolus to lower threshold needed to initiate swallow response and improve timeliness of the swallow

Bolus volume modification

Altering cup size or supervised ingestion

Method of bolus delivery

Open cup, spoon, straw, spouted cup, sports bottle

Body posture

Supported upright with or without pillows

Head or facial posture



Head rotation/tilt

Head is tilted toward the strong side to keep food on chewing surface


Head turn

Head is typically turned toward the damaged or weak side to direct bolus to the stronger of lateral channels of the pharynx


Chin tuck

Chin is tucked down toward the neck during the swallow, bringing tongue base closer to posterior pharyngeal wall, narrowing opening to the airway, and widening vallecular space


Effortful swallow

Increases posterior tongue base movement to facilitate bolus clearance. Patient is instructed to swallow and push hard with tongue against hard palate


Mendelsohn maneuver

Designed to elevate the larynx and open esophagus during the swallow to prevent food/liquid from entering the airway. Patient holds the larynx in elevated position at peak of hyolaryngeal elevation


Supraglottic swallow

Designed to voluntarily close vocal folds by holding one’s breath before and during swallow to protect the airway. Patient is instructed to hold their breath just before swallowing (closing the vocal folds) and cough immediately after the swallow


Super-supraglottic swallow

Designed to voluntarily move the arytenoids anteriorly, closing off the entrance to laryngeal vestibule before and during the swallow. It is similar to supraglottic swallow but involves increased effort during the breath hold before the swallow, which assists with glottal closure


Pacing of food or liquid rate of ingestion

Recommendations of patient-specific rate of liquid or food ingestion to assist caregivers


Environmental adjustments

Limiting distractions; recommendations for frequency, timing, and volume of meals/feeds