Compensatory technique |
Examples |
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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 |
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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 |
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Bolus volume modification |
Altering cup size or supervised ingestion |
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Method of bolus delivery |
Open cup, spoon, straw, spouted cup, sports bottle |
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Body posture |
Supported upright with or without pillows |
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Head or facial posture |
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Head rotation/tilt |
Head is tilted toward the strong side to keep food on chewing surface |
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Head turn |
Head is typically turned toward the damaged or weak side to direct bolus to the stronger of lateral channels of the pharynx |
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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 |
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Effortful swallow |
Increases posterior tongue base movement to facilitate bolus clearance. Patient is instructed to swallow and push hard with tongue against hard palate |
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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 |
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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 |
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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 |
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Pacing of food or liquid rate of ingestion |
Recommendations of patient-specific rate of liquid or food ingestion to assist caregivers |
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Environmental adjustments |
Limiting distractions; recommendations for frequency, timing, and volume of meals/feeds |