Compensatory Techniques

Compensatory techniques are used to alter the swallow, however compensations may not create a lasting effect to the swallow.

Compensatory strategies may be short term or used more long-term, such as with patients with head and neck cancer.

Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure.

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.

Any compensatory strategy should be viewed during instrumental assessment to determine the effectiveness and accuracy of completion.

Maneuvers: 

Supraglottic Swallow

  • To close vocal cords prior to the swallow.
  • Improves coordination of the swallow.  
  • Use when you see aspiration prior to or during the swallow.
  • Use with a delayed pharyngeal swallow.

Logemann recommends 10x/day x5 min with 5-6 swallows each time as exercise.  (Frymark et al 2009)

Super Supraglottic Swallow

  • For early closure at the entrance to the airway.
  • Facilitates timing and extent of laryngeal closure at specific levels of the larynx.
  • Use with penetration/aspiration prior to or during the swallow.
  • Use with a delayed pharyngeal swallow.

Mendelsohn Manevuer

  • To assist in laryngeal elevation.
  • Widens the valleculae.
  • Use for reduced laryngeal elevation.
  • Use for reduced PharyngoEsophageal (PES) opening.
  • Use for discoordianted swallow.

Effortful Swallow

  • Increase strength of the overall swallow.
  • Use with vallecular residue.
  • Use with reduced tongue base retraction.

Postures:

Chin Tuck

  • Widens valleculae.
  • Helps patient keep bolus in the oral cavity.
  • Narrows airway.
  • Use with oral containment issues (posterior loss of bolus resulting in aspiration).
  • Use with reduced airway closure.
  • Use with vallecular residue.

Head Turn (to weak side)

  • Closes the weak side of the swallow directing the bolus to the stronger side.
  • Use with unilateral pharyngeal paralysis or paresis.

Head Back

  • May assist patients with poor oral control or difficulty propelling the bolus.
  • Pharyngeal phase must be intact.
  • Use with patients with poor anterior-posterior propulsion of bolus such as with glossectomy.

Side Lying

  • To help clear pharyngeal residue by altering gravity.
  • Use with reduced pharyngeal contraction (pharyngeal residue, aspiration after swallow).

Changes in the bolus/Sensory

Texture-give a variety of textures.  Patient may be more successful with a bolus they have to chew.  (Don’t try one texture only!!)

Viscosity-May trial thicker consistencies to determine if there is an effect on the swallow.  (May help you determine if thick liquids could be used therapeutically during sessions, not necessarily for diet changes.)

Temperature-Patients may respond differently with a hot bolus vs. a cold bolus.

Sour-Try different tastes.  Sour has been known to stimulate a faster swallow.  Patients may respond to differing tastes.

Size-Patient may have difficulty with a small bolus vs. a large bolus or vice versa.   Some patients require a larger bolus to trigger the swallow.

Pressure-Patient may respond with a swallow given pressure from the spoon as presenting the bolus.

Diet Consistency Changes:

Remember, diet consistency changes should be considered as a last resort!  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.

For more information on the new standardized diet consistency levels, visit the IDDSI website.

References:

Corbin-Lewis, K., & Liss, J. M. (2014). Clinical anatomy & physiology of the swallow mechanism. Nelson Education.

https://iddsi.org/

https://www.asha.org/PRPSpecificTOpic.aspx?folderid=8589942550&section=Treatment

Logemann, J. A. (1993). Manual for the videofluorographic study of swallowing (Vol. 2). Austin, TX: Pro-ed.

Langmore, S. E., Kenneth, S. M., & Olsen, N. (1988). Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia2(4), 216-219.

McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology.

Ashford, J., McCabe, D., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Hammond, C. S. (2009). Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part III–impact of dysphagia treatments on populations with neurological disorders. Journal of Rehabilitation Research & Development46(2).

McCabe, D., Ashford, J., Wheeler-Hegland, K., Frymark, T., Mullen, R., Musson, N., … & Schooling, T. (2009). Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part IV–impact of dysphagia treatment on individuals’ postcancer treatments. Journal of Rehabilitation Research & Development46(2).

Frymark, T., Schooling, T., Mullen, R., Wheeler-Hegland, K., Ashford, J., McCabe, D., … & Hammond, C. S. (2009). Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part I–background and methodology. Journal of Rehabilitation Research & Development, 46(2).

Wheeler-Hegland, K., Frymark, T., Schooling, T., McCabe, D., Ashford, J., Mullen, R., … & Musson, N. (2009). Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part V–Applications for clinicians and researchers. Journal of Rehabilitation Research & Development46(2).

Wheeler-Hegland, K., Ashford, J., Frymark, T., McCabe, D., Mullen, R., Musson, N., … & Schooling, T. (2009). Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part II–impact of dysphagia treatment on normal swallow function. Journal of Rehabilitation Research & Development46(2).

McCoy, Y., & Wallace, T. (2018). The Adult Dysphagia Pocket Guide: Neuroanatomy to Clinical Practice. Plural Publishing.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 thoughts on “Compensatory Techniques

  1. Dear Tffany, I´d like to ask you about the term: “posterior loss of bolus resulting in aspiration”. I am not sure if I understood it well. Could you please describe me this issue or to be more concrete – give me an example? Thank you in advance! Silvia / SLP Slovakia

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