Types of Therapy

Oral and/or Pharyngeal Strengthening: Oral/pharyngeal strengthening is typically implemented by a certified and licensed speech-language pathologist in order to gain strength, range of motion, and coordination of the oral and pharyngeal muscles.

1. Oral motor (lip, cheek, tongue, jaw) exercises against resistance, various postures/movements
2. Deep Instrinsic muscular stretch and stimulation
3. Deep Pharyngeal Neuromuscular Stimulation (DPNS)
4. Pharyngeal Head Lifts/Shaker Exercises
5. Compensatory Strategy Training to reduce the risk for aspiration.
6. Electric Stimulation/Vital Stimulation
7. Effortful Swallow/Masako Maneuver

Maneuvers that are implemented to ensure a safe swallow including:

1. Head Turn – by rotating the head to the side of either motor or sensory weakness, the patient can eliminate the injured side of the pharynx from the food bolus path.
2. Chin tuck – By placing the chin downwards toward the chest, the patient widens the valleculae to prevent bolus from entering the airway, puts the epiglottis in a more protective position, and narrows the laryngeal entrance. This should NOT be recommended without an objective view of the swallow!
3. Effortful Swallow – The patient is instructed to bear down, or to squeeze hard with all of their head and neck muscles while swallowing. Some are instructed to pretend/visualize swallowing an entire hard boiled egg.
4. Supraglottic Swallow – Inhale and hold breath (closes the vocal folds); place bolus in mouth and swallow while holding breath; cough after swallowing before inhaling (clearing any residue that may have entered the larynx).
5. Mendelsohn Maneuver – The patient is instructed to hold the thyroid cartilage up for several seconds. In this way, the larynx is kept tilted forward and elevated, thereby allowing the upper esophageal sphincter to relax.

These behavioral maneuvers should be assessed for its effectiveness on each individual patient as part of a swallowing evaluation. These are not always effective on everyone.

Certain medications may be prescribed to help the patient swallow safely.

1. Mucolytic agents: Medications that thin-out thick secretions. Sometimes patients have very thick phlegm and mucus that makes it difficult to swallow. These can thin the thick secretions so that they could be more effectively expectorated and coughed.
2. Anti-acid medications: Swallowing problems are sometimes due to untreated or insufficiently treated acid reflux disease. The acid causes swelling in the throat, which can contribute to swallowing difficulties. Under those circumstances, anti-acid medication is prescribed in order to help alleviate the throat swelling that may be contributing to the swallowing problem.

Particular consistencies are assessed during a swallowing exam. Various food volumes and consistencies are assessed to determine which combinations allow the patient to swallow easily and safely.

Areas to consider are fatigue, willingness to eat and drink what is being recommended, the ability to follow and carry over certain swallowing techniques that me by recommended. The evaluator has to take into consideration the aspiration, choking, malnutrition, and dehydration risks. One risk may lead to one recommendation; whereby another risk may lean toward another. In other words, two patients with the same swallowing function may have different recommendations.