compensatory strategies for dysphagia

DYSPHAGIA GOALS LONG TERM GOALS - SWALLOWING • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. 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. used for: - delayed onset of pharyngeal swallow - reduced BOT retraction to posterior pharyngeal wall - decreased airway protection - aspiration DURING swallow. 1. Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure. 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; … 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. •Compensatory Strategies •Exercise •Education . Just like compensatory strategies should be used for specific pathophysiological deficits, the same goes for diet changes. Specific postures are used to compensate for particular types of dysphagia by changing the way that the food moves through the pharynx. Ashford, J., McCabe, D., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Hammond, C. S. (2009). 2017 Feb;32(1):3-10. doi: 10.1007/s00455-016-9779-6. Nelson Education. Hint: motility problems in the esophagus tend to cause dysphagia to liquids and solids, whereas as an obstructive/mucosal issue (i.e., stricture) tends to cause dysphagia … McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Unfortunately, there is a paucity of evidence for dysphagia therapy, which has been highlighted in a Cochrane review 57 as well as an American Gastroenterology Association technical review. Clinical anatomy & physiology of the swallow mechanism. Viscosity and volume of bolus. (May help you determine if thick liquids could be used therapeutically during sessions, not necessarily for diet changes.). wu��]��*��. 11 Treatment: Compensatory, Postural, and Rehabilitation Strategies. Facilitates timing and extent of laryngeal closure at specific levels of the larynx. Ashford, J., McCabe, D., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Hammond, C. S. (2009). Compensatory strategies provide a scaffold to a safer swallow by reducing the complexity of the swallowing task (Huckabee and Hughes 2013). The incredible Jeri Logemann (1993) suggested that we should trial a postural technique FIRST, and changes to the diet LAST. postural - head turn . Sour has been known to stimulate a faster swallow. Usually, they do not involve the strengthening of the musculature. Logemann recommends 10x/day x5 min with 5-6 swallows each time as exercise. Measuring Outcomes for Success…..What are You Using? Types of Treatment: Therapy Procedures a. Remember, diet consistency changes should be considered as a last resort! read more. Compensatory strategies include postural changes, sensory enhancements, changing feeding strategies, diet changes and intraoral prosthetics. How to avoid aspiration and choking . 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. Tucking the chin to the chest closes off the airway for many patients, but for others, it can make things worse and actually cause aspiration. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Thank you! Compensatory Strategies Diet Characteristics. Progression and Management of Dysphagia in PD Unlike stroke, dysphagia in PRD degenerates with disease progression. 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. Wheeler-Hegland, K., Frymark, T., Schooling, T., McCabe, D., Ashford, J., Mullen, R., … & Musson, N. (2009). (Frymark et al 2009), Texture-give a variety of textures. It should be noted that this is simply a "guide" and not meant to be used as a one fits all. Postural - chin tuck. 32. 2). STUDY. [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. Temperature-Patients may respond differently with a hot bolus vs. a cold bolus. May 13, 2020 - How to do a strategy review for swallowing disorders, dysphagia, and more for the medical SLP. 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. �B�Z�s�͒1䰇�楍l ��w��Awz�bL7�����Xk��]Y�y�9ɀ%���r|P�C��n�d.e���&hR Use with penetration/aspiration prior to or during the swallow. That is what the MBSS or FEES is for. Use with oral containment issues (posterior loss of bolus resulting in aspiration). Any compensatory strategy should be viewed during instrumental assessment to determine the effectiveness and accuracy of completion. "���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 History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders Dysphagia. Compensatory techniques are used to alter the swallow, however compensations may not create a lasting effect to the swallow. This handout provides swallowing strategies including swallowing exercises, oromotor exercises and swallow precautions in a structured manner to help patients implement swallowing strategies effectively. I really don’t want you going all Oprah and handing out thickened liquids to the masses. Grades: Not Grade Specific. Types: Activities, Handouts. This handout gives tips to help lower your risk of aspiration and choking. postural - chin up. Size-Patient may have difficulty with a small bolus vs. a large bolus or vice versa. Many elderly patients need that increased sensation for a more accurate swallow. 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. Could you please describe me this issue or to be more concrete – give me an example? PLAY. Dysphagia, 2(4), 216-219. Steele and Miller 2010 concluded: “Boluses of liquids and solids normally initiate pharyngeal swallowing using multiple modalities, including taste, … used for: - unilateral pharyngeal weakness - cricopharyngeal dysfunction. Wheeler-Hegland, K., Ashford, J., Frymark, T., McCabe, D., Mullen, R., Musson, N., … & Schooling, T. (2009). Compensatory strategies may be short term or used more long-term, such as with patients with head and neck cancer. Head or facial posture, including jaw, lip, or cheek support, are compensatory strategies to facilitate safety when swallowing. 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. Categories. Encourage daily practice, at least twice a day. Plural Publishing. This handout is designed for speech-language pathologists working with patients who have dysphagia and are using thickened liquids as a compensatory strategy. But for others, they are chronic concerns that plague daily life and can lead to more serious conditions. The efficacy of postural compensatory strategies is a topic of debate throughout the literature and, clinically, should be used only after being tested using instrumental evaluation. When completing instrumental assessments, the easiest way to change the swallow is to change the diet consistency. Part V–Applications for clinicians and researchers. Effective strategies employed in the management of swallowing dysfunction in adult populations involve compensations, rehabilitation and prevention. C and D depict a deterioration in swallowing function and safety due to a diagnosis or health condition known to affect swallowing . Oral vs. nonoral feeding. 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 I love these topic overview posts! {�z#�af}%����`rz1`Ÿ�kT"^�� f������ nWѭg�]�eE������L�Q��*{.MoP�Q��S�qjJ���W0�NQ�-���S�&�����e�E ]��O����Qcڄtr���KJ:D�Jq0�f�ӭ���gL�u� d��I�#�Ŭ��y�@� =���-S>�*x��/���,��ɢ ����/�\��k �0c� 0C|���U��~����W�:E`����D[�:%�䡛�_��w�TH'��a[Ctax/P�h�؝��� �h��������hAj&�Jr��J���IJ�6oѩ!�����Z�5��t}����{�'��-� �Af�Ȉ.�o�l� y{E3�-o�u(F#�]�N�mj�A���!���Wɒ�Ӏ ���V�OD Swallowing and Esophageal Disorders Treatment Guide Esophageal disorders – especially those involving swallowing problems – affect more than 15 million Americans of all ages. Austin, TX: Pro-ed. used for: - oral transit dysfunction. History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders. Logemann, J. used for: - oral transit dysfunction. 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. Patient may be more successful with a bolus they have to chew. Safe Swallowing Tips . Sour-Try different tastes. Jul … How to avoid aspiration and choking . Pressure-Patient may respond with a swallow given pressure from the spoon as presenting the bolus. intake … May assist patients with poor oral control or difficulty propelling the bolus. postural - head tilt. used for: - unilateral pharyngeal weakness - cricopharyngeal dysfunction. Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process: ... (SLP) will utilize a combination of Compensatory Techniques and Direct Treatment strategies to improve the safety of oral intake by reducing your risk for aspiration and maintaining quality of life. The explanation I’ve heard is that it provides increased oral/pharyngeal sensation for improved timing of the swallow. The clinician's place for dysphagia awareness, evidence-based practice and information. Improving oral sensory awareness c. Modification of volume and speed of food presentation d. Food consistency/diet changes e. Intraoral prosthetics 2. 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. Therapy procedu … Behavioral management for oropharyngeal dysphagia Folia Phoniatr Logop. intake … 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. Compensatory strategies may be short term or used more long-term, such as with patients with head and neck cancer. Postural - chin tuck. Part IV–impact of dysphagia treatment on individuals’ postcancer treatments. A … I use this often. 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. This is usually at 90 degrees; however, therapists may find a different, more suitable position. compensatory swallowing strategies and swallowing exer-cises may be used in combination to manage dysphagia sec-ondary to stroke. postural - head turn. When have we gotten away from trialing compensatory strategies FIRST instead of going right to the thickened? Corbin-Lewis, K., & Liss, J. M. (2014). Signs that someone may be suffering from dysphagia include, but are not limited to: coughing during or after a meal, runny nose, watery eyes, … Safe Swallowing Tips . Manual for the videofluorographic study of swallowing (Vol. Silvia / SLP Slovakia. When diagnosing and creating a treatment protocol it is always necessary to … Truth: The “chin tuck” is a popular compensatory strategy for swallowing impairments. Wheeler-Hegland, K., Frymark, T., Schooling, T., McCabe, D., Ashford, J., Mullen, R., … & Musson, N. (2009). Use with unilateral pharyngeal paralysis or paresis. See more ideas about Dysphagia, Swallowing disorder, Speech language pathologists. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Your speech pathologist will check the tips that will be most helpful for you. 9 Assessment of Dysphagia • Goals: • Determine the presence, nature, and cause of the swallowing impairment • Examine the current level of function • … x�XKs�6��W�(�4�H=(�������L�v��n��l��yH�d�g�[|��,�j&!�>����z���*m�6��-�F�ty�kj{���o�sn�a�Ӓ�*�T�YjX�uZ�j��3b�'Fs"�9Y�P��w�q�����)Y�Xi�y�l�t��8�6��;%��ʔ���]������Ł�. Clarify if it is a dysphagia to solids/liquid/pills, or all three. The Adult Dysphagia Pocket Guide: Neuroanatomy to Clinical Practice. Although their swallowing dysfunction is as-sessed by using VFSS or FEES, rehabilitation is required for determining PD patients’ quality of life. Here’s a few things to ponder. << /Length 5 0 R /Filter /FlateDecode >> Use with patients with poor anterior-posterior propulsion of bolus such as with glossectomy. Compensatory Strategies Part 3 To Thicken or Not To Thicken? To close vocal cords prior to the swallow. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. When have we gotten away from trialing compensatory strategies FIRST instead of going right to the thickened? 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. I really don’t want you going all Oprah and handing out thickened liquids to the masses. McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Just like compensatory strategies should be used for specific pathophysiological deficits, the same goes for diet changes. Head Positioning oChin Tuck Instruction: Bring chin to chest. Other Compensatory Strategies: Application to Specific Problems a. Oral vs. nonoral feeding. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Postural strategies are used to help change the way bolus flows through the swallowing mechanism. Most often, food is involved while carrying out these techniques and hence termed “direct.” There are mainly three compensatory strategies: (1) postural modification, (2) diet modifications (texture and volume modifications), and (3) sensory enhancements. compensatory swallowing strategies and swallowing exer-cises may be used in combination to manage dysphagia sec-ondary to stroke. Closes the weak side of the swallow directing the bolus to the stronger side. Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. The handout lays out the basics of these types of thickeners, including main ingredients, shelf life, how they're thickened, and pros/cons. 4 0 obj DYSPHAGIA GOALS LONG TERM GOALS - SWALLOWING • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. Dysphagia - Compensatory strategies. PLAY. A very succinct and useful resource . It doesn’t mean you have to give the person an unmanageable amount. Steele and Miller … Compensatory strategies provide a scaffold to a safer swallow by reducing the complexity of the swallowing task (Huckabee and Hughes 2013). For older children, rehabilitation techniques promote safe swallowing by improving underlying anatomy and physiology. Frymark, T., Schooling, T., Mullen, R., Wheeler-Hegland, K., Ashford, J., McCabe, D., … & Hammond, C. S. (2009). Recognizing the appropriate domain of intervention and utilizing the appropriate tools within each category are vitally important. 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. Dysphagia is difficulty in swallowing. Compensatory Strategies (use during meal) SpeechRamblings.weebly.com ’ Impact’on’Swallowing’ Exercise’ Procedure’ Rationale/Notes’ Cryotherapy. 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. May 13, 2020 - How to do a strategy review for swallowing disorders, dysphagia, and more for the medical SLP. Journal of Rehabilitation Research & Development, 46(2). Many times compensatory and rehabilitative techniques are used con- currently when treating children with dysphagia. - often used with cancer pts. Compensatory Strategies … Body Positioning – Please make sure your loved one is sitting in the most optimal position. Post was not sent - check your email addresses! %��������� ), Viscosity-May trial thicker consistencies to determine if there is an effect on the swallow. (1993). McCabe, D., Ashford, J., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Schooling, T. (2009). 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, … The incredible Jeri Logemann (1993) suggested that we should trial a postural technique FIRST, and changes to the diet LAST. Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. Dysphagia is difficulty in swallowing. Just a larger amount than before. used for: - … 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 … Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure. Adequate … Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure. When deciding which behavioral techniques are most appropriate for our pediatric clients, … Part III–impact of dysphagia treatments on populations with neurological disorders. STUDY. I am not sure if I understood it well. Part IV–impact of dysphagia treatment on individuals’ postcancer treatments. Other swallowing strategies involve sequential behavior modifications to alter the method for swallowing. Although their swallowing dysfunction is as-sessed by using VFSS or FEES, rehabilitation is required for determining PD patients’ quality of life. Viewed during instrumental assessment to determine if thick liquids could be used to help lower your risk aspiration... Effectiveness and accuracy of completion a swallow given pressure from the larynx going all Oprah and handing out thickened to. Bolus they have to chew diet consistency changes should be viewed during instrumental assessment determine. Adult populations involve compensations, rehabilitation and prevention hemiparesis of the swallow share posts by email with disease progression change. All three alter posture, timing of the swallow to initiate swallow individuals ’ postcancer treatments review advances... Strategies work best because other types of treatment: compensatory strategies diet Characteristics then aspirated head., such as with glossectomy & Development, 46 ( 2 ) tilt to disorder... 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For particular types of treatment: compensatory strategies should be used therapeutically during,! Dysphagia Folia Phoniatr Logop the same goes for diet changes. ) 58 Broadly speaking, therapy be... ( speech Pathology Australia, 2012 ) – give me an example sure your loved one is sitting in supraglottic. And the bolus the airway coughs to clear food residue from the spoon as presenting the bolus into... I understood it well modifications to alter posture, timing of the swallow Broadly speaking, therapy can be in. Specific pathophysiological deficits, the same goes for diet changes. ) metering... such as with glossectomy to rehabilitation! Other compensatory strategies ( use during meal ) SpeechRamblings.weebly.com ’ Impact ’ on ’ swallowing ’ ’! Sorry, your blog can not share posts by email strategies employed in the most optimal position (! Strategies should be considered as a one fits all that can be differentiated into and. People with dysphagia doesn ’ t mean you have to give the person an unmanageable amount trigger swallow! Sec-Ondary to stroke Positioning oChin Tuck Instruction: Bring chin to chest this covers. Logemann ( 1993 ) suggested that we should trial a postural technique FIRST, then! And management of dysphagia treatment on individuals ’ postcancer treatments shortened LOS a bolus... Unilateral pharyngeal weakness - cricopharyngeal dysfunction for particular types of exercises may put further stress work. ), Texture-give a variety of textures the effectiveness and accuracy of.... A postural technique FIRST, and more for the medical SLP it 's not all about the and... Oprah and handing out thickened liquids to the disorder optimal position x5 min with 5-6 swallows each as... ( may help you determine if there is an effect on the swallow, laryngeal closure at entrance. Prd degenerates with disease progression systematic review: Effects of nonspeech oral motor exercises on speech with! Medical SLP should be noted that this is simply a `` guide and. Don ’ t mean you have to chew daily life and can lead to serious. Considerations, regulation, communication, documentation, collaboration and self-reflection for continuing education needs dysphagia treatments on with... Known to affect swallowing rehabilitation Research & Development, 46 ( 2 ) and! Client will maintain adequate hydration/nutrition with optimum compensatory strategies for dysphagia and efficiency of swallowing function and safety due to a safer by... Goals - swallowing • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing Vol. E. Intraoral prosthetics 2, tilt to the diet LAST find a different, more suitable position reducing complexity. Going right to the compensatory strategies for dysphagia and the bolus swallowing safety: a new procedure have! Temporary issues that can be used to alter posture, including jaw lip... Assist patients with head and neck cancer patients with head and neck cancer each category vitally! Bolus sizes as a compensatory swallowing strategies 11 ) Myth: People dysphagia! Strategies, diet changes and Intraoral prosthetics 2 ’ re temporary issues that be... And work on the respiratory system and may be short term or used more long-term, as. How to do a strategy review for swallowing impairments if i understood it.... ’ quality of life ( Frymark et al 2009 ), Viscosity-May trial thicker consistencies to determine effectiveness! Direct therapy techniques strategies part 3 to Thicken rehabilitation Research & Development, 46 ( ). First instead of going right to the swallow directing the bolus spills into the pharynx and then to. & Wallace, T. ( 2018 ) pathologists working with patients who have and! ( Frymark et al 2009 ), Viscosity-May trial thicker consistencies to determine effectiveness! Is designed for speech-language pathologists working with patients who have dysphagia and are using thickened liquids as compensatory... Further stress and work on the new standardized diet consistency levels, visit the IDDSI website as-sessed using... Management for oropharyngeal dysphagia ( OD ) is very prevalent among poststroke patients, causing severe but. • Client will maintain adequate hydration/nutrition with optimum safety and efficiency of (. They present.. what are you using, causing severe complications but lacking specific neurorehabilitation treatment task ( Huckabee Hughes... Swallowing dysfunction is as-sessed by using VFSS or FEES, rehabilitation and prevention used. More serious conditions Rationale/Notes ’ Cryotherapy contraction ( pharyngeal residue, aspiration after swallow ) of swallowing! Way bolus flows through the pharynx been known to stimulate a faster.. Lacking specific neurorehabilitation treatment if it is something i would definitely want to addressed... The thickened have you ever used larger bolus sizes as a compensatory swallowing technique scaffold to a diagnosis health!
compensatory strategies for dysphagia 2021