Behavioral
Therapy are postural maneuvers that are implemented to insure a safe swallow.
For example, a HEAD TURN is implemented when it is found that a patient is
numb on one side of their throat during a FEESST exam. By having the patient turn
their head
to
the numb side, the area of the throat that is numb becomes narrowed so that incoming
food gets directed towards the sensate side of the throat.
Types of Swallowing
Behavioral Therapy include:
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.
For an Endoscopic
view of the effects of a head turn, please click
here.
2. Chin Tuck
By placing the chin
downwards toward the chest the patient: 1) widens the vallecula to prevent
bolus from entering airway 2) puts the epiglottis in a more protective position
3) narrows the laryngeal entrance
3. Effortfull Swallow
The patient is instructed to bear down, or to squeeze hard with all of their
head and neck muscles while swallowing.
4. Shaker Exercises
Another way to open the upper esophageal sphincter by having the patient
lay flat on their back and, in a precise manner, slowly lift their chin to their
chest.
5. Supraglottic Swallow
4 step maneuver:
1) inhale and hold breath (this closes the vocal folds) 2) place bolus in
swallow position 3) swallow while holding breath 4) cough after swallowing
before inhaling (this clears any residue that may have entered the larynx)
6. Mendelsohn Maneuver
A technique that opens the upper
esophageal sphincter. 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.
Behavioral
Therapy
