compensatory strategies for dysphagia

[2] It is imperative that these strategies are observed during the MBSS because they don’t always make the swallow better and can often times make the swallow more compromised. Nelson Education. Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. Wheeler-Hegland, K., Frymark, T., Schooling, T., McCabe, D., Ashford, J., Mullen, R., … & Musson, N. (2009). The Dysphagia Outreach Project Giving Event. Sorry, your blog cannot share posts by email. Compensatory Techniques are used to increase control of the swallow to protect the airway and … Supraglottic and Super supraglottic swallows: These are useful strategies for people with airway protection problems, although they are a bit laborious to use through an entire meal. While most compensatory strategies do not cause long-term effects to the swallowing system, some can be used as exercise to create a lasting effect to swallowing. In the supraglottic swallow a person inhales, holds their breath, swallows, and then coughs to clear food residue from the larynx. intake … Types: Activities, Handouts. Truth: The “chin tuck” is a popular compensatory strategy for swallowing impairments. Many times compensatory and rehabilitative techniques are used con- currently when treating children with dysphagia. Encourage daily practice, at least twice a day. ---Compensatory changes usually do not increase muscular effort or the duration of airflow closure, which tends to be a problem with patients who have a respiratory disease. When the bolus spills into the pharynx prior to the swallow and the bolus is then aspirated. Improving oral sensory awareness c. Modification of volume and speed of food presentation d. Food consistency/diet changes e. Intraoral prosthetics 2. When have we gotten away from trialing compensatory strategies FIRST instead of going right to the thickened? The instrumental swallowing assessment helps the clinician to identify the biomechanical aspects of the patient’s swallowing dysfunction, determine the risk of aspiration, assess the patient’s compensatory strategies, and make swallowing rehabilitation training recommendations through the appropriate use and interpretation of a diagnostic swallow procedure. Describe the major compensatory strategies, particularly food texture and liquid consistency modification, which can be used to minimize the impact of dysphagia on health and quality of life. (Don’t try one texture only!! To close vocal cords prior to the swallow. compensatory swallowing strategies and swallowing exer-cises may be used in combination to manage dysphagia sec-ondary to stroke. Compensatory strategies include postural changes, sensory enhancements, changing feeding strategies, diet changes and intraoral prosthetics. Corbin-Lewis, K., & Liss, J. M. (2014). Langmore, S. E., Kenneth, S. M., & Olsen, N. (1988). Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. Other swallowing strategies involve sequential behavior modifications to alter the method for swallowing. Compensatory Strategies (use during meal) SpeechRamblings.weebly.com ’ Impact’on’Swallowing’ Exercise’ Procedure’ Rationale/Notes’ Cryotherapy. Do not immediately trial thickened liquids and change a diet without first trialing other strategies that may allow a patient to safely swallow thin liquids. Compensation Management of dysphagia includes the incorporation of compensatory strategies to immediately address swallowing safety (e.g., aspiration) and efficiency (e.g., residue) by altering pharyngeal dimensions, increasing pressure, and/or redirecting bolus flow. - often used with cancer pts. 1. Dr. Jeri Logemann (1993) has suggested using compensatory strategies/maneuvers in the following order: Postural techniques Sensory techniques Maneuvers Diet changes Remember we can often change the swallow through sensory techniques. Could you please describe me this issue or to be more concrete – give me an example? Standard practice consists in modifying the consistency of food and liquids administered to patients with dysphagia, based on the findings of the clinical exploration and/or videofluoroscopy. This handout is designed for speech-language pathologists working with patients who have dysphagia and are using thickened liquids as a compensatory strategy. When deciding which behavioral techniques are most appropriate for our pediatric clients, … Facilitates timing and extent of laryngeal closure at specific levels of the larynx. Increase strength of the overall swallow. Postural - chin tuck. ASHA’s Practice Portal assists audiologists and speech-language pathologists in their day-to-day practices by making it easier to find the best available evidence and expertise in patient care, identify resources that have been vetted for relevance and credibility, and increase practice efficiency. To help clear pharyngeal residue by altering gravity. Wheeler-Hegland, K., Ashford, J., Frymark, T., McCabe, D., Mullen, R., Musson, N., … & Schooling, T. (2009). Austin, TX: Pro-ed. I use this often. Posterior 1. ), Viscosity-May trial thicker consistencies to determine if there is an effect on the swallow. Remember, diet consistency changes should be considered as a last resort! Post was not sent - check your email addresses! Dysphagia - Compensatory strategies. While most compensatory strategies do not cause long-term effects to the swallowing system, some can be used as exercise to create a lasting effect to swallowing. Steele and Miller … Diet modifications: Are we just the diet police? Postural - chin tuck. Clarify if it is a dysphagia to solids/liquid/pills, or all three. Jul … 58 Broadly speaking, therapy can be differentiated into compensatory and rehabilitative strategies. (1993). Part II–impact of dysphagia treatment on normal swallow function. McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. For more information on the new standardized diet consistency levels, visit the IDDSI website. Other Compensatory Strategies: Application to Specific Problems a. Treatment strategies are chosen based on a number of different factors including diagnosis, prognosis, reaction to compensatory strategies, severity of dysphagia, cognitive status, respiratory function, caregiver support, and patient motivation and interest. Head Positioning oChin Tuck Instruction: Bring chin to chest. used for: - unilateral pharyngeal weakness - cricopharyngeal dysfunction. Treatment for Dysphagia: Matching Treatment to the Disorder . Size-Patient may have difficulty with a small bolus vs. a large bolus or vice versa. "���t��z/lD4��*�b�Bd F����A� {D��]*@�� ���"�0��������t@�d��Iԙ��cLV���d��vrΝ��Ɨ��N�U� [�5��e���B�SkJ_��|g�����4Mu�[S/8d����X�-�22ڜ��͂C�^H��)��C�X��6)�r;>�2�W�L�2f������B}�«5?�rmk]4Q*ʒ�7�5�d}�v������eT��S�;Z��ϽB5�&mnk��T׆M�2O-3��,��RWoyX�Jw͌���� ��ܿ?�����+Kr�ŷ��P�,����g2�x&�9M¹.3C�bS Oral and Pharyngeal ROM Exercises c. Sensory … Many elderly patients need that increased sensation for a more accurate swallow. 9 Assessment of Dysphagia • Goals: • Determine the presence, nature, and cause of the swallowing impairment • Examine the current level of function • … Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. May 13, 2020 - How to do a strategy review for swallowing disorders, dysphagia, and more for the medical SLP. Reduced Airway Closure, Reduced Laryngeal Elevation, & Aspiration --Compensatory Strategies work best because other types of exercises may put further stress and work on the respiratory system and may be unproductive. postural - chin up. Part V–Applications for clinicians and researchers. This handout gives tips to help lower your risk of aspiration and choking. Dysphagia - Compensatory strategies. Specific postures are used to compensate for particular types of dysphagia by changing the way that the food moves through the pharynx. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. C and D depict a deterioration in swallowing function and safety due to a diagnosis or health condition known to affect swallowing . Patient may be more successful with a bolus they have to chew. Part III–impact of dysphagia treatments on populations with neurological disorders. I am not sure if I understood it well. As such, it is critical that the swallowing therapist have a thorough understanding of both compen-satory strategies and exercises to address the needs of patients admitted for stroke rehabilitation and the knowl-edge to devise a management program that … The handout lays out the basics of these types of thickeners, including main ingredients, shelf life, how they're thickened, and pros/cons. 8 Overview: Components of a Comprehensive Dysphagia Program •Emphasis in both assessment and treatment is influenced by the characteristics of the client, his home environment, and his caregivers. requiring compensatory strategies for dysphagia. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. STUDY. Wish List. Use when you see aspiration prior to or during the swallow. Have the patient point exactly where. postural - head tilt. used for: - delayed onset of pharyngeal swallow - reduced BOT retraction to posterior pharyngeal wall - decreased airway protection - aspiration DURING swallow. Many times compensatory and rehabilitative techniques are used con-currently when treating children with dysphagia. A. I really don’t want you going all Oprah and handing out thickened liquids to the masses. Some patients require a larger bolus to trigger the swallow. Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure. The incredible Jeri Logemann (1993) suggested that we should trial a postural technique FIRST, and changes to the diet LAST. used for: - oral transit dysfunction. Compensatory strategies may include postural adjustments, like a head turn or chin tuck, swallowing maneuvers, such as a Mendelsohn maneuver or supraglottic swallow and/or diet modifications. Oral motor control exercises b. Manual for the videofluorographic study of swallowing (Vol. Silvia / SLP Slovakia. Steele and Miller 2010 concluded: “Boluses of liquids and solids normally initiate pharyngeal swallowing using multiple modalities, including taste, … Measuring Outcomes for Success…..What are You Using? Frymark, T., Schooling, T., Mullen, R., Wheeler-Hegland, K., Ashford, J., McCabe, D., … & Hammond, C. S. (2009). May 13, 2020 - How to do a strategy review for swallowing disorders, dysphagia, and more for the medical SLP. Sour has been known to stimulate a faster swallow. 11.1 Introduction; 11.2 Compensatory, Postural, and Rehabilitative Strategies; 11.3 Principles to Consider When Planning Treatment; 11.4 Evidence Base for Treatment of Dysphagia; 11.5 Treatment for Different Phases of Swallowing Below is a list of common compensatory swallowing strategies. According to Dysphagia Following Stroke (Daniels & Huckabee, 2014), a few key points to consider when deciding to recommend thickened liquids include: 1. History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. McCabe, D., Ashford, J., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Schooling, T. (2009). McCoy, Y., & Wallace, T. (2018). Your speech pathologist will check the tips that will be most helpful for you. 2. Use with penetration/aspiration prior to or during the swallow. Journal of Rehabilitation Research & Development, 46(2). Gravity assist. A Compensatory Strategy Review for Swallowing Disorders; Blog; Books; MBSimp Physiological Impairment Review; Podcast; The Step-by-Step Guide to Advocating for Access to Instrumentation; … When diagnosing and creating a treatment protocol it is always necessary to … postural - chin up. Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure. Just like compensatory strategies should be used for specific pathophysiological deficits, the same goes for diet changes. We have a few more tools in our toolbox that we can explore first before we resort to the Oprah thickened liquids method and you discharge everyone on your caseload so that you can get to … Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. The pathophysiology of oropharyngeal biomechanics can be assessed by videofluoroscopy, as … Compensatory strategies have an immediate, but temporary effect on swallow safety; rehabilitative strategies may promote a long-term effect and change the physiology of the swallow. Swallowing Strategies 1) POSTURAL CHANGES: a) Chin Tuck: i) Used For: (1) Delayed onset pharyngeal swallow (2) Reduced base of tongue retraction to posterior pharyngeal wall approximation (3) Decreased airway protection (4) Aspiration DURING the swallow ii) Instructions: (1) Bring chin to chest iii) Rationale: (1) Pushes base of tongue towards pharyngeal wall (2) Expands vallecular recesses (3) Narrows the … Compensatory strategies may be short term or used more long-term, such as with patients with head and neck cancer. intake … Helps patient keep bolus in the oral cavity. stream This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for poststroke OD. American Journal of Speech-Language Pathology. Use with unilateral pharyngeal paralysis or paresis. A … Temperature-Patients may respond differently with a hot bolus vs. a cold bolus. Compensatory Strategies … Body Positioning – Please make sure your loved one is sitting in the most optimal position. 32. McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). intake without overt signs and symptoms of aspiration for the highest appropriate diet level • Client will utilize compensatory strategies with optimum safety and efficiency of swallowing function on P.O. Part IV–impact of dysphagia treatment on individuals’ postcancer treatments. Pillars of dysphagia management; Compensatory strategies: It's not all about the chintuck! Effective strategies employed in the management of swallowing dysfunction in adult populations involve compensations, rehabilitation and prevention. (Hyper).. This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for … The Dysphagia by Rationale is a quick two sided cheat sheet organized by Dysphagia Diagnosis and presents recommended therapeutic strategies to attempt along with the rationales of why these treatments strategies are appropriate. Compensatory strategies have an immediate, but temporary effect on swallow safety; rehabilitative strategies may promote a long-term effect and change the physiology of the swallow. Trialing compensatory strategies does require the evaluating clinician to think critically and quickly, but wouldn’t you rather try this first than significantly … When have we gotten away from trialing compensatory strategies FIRST instead of going right to the thickened? Here’s a few things to ponder. Signs that someone may be suffering from dysphagia include, but are not limited to: coughing during or after a meal, runny nose, watery eyes, … It should be noted that this is simply a "guide" and not meant to be used as a one fits all. Lateral: used with hemiparesis of the tongue and pharynx, tilt to the intact side for bolus direction. When deciding which behavioral techniques are most appropriate for our pediatric clients, … Grades: Not Grade Specific. How to avoid aspiration and choking . Journal of Rehabilitation Research & Development, 46(2). Logemann recommends 10x/day x5 min with 5-6 swallows each time as exercise. 11 Treatment: Compensatory, Postural, and Rehabilitation Strategies. 2). Your speech pathologist will check the tips that will be most helpful for you. Swallowing and Esophageal Disorders Treatment Guide Esophageal disorders – especially those involving swallowing problems – affect more than 15 million Americans of all ages. * Educate patients and caregivers about the signs and symptoms of … %PDF-1.3 PLAY. Dr. Jeri Logemann (1993) has suggested using compensatory strategies/maneuvers in the following order: Postural techniques; Sensory techniques; Maneuvers; Diet changes; Remember we can often change the swallow through sensory techniques. Exhibits difficulties swallowing, compensatory techniques are attempted Techniques may be as simple as: Adjusting posture Dietary strategies (4 levels) Liquid thickeners Examples of Compensatory Strategies: Head turn to the weaker side to close it off, and prevent a bolus from traveling down the weaker side by twisting the pharynx Head tilt to the stronger side, directs the bolus to the stronger side … used for: - unilateral pharyngeal weakness - cricopharyngeal dysfunction. (Frymark et al 2009), Texture-give a variety of textures. Compensatory Strategies Part 3 To Thicken or Not To Thicken? Compensatory strategies provide a scaffold to a safer swallow by reducing the complexity of the swallowing task (Huckabee and Hughes 2013). Use with reduced pharyngeal contraction (pharyngeal residue, aspiration after swallow). For early closure at the entrance to the airway. PLAY. Clinical anatomy & physiology of the swallow mechanism. McCabe, D., Ashford, J., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Schooling, T. (2009). 3/1/2015 9 Identification/Screening If the patient is fed by staff, observe during mealtime to assess: • Rate of feeding • Patient’s response to different foods and liquids (textures, temperatures, flavors) • Patient’s behaviors during mealtime 33 Identification/Screening zThe accuracy of your bedside screening can be improved … Part V–Applications for clinicians and researchers. Speech therapists instruct individuals in use of compensatory swallowing strategies, strengthening exercises, positioning and diet texture recommendations to increase overall safety when swallowing to promote a safe, healthy, and satisfying lifestyle. Compensatory strategies provide a scaffold to a safer swallow by reducing the complexity of the swallowing task (Huckabee and Hughes 2013). Just a larger amount than before. Safe Swallowing Tips . Patient Education Speech Pathology Services The tips checked below will lower your risk for aspiration (getting food or liquid in your lungs) and choking: Special swallowing strategies: _____ _____ … Fiberoptic endoscopic examination of swallowing safety: a new procedure. Compensatory Swallowing Strategies. Dysphagia is difficulty in swallowing. wu��]��*��. used for: - oral transit dysfunction. Rehabilitation: Connecting exercises to specific deficits; Collaboration with registered dietitian; Sarcopenia, failure to thrive, frailty; Collaboration with the entire team (e.g., RN, OT, PT, physicians/NPs/PAs) and making appropriate referrals (e.g., GI, ORL, … Of laryngeal closure propulsion of bolus resulting in aspiration ” children, is... Evidence-Based systematic review: Effects of nonspeech oral motor exercises on speech – Please make your! With reduced pharyngeal contraction ( pharyngeal residue, aspiration after swallow ) when treating children dysphagia... Exer-Cises may be more successful with a bolus they have to chew patient may be short or. To determine the effectiveness and accuracy of completion ), Viscosity-May trial thicker to... With head and neck cancer increased sensation for improved timing of the swallowing task ( Huckabee and Hughes )! Children with dysphagia shouldn ’ t use straws the masses spoon as presenting the spills. 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Closure at the entrance to the stronger side disorders includes the introduction of compensatory strategies in management swallowing. … Body Positioning – Please make sure your loved one is sitting in the pathophysiology, diagnosis and. To alter the swallow new procedure swallowing task ( Huckabee and Hughes 2013.. Prd degenerates with disease progression sure your loved one is sitting in the most optimal position e. Intraoral prosthetics.! Meal ) SpeechRamblings.weebly.com ’ Impact ’ on ’ swallowing ’ exercise ’ procedure ’ Rationale/Notes ’ Cryotherapy sure! The bolus spills into the pharynx swallowing ’ exercise ’ procedure ’ Rationale/Notes ’ Cryotherapy - unilateral pharyngeal weakness cricopharyngeal... Or head lift maneuver are examples of rehabilitation Research & Development, (. Particular types of dysphagia treatment on normal swallow function could you Please describe me this issue or to be successful. Constrained by shortened LOS compensate for particular types of dysphagia in PRD degenerates with progression... And Impact of compensatory strategies Thicken or not to Thicken or not to Thicken t! When the bolus popular compensatory strategy should be used for: - pharyngeal! Oral control or difficulty propelling the bolus posteriorly to initiate swallow used for: - unilateral pharyngeal weakness - dysfunction... Residue, aspiration after swallow ) measuring Outcomes for Success….. what are you?! Please make sure your loved one is sitting in the supraglottic swallow a person inhales holds. 90 degrees ; however, therapists may find a different, more suitable.! Who have dysphagia and are using thickened liquids as a one fits all causing severe complications but lacking neurorehabilitation! Or difficulty propelling the bolus pick and choose for your patients based on the swallow for! Liquids to the swallow nonspeech oral motor exercises on speech a FEES/MBS FIRST but it still seems risky aspiration.... And can lead to more serious conditions postural changes b FEES, rehabilitation also... Provides increased oral/pharyngeal sensation for improved timing of the swallow and the bolus term or used more long-term such..., Kenneth, S. e., Kenneth, S. M., & Liss J.. '' and not meant to be more successful with a bolus they have to chew IV–impact of treatment. Advances in the supraglottic swallow a person inhales, holds their breath, swallows, physiologically! Intervention and utilizing the appropriate tools within each category are vitally important journal of rehabilitation Research & Development, (! Strategies can be used for specific pathophysiological deficits, the same goes for diet changes. ) strategies!

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