Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Treatment of Dysphagia


Treatment of dysphagia can be conducted in multiple ways. There are direct and indirect procedures to help treat swallowing disorders. It is common to provide a client with both direct precautions/compensations to do while eating or drinking as well as indirect procedures for strengthening structures, increasing range of motion, etc. Each phase of the swallow generally has certain difficulties. These difficulties will be touched on and given direct and indirect treatment options, if appropriate.

Oral Preparatory Phase

Stasis on tongue

Physiologically: impaired bolus cohesion/formation

Direct treatment: more cohesive bolus, small bites, slow rate, liquid wash, multiple swallows

Indirect treatment: lingual exercises such as protrusion with resistance, lateral movement with resistance, tip elevation

Adherence to hard palate

Physiologically: impaired bolus formation

Direct treatment: limited bolus, slow rate, liquid wash

Indirect treatment: lingual strengthening such as protrusion with resistance, lateral

movement with resistance, tip elevation, retrievable bolus

Impaired labial seal

Physiologically: impaired oral sensation or decreased labial strength

Direct treatment: limited bolus, slow rate, more cohesive bolus

Indirect treatment: labial strengthening exercises: pucker/smile, cheek puff, press lip

holds, pucker holds

Pocketing in cheek

Physiologically: impaired oral sensation, decreased buccal tension, or decreased lingual strength

Direct treatment: push food out of cheek by pushing on cheek with hand, lingual sweep, limited bolus, liquid wash

Indirect treatment: cheek puffs for buccal strengthening, lingual strengthening such as

anterior/posterior sweep along inside of cheek, protrusion with resistance, lateral movement with resistance

Oral Phase

Excessive premature spillage

Physiologically: decreased anterior-posterior transit, impaired bolus control

Direct treatment: Chin tuck, limited bolus, cohesive bolus, slow rate, tilt head forward to keep food in mouth until ready

to swallow

Indirect treatment: back of tongue strengthening such as back elevation, effortful /ka/ or /ga/, or yawns

Prolonged anterior/posterior movement

Physiologically: decreased lingual strength

Direct treatment: quick swallow, small bolus, bolus change (sour, texture), tilt head

back to promote swallow

Indirect treatment: quick swallows, ant/pos lingual strengthening

Pharyngeal Phase

Residual secretions

Physiologically: dehydration

Direct treatment: encourage fluids intake, increase free water in PEG, discourage sticky foods

Delayed initiation of swallow

Physiologically: decreased sensation, reflex delay, decreased base of tongue strength

Direct treatment: quick swallow, small bolus, bolus change (sour or texture), tilt head back to promote initiation, chin

tuck, thermal stimulation

Indirect treatment: base of tongue strengthening with masako, quick swallows

Stasis in velopharyngeal port or nasal cavity

Physiologically: velopharyngeal dysfunction

Direct treatment: effortful swallow may help

Indirect treatment: exercises to strengthen velum such as effortful /ka/ or /ga/ and breathing tasks

Reduced laryngeal elevation

Physiologically: impaired laryngeal excursion

Direct treatment: chin tuck, effortful swallow

Indirect treatment: Shaker’s, Mendelsohn maneuver

Reduced laryngeal closure

Physiologically: impaired vocal fold (true or false) adduction

Direct treatment: breath hold swallow, supraglottic swallow, super supraglottic swallow

Indirect treatment: vocal fold strengthening such as falsetto /i/ or breath hold reps

Stasis in valleculae

Physiologically: reduced laryngeal elevation or tongue base retraction

Direct treatment: chin tuck, effortful swallow, multiple swallows, limited bolus, liquid wash

Indirect treatment: Shaker’s, Mendelsohn maneuver, Masako

Stasis in lateral channels (pyriform sinuses)

Physiologically: impaired pharyngeal constriction (ipsilateral or bilateral), decreased sensation

Direct treatment: head tilt, head turn, multiple swallows, liquid wash

Indirect treatment: shaker, Mendelsohn

Stasis in posterior pharyngeal wall

Physiologically: impaired pharyngeal constriction, decreased sensation

Direct treatment: multiple swallows, liquid wash, chin tuck, effortful swallow

Indirect treatment: singing, falsetto /i/, shaker

Stasis in pyriform sinus

Physiologically: impaired pharyngeal constriction

Direct treatment: head turn, multiple swallows, liquid wash, effortful swallow

Indirect treatment: singing, falsetto /i/, Mendelsohn, shaker

Additional Links:

Fantastic overview by Dr. Logemann- http://www.nature.com/gimo/contents/pt1/full/gimo50.html

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