Techniques

Question 0

Name the compensatory posture techniques

Answer 0

Chin tuck
Head rotation
Heat tilt
Side lying
Neck extension

Question 1

What does the patient need to understand?

Answer 1

What should be happening in their swallow
What isn’t happening
Why this is an issue for them
What they can do to change it

Question 2

Name the two compensatory delivery options

Answer 2

Rate of delivery

Mode of delivery

Question 3

Name the compensatory sensory techniques

Answer 3

Taste/flavour
Temperature
Size and texture

Question 4

Name compensatory bolus modifications

Answer 4

Consistency

Question 5

Name compensatory bolus control and clearance techniques

Answer 5

Pharyngeal expectoration
Lingual sweep
Double swallow

Question 6

Name the rehabilitatory voluntary control/swallow manoeuvres…

Answer 6

Controlled swallow
Effortful swallow
Supraglottic swallow
Super supraglottic swallow
Mendelssohn's manoeuvre

Question 7

Name the rehabilitatory exercise/stimulation programs

Answer 7

Masako manoeuvre 
Shaker (head lift) exercise
Orofacial exercise
Vocal adduction exercises
Breathing exercises
Pharyngeal strengthening exercises

Question 8

Describe the chin tuck technique

Answer 8

Tuck chin to chest and look at knees during swallow

Question 9

When do you use the chin tuck technique

Answer 9

For delayed onset pharyngeal swallow in isolation, or reduced posterior movement of the tongue
Also worth a try to see if it helps with premature spill

Question 10

How does the chin tuck work

Answer 10

Moves epiglottis forward and narrows entrance to larynx - improved protective closure of larynx under base of tongue
Reduces anterior-posterior dimensions of the pharynx bringing base of tongue and posterior pharyngeal wall closer

Question 11

Describe the head rotation…

Answer 11

Torso remains forward

Turn head to weak side to full extent of comfort

Question 12

How does head rotation work?

Answer 12

Closes weaker pharyngeal side and directs bolus down stronger side
Aids upper oesophageal sphincter opening due to mechanical action

Question 13

Who do you use head rotation on?

Answer 13

Patients who show unilateral weakness

Question 14

Describe head tilt

Answer 14

Patient instructed to tilt head towards stronger, non-damaged side during oral intake

Question 15

How does the head tilt work

Answer 15

Tilting head to the stronger side may direct bolus does the stronger side

Question 16

Who do you use head tilt with

Answer 16

Impaired oral motor control
Unilateral pharyngeal weakness
Asymmetric altered anatomy

Question 17

Describe neck extension

Answer 17

Patient to extend neck with back erect when preparing to transfer the bolus out of the oral cavity into the pharynx

Question 18

How does the neck extension work?

Answer 18

Uses gravity to move the bolus into the pharynx (but inhibits UES opening)

Question 19

Who do you use neck extension with?

Answer 19

Patients with profound oral phase impairment who do have good airway protection abilities

Those with excellent cognition

Question 20

What are the Different modes of delivery?

Answer 20

Self-feeding vs fed

Question 21

What are the benefits of self-feeding

Answer 21

Can assist orientation and awareness. Facilitate improved oral stage

Question 22

Who can’t be asked to self-feed

Answer 22

Patients with poor cognition, bad positioning, physical capacity

Question 23

How can you alter rate of intake?

Answer 23

Slow it down by using…
Teaspoon vs standard spoon
Small cup vs standard cup
Put fork/spoon down between mouthfuls

Question 24

Who benefits from a change in rate of intake?

Answer 24

Patients with poor oral control | Or patients with dementia/TBI - impulsive

Question 25

What are different routes of intale

Answer 25

Oral - cup, straw, fork/spoon | Non-oral - NGT, PEG, TPN

Question 26

What are some problems with the straw?

Answer 26

Harder to control bolus size | Can be dangerous as negative suction action can cause fluids to be pulled quickly into pharynx and aspirated

Question 27

Who is the straw beneficial for?

Answer 27

Patients with poor oral control

Question 28

How does thermotactile stimulation work?

Answer 28

Clinician uses small, ice cold mirror to stroke and stimulate the base of the anterior faucial arch to enhance sensory awareness, which can help trigger swallow

Question 29

How does orofacial brushing work?

Answer 29

Clinician uses brushes/fingers/cold swabs to stroke the facial muscles and oral structures to either enhance awareness, or reduce hypersensitivity It enhances sensory awareness of oral and facial structures to help encourage oral movement to help stimulate swallowing

Question 30

How does cold bolus, sour bolus, carbonated bolus and textured bolus work?

Answer 30

Enhances sensory awareness and therefore can help trigger swallow and speed up total swallow duration

Question 31

Who are cold/sour/carbonated/textured bolus used with

Answer 31

Patients with slow oral transit and delayed swallow trigger

Question 32

How does changing the size of bolus help?

Answer 32

By altering the volume in the mouth, it either provides the patient with more sensory feedback - OR - by reducing size, assists ability to control bolus

Question 33

What are the benefits of thickened fluids

Answer 33

Reduces aspiration risk for some patients | Slows the flow of bolus, increases the cohesion of the bolus

Question 34

What is a problem with thick fluids?

Answer 34

Can be hard for patients to propel

Question 35

How does the lingual sweep work?

Answer 35

Use tongue (or finger) to clear residue from buccal, sublingual, intra-oral areas

Question 36

How does second swallow/clearing swallow work?

Answer 36

After each bolus swallow, the patient has a dry swallow to clear residue

Question 37

What are other techniques that can be used to control the bolus?

Answer 37

Patients need to concentrate on food and not get distracted Discourage laughing and talking while eating Go slowly Give small mouthfuls Make sure each mouthful has been swallowed before giving next bite

Question 38

Describe a controlled swallow

Answer 38

Teach patient to control bolus in mouth and then train commencing swallow at will, then combine

Question 39

What is involved in an effortful swallow?

Answer 39

As you swallow, squeeze hard with all your muscles (should get increased lingual effort) Used for problems with base of tongue and bolus clearance

Question 40

When do you teach a controlled swallow?

Answer 40

For patients with issues with bolus containment and initiation of swallow

Question 41

What is a supraglottic swallow?

Answer 41

Take a breath and hold it while swallowing bolus. | Post swallow expel air forcefully with cough prior to inhalation

Question 42

What is the point if supraglottic swallow?

Answer 42

Provides conscious, volitional airway protection

Question 43

Who do we use supraglottic swallow with?

Answer 43

Patients with inadequate airway protection particularly silent aspiration

Question 44

Describe the super-supraglottic swallow

Answer 44

Take a deep breath and bear down while swallowing the bolus. After the swallow, exhale forcefully or cough

Question 45

What is the point of the super-supraglottic swallow?

Answer 45

Designed to close entrance (not just the folds) of the the airway before and during the swallow

Question 46

Who do you use the super-supraglottic swallow with?

Answer 46

Patients with problems with airway protection

Question 47

Describe the Mendelssohn manoeuvre.

Answer 47

Become familiar with movement of larynx when swallowing and then try to hold the larynx up for a few seconds during a dry swallow. Then try with bolus swallow

Question 48

Who do we use the Mendelssohn manoeuvre withL

Answer 48

People with problems with airway protection, and poor Cricopharyngeal opening

Question 49

What does the Mendelssohn manoeuvre do?

Answer 49

Designed to increase the extent and duration of laryngeal elevation and thereby increase duration and width of Cricopharyngeal opening

Question 50

What are the benefits of oromotor therapy?

Answer 50

``` Improved jaw strength and range of movement Buccal tension Lip closure Improve lingual manipulation Improve tongue strength ```

Question 51

How do we improve base of tongue to posterior pharyngeal wall?

Answer 51

Masako technique - hold tongue tip between teeth and swallwo

Question 52

What is a way to improve pharyngeal contractions

Answer 52

Dry gargle

Question 53

What is the aim of the head lift (Shaker) technique

Answer 53

Strengthening the supra hyoid muscles - including geniohyoid, thyrohyoid, digastric muscles

Question 54

How do we determine fluid consistency?

Answer 54

Line spread test