DYSPHAGIA-EBM (STRATEGIES FOR ENTERAL FEEDING)

SUMMARY

COMPENSATORY STRATEGIES
1. General measures: changes to posture, elevation of head of bed, feeding in the upright position, changing size and consistency of bolus, slow swallowing.
2. Chin tuck: brings the base of the tongue closer to the posterior pharyngeal wall to prevent entry of bolus into the larynx.
3. Head tilt: uses gravity to guide the bolus into the ipsilateral pharynx.
4. Head rotation: closes the ipsilateral pharynx and forces food down the contralateral side, hence turn the head towards the paretic side.
5. Supraglottic swallow: concomitant breath holding and swallowing closes the vocal folds to protect the trachea.
6. Super supraglottic swallow: adds Valsalva maneuver to maximize vocal fold closing.
7. Mendelsohn maneuver: patient voluntarily holds the larynx at its maximal height to lengthen the duration of the cricopharyngeal opening.
8. Thermal stimulation: to sensitize the swallowing reflex.
9. Oral/motor exercises: to improve tongue and lip strength, ROM, velocity, precision, vocal-fold adduction.

RESTORATIVE STRATEGIES
10. Masako technique: holding the tongue.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.