Major focus area

Feeding Therapy -> Swallowing

Short description

Compensatory and facilitation techniques are not only airway protective swallowing maneuvers but they also help facilitate the return of pharyngeal function. These techniques can be used with patients who understand the rationale for the maneuver, follow two- to three-step instructions, and retain instructions over time. There are 4 compensatory/facilitation swallowing maneuvers that have been shown to improve airway protection and the efficiency of bolus passage through the aerodigestive tract: Supraglottic swallow, Super-supraglottic swallow, effortful swallow and Mendelsohn maneuver (Swigert, 2007; Logemann, 1998; Huckabee and Steele, 2006).

Long description

Compensatory and facilitation techniques are not only airway protective swallowing maneuvers but they also help facilitate the return of pharyngeal function. These techniques can be used with patients who understand the rationale for the maneuver, follow two- to three-step instructions, and retain instructions over time.

There are 4 compensatory/facilitation swallowing maneuvers that have been shown to improve airway protection and the efficiency of bolus passage through the aerodigestive tract: Supraglottic swallow, Super-supraglottic swallow, effortful swallow and Mendelsohn maneuver (Swigert, 2007; Logemann, 1998; Huckabee and Steele, 2006).

Supraglottic swallow: This is indicated for patients who cannot attain laryngeal closure or airway closure prior to and during a swallow. It works to provide five areas of approximating laryngeal valving sufficient to achieve strong laryngeal closure prior to and during the swallow. The supraglottic swallow involves the following steps:

1. Take and hold a breath.
2. Place food or liquid in the mouth.
3. Swallow (once or twice, depending on the efficiency of pharyngeal clearance.)
4. Clear your throat.
5. Swallow again. The patient is instructed not to breath at any point during the sequence to prevent inhalation of pharyngeal stasis or residue. SLP must be careful to instruct patient to clear the throat “out” rather than to cough, because many patients will attempt to inhale before a coughing maneuver.

Super-supraglottic swallow: This follows the identical sequence to the supraglottic swallow, but the patient is instructed to use additional force during the sequence to provider greater muscular tension. Studies show the super-supraglottic swallow improves the rate of laryngeal elevation and improves movement of the tongue base.

Effortful Swallow: This is used with a patient who presents with incomplete pharyngeal clearance resulting from incomplete tongue base retraction. The patient is instructed to swallow hard or with effort and attempt to feel the backward motion of the tongue. By telling the patient to put emphasis on the tongue base pushing against the palate more pressure in the upper pharynx will be created.

Mendelsohn Maneuver: This is effective in patients with incomplete opening or premature closing of the UES. If a patient voluntarily maintains the larynx in its elevated /anteriorly displaced position, at the height of the swallow, the cricopharyngeaus (UES) increases the duration of its opening, duration of laryngeal closure and tongue base retraction. Patients who are taught to do this will have more complete pharyngeal clearance. The SLP instructs the patient to perform a dry swallow or 1-mL of water and hold the larynx in the elevated position for 3 to 5 seconds. This is typically prescribed when a patient is demonstrating aspiration after the swallow from the residue in the pyriform sinuses.