Table 10 - Behavioral swallowing treatments options for oropharyngeal dysphagia
From the following article
How to perform video-fluoroscopic swallowing studies
Gary D. Gramigna
GI Motility online (2006)
doi:10.1038/gimo95
| Category/technique | Execution/rationale | Indication |
|---|---|---|
| Diet modification | Requires patient acceptance | Limited research evidence |
| Thickened liquids | Reduced tendency to spill over tongue base (reliability and patient acceptance difficult) | Disordered tongue function Preswallow/spill aspiration Impaired laryngeal closure Delayed swallow response |
| Thin liquids | Offers less resistance to flow | Weak pharyngeal contraction Reduced UES opening |
| Maneuvers | Requires increased concentration on swallowing | Limited research evidence |
| Supraglottic swallow | Breath hold, hard swallow, forceful exhalation (increases vocal cord closure) | Aspiration during swallow due to poor airway protection, improve airway closure |
| Effortful swallow | Effortful tongue action (increases posterior tongue base movement) | Poor posterior tongue base motion |
| Extra swallow | Dry swallow before next mouthful (to assist residue clearance) | Poor pharyngeal clearance |
| Mendelsohn maneuver | Prolong hyoid elevation (guided by manual palpation or focus on suprahyoid muscles contractions) | Prolongs UES opening with cases of poor pharyngeal clearance and laryngeal elevation; possibly improve coordination of swallow events |
| Postural adjustments | Requires ability to perform | Limited research evidence |
| Head tilt | Tilt head to stronger side (gravity helps bolus control) | Poor tongue control, asymmetric weakness |
| Head rotation | Rotate head to the weaker/affected side (directs food away from damaged side) | Unilateral pharyngeal weakness Reduced UES opening |
| Chin tuck | Chin flexed to chest (repositions tongue base, narrows airway opening,? widens valleculae, need outcome studies) | Aspiration before or during swallow Delayed swallow response Reduced tongue base motion |
| Side-lying with elevation | 30 degrees to allow bolus to travel R or L of laryngeal aditus | Aspiration, pharyngeal weakness Position limitations upright |
| Facilitating techniques | Largely unproved but hope for future research | Limited research evidence |
| Education/biofeedback | surface EMG (sEMG), swallow endoscopy (FEES), augment volitional component suprahyoid contraction, vocal cord closure | Poor pharyngeal clearance Reduced laryngeal closure, improve awareness of biologic functions |
| Strengthening exercises | Isometric/isokinetic head raising exercise (Shaker), lingual resistance (Robbins), other various (unclear role for e-stim) | Reduced UES opening (post-swallow residue): (1) increase cross-sectional area of UES, (2) improve flow through UES, (3) reduced hyolaryngeal elevation, (4) reduced lingual propulsion, (5) nonprogressive disease when exercise not contraindicated |
| Tactile-thermal application (thermal stimulation) | Cold tactile rubbing to anterior faucial pillars (heighten sensitivity for swallow response, variations prevalent now) | Delayed or absent swallow response |
| Thermal gustatory | Sour bolus (facilitate swallow response; promising but unproved) | Described in Huntington's cases, stroke, combine sensory stimulations (cold, sour) |
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