When a patient is referred to a speech and language therapist for the management of swallowing difficulties, multiple options are available to address these issues. The choice is based on a detailed assessment of the patient’s swallowing physiology and function. Patients may be advised on diet texture modifications, specific exercises targeted to improve physiology, or the use of compensatory strategies. These options are often used in combination. Compensatory strategies may not change physiology but they do alter the biomechanics of swallowing. This may make it possible for an individual to continue eating and drinking safely (as opposed to nil by mouth) whilst also undertaking rehabilitative swallowing exercises. This historical review provides an excellent account of compensatory strategies classified into: 1) bolus variables such as volume and viscosity, 2) postures such as head turn/tilt, chin tuck, side lying, 3) sensory enhancements such as thermal-tactile stimulation and the use of taste stimuli and carbonation, 4) other intuitive strategies such as double swallows and ‘liquid washes’ to help clear residue. The author cites early studies highlighting the potential benefits of particular strategies as well as confirmatory studies using more advanced technologies. Different compensatory strategies alter swallowing mechanics in different ways. A larger bolus volume alters multiple aspects of the swallow such as an increase in tongue pressure, an increase in sub-mental and laryngeal muscle activity, and an earlier onset and longer duration of hyo-laryngeal movement and upper oesophageal opening times. Head postures can also alter the biomechanics of swallowing in ways that may be helpful to support dysphagic patients to continue eating an oral diet. Chin tuck during swallowing of liquids for example, was reported to be as effective in preventing aspiration as the use of thickened fluids in patients with Parkinson’s disease and dementia. This is a useful overview of compensatory strategies that may help manage dysphagia. The author is mindful not to suggest that compensatory strategies are a panacea for solving swallowing problems.
How do you solve a problem like Dysphagia?
Reviewed by Roganie Govender
History of the use and impact of compensatory strategies in management of swallowing disorders.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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