Swallow Compensatory Strategies

VIDEO

Head Position (Postural) Strategies

 

Supraglottic Swallow

 

Super-Supraglottic Swallow

 

Purpose of Exercises:
Head Position (Postural) Strategies:
– Repositioning of anatomy (based on type of dysphagia) to reduce aspiration risk.
Supraglottic Swallow:
– Closure of true vocal folds, assisting airway protection before and during swallow.
Super-Supraglottic Swallow:
– Closure of true vocal folds, false vocal folds and anterior tilt of arytenoid, assisting airway protection before and during swallow.

Medical Contraindications (populations to avoid these exercises):
Head Position (Postural) Strategies:
– Recent neck / cervical spinal surgery or injury
(Super-)Supraglottic Swallow:
– Respiratory conditions, due to increased challenge on the respiratory system
– Uncontrolled high blood pressure
– History of stroke and coronary artery disease: Chaudhuri, G., Hildner, C. D., Brady, S., Hutchins, B., Aliga, N., & Abadilla, E. (2002). Cardiovascular effects of the supraglottic and super-supraglottic swallowing maneuvers in stroke patients with dysphagia. Dysphagia, 17(1), 19-23.

Precautions / Tips:
– Only attempt these exercises if prescribed by your Speech Therapist. Without proper guidance there is a good chance they may cause more harm than benefit.
– Usefulness of head position (postural) strategies is best identified during Videofluoroscopy (Modified Barium Swallow).
Head Turn (Left/Right): ensure the client does not turn his/her shoulders/torso when doing this technique.

Research Articles:
– Kasahara, T., Hanayama, K., Kodama, M., Aono, K., & Masakado, Y. (2009). The efficacy of supraglottic swallow as an indirect swallowing exercise by analysis of hyoid bone movement. Tokai Journal of Experimental & Clinical Medicine, 34, 71–75.
– Kendall, K. A., Leonard, R. J., & McKenzie, S. (2004). Airway protection: evaluation with videofluoroscopy. Dysphagia, 19(2), 65-70.
– Lazarus, C., Logemann, J. A., & Gibbons, P. (1993). Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head & neck, 15(5), 419-424.
– Logemann, J. A. (1998). Evaluation and treatment of swallowing disorders (2nd ed.). Austin, TX: Pro-Ed.
– Ohmae, Y., Logemann, J. A., Kaiser, P., Hanson, D. G., & Kahrilas, P. J. (1996). Effects of two breath-holding maneuvers on oropharyngeal swallow. Annals of Otolaryngology, Rhinology, & Laryngology, 105, 123–131.
– Rasley, A., Logemann, J. A., Kahrilas, P. J., Rademaker, A. W., Pauloski, B. R., & Dodds, W. J. (1993). Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture. American journal of roentgenology, 160(5), 1005-1009.

*Articles cited are a limited sample only, and there may be other & more recent evidence which supports / contraindicates use of this exercise.

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