Slp conversation compensatory strategies

Fax: (228) 832-4033

12303 Hwy 49, Gulfport, MS 39503

A Speech-Language Pathologist (SLP) evaluates and treats disorders of speech, language, voice, and swallowing. As part of an interdisciplinary treatment program, the speech language pathologist educates and counsels people on the impact of and strategies for communication disorders.

A qualified speech language pathologist is certified by the American Speech-Language-Hearing Association (CCC-SLP). www.asha.org/public/speech/

A Speech Language Pathologist must have a master's degree and a state license.

Slp conversation compensatory strategies

Compensatory Strategies

- Thin/Thickened Liquids: nectar thick, honey thick, and pudding thick.

- Thin/Thick puree food

- Chopped/Mechanical soft diet

- Alternative texture/temperature - Alternate liquids and solids: to eliminate residue.

- Throat clearing: to eliminate residue.

- When/where/how the pt is eating/being fed

- Consider pt's position during meals

- Most importantly, consider pt's etiology and how it may be effecting PO intake

Thickening Liquids

-Thickened liquids that are hot when you thicken them, can get thicker as they cool so you may need to change the way you thicken hot liquids.

- Thickening liquids also is dependent on the weather outside! With increased humidity or chill, thickening will have to alter.

-If you allow them to sit, they will thicken.

-If you notice tiny clumps/lumps in the thickened liquid, this defeats the purpose of thickening a liquid as they did not mix well with the liquid.

-Creatine/BUN blood levels to monitor for adequate hydration

Thin Liquids Handout for Patient

-Small bites/small sips -

-Liquid wash to clear oral, pharyngeal, valleculae, etc. residue.

-Dry swallow - clear residue

-Multiple swallows - to clear residue

Move the head to better side, bolus is redirected through oral cavity and oral bolus transport is improved.

Put chin down to move bolus anterior. It prevents premature spillage and widens the valleculae so spillage hesitates there giving more time for VF's to close thereby reducing the risk of aspiration.

Bypass oral stage by utilzing gravity to clear oral cavity

Therapeutic Dysphagia Strategies

Sensory strategies include changing volume, texture, temperature, or taste therefore changing the sensory feedback provided by the bolus (Logemann, 1989, '97).

For patients with apraxia of the swallow, it may be best to let them feed themselves allowing the swallow to be more automatic.

Used if there is a delayed swallow to increase sensitivity.

The patient produces an exaggerated suck with the lips closed followed by an exaggerated vertical back-tongue motion prior to swallowing attempts. (Have the patient suck on a posicle stick). The sucking action pulls saliva to the back of the mouth, and this seems to help trigger the swallow more rappidly. So, this technique is also based on the idea that increased oral sensation will help to trigger the swallow.

assist with structural/tissue damage

involve pushing against tongue depressor or spoon to create "resistance"

used to increase laryngeal elevation. Involve repetitive /i/ or /ng/.

1. Take a breath in.

Hold your breath tightly. Now, swallow twice, release your breath with a sharp cough, and swallow again.

Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.

McConnel, F.M., Mendelsohn, M.S., & Logemann, J.A. (1987). Manofluorography of deglutition after supraglottic laryngectomy. Head and Neck Surgery, 5, 142-150

Ask pt to inhale and hold their breath very tightly, bearing down. Instruct pt to continue to hold breath lightly while swallowing. (immediately after the swallow the pt should cough to clear any residue)

Ohmae, Y., Logemann, J.A., Kaiser, P., Hanson, D.G., & Kahrillas, P.J. (1996). Effects of two breath-holding maneuvers on oropharyngeal swallow. Annals of Otology, Rhinology, and Laryngology, 105, 123-131.

Lie flat on your back with no pillow under your head. Lift your head to look at your toes, while keeping your shoulders. Hold the position for 30 seconds and then release.

Shaker, R., Kern, M., Bardan, E., Taylor, A., Stewart, E., Hoffmann, R.G., Arndorfer, R.C., Hoffmann, C., & Bonnevier, J.

Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. AJR, 272: G1518-1522, 1997.

Tongue hold between teeth while swallowing.

Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Evaluation of manometric measures during tongue-hold swallows. American Journal of Speech-Language Pathology, 18, 65-73 : Examined manometric measures during the Masako and concluded that while the technique should not be done during PO trials as it reduces oropharyngeal pressure generation, there may be increased pharyngeal constrictor strength after regular training.

Swallow as hard as you can with food or saliva. Push as hard as you can with the tongue against the roof of your mouth while you swallow.

Shanahan, T.K., Logemann, J.A., Rademeker, A.W., Pauloski, B.R., & Kahrillas, P.J. (1993). Chin down posture effects on aspiration in dysphagic patients. Archives of Physical Medicine and Rehabilitation, 74, 736-739.

1. Swallow normally. Feel the larynx (voice box) lift during the swallow.

Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral cancer patient. Head and Neck, 15, 419-424.

Logemann, J.A., & Kahrilas, P.J. (1990). Relearning to swallow post CVA: Application of maneuvers and indirect feedback: A case study. Neurology, 40, 1136-1138.

Jaw Opening Exercise

1. Hold the jaw in the maximally opened position for 10 seconds.

Instrumental

Newer techniques such as NMES and Vitalstim have been introduced and are more widely being used. See My Blog for recent studies. Though controversial, many clinicians feel they have seen change in their pt's with use of these types of protocols. They require training and certification. Recent studies suggest that NMES is most efficient when utilized in conjunction with therapeutic dysphagia strategies.

Dysphagia Assessment and Treatment Documents for Sale

NEW! Dysphagia Bundle Package!

NEW! The Dysphagia Patient Education Handout Package

Dysphagia Treatment with Rationale

UPDATED Dysphagia Treatment II

Bedside Swallow Examination

Videofluoroscopy (VFFS)/Modified Barium Swallow Study (MBSS) Examination Report

Amy Speech & Language Therapy, Inc.

Copyright © 2010 Amy Speech Language Therapy. All Rights Reserved.