Head posture adjustments are considered compensatory strategies. There is no rehabilitative impact and no lasting functional effect on swallowing (Crary & Groher, 2010). These strategies are appropriate to use if the prognosis is good for the eventual successful swallow in the absence of compensatory strategies. For example, swallowing dysfunction is common in patients who experienced a stroke. According to Vose et al. (2014), "more than 50% of the 665 thousand stroke survivors will experience dysphagia acutely of which approximately 80 thousand will experience persistent dysphagia at 6 months." 

Purpose: Compensatory strategies allow for a safe swallow until a functional swallow can be restored (Crary & Groher, 2010).

Population: Persons with swallow deficits at the oral or pharyngeal stage (Crary & Groher, 2010). 

• Buccinator weakness - Head tilt

• Poor tongue base retraction - Head tilt, chin tuck

• Incomplete epiglottal inversion - Head tilt, chin tuck 

• Weak pharyngeal constrictors - Head turn 

• Reduced PES opening due to reduced laryngeal elevation - Head turn 

Procedure: See below. 

Objective: Patient will use a chin tuck (compensatory strategy) for _ consistencies during mealtimes for 8 weeks to reduce the risk of aspiration, as evidenced through SLP and patient data collection. 

Data Collection: Determine the best method for collecting data (patient, caregiver, etc.). Provide a table for at-home data collection, as necessary. The patient/caregiver can add a check or plus to demonstrate the task was completed. Provide directions and videos below for support. Note: biofeedback (e.g. MBSS) can be used to determine the effectiveness of compensatory strategies if needed.

e.g. The patient/caregiver can put a check mark to demonstrate the compensatory strategy was used during mealtimes. 

Monday: breakfast _, lunch _, dinner_
Tuesday: breakfast _, lunch _, dinner_
Wednesday: breakfast _, lunch _, dinner_
Thursday: breakfast _, lunch _, dinner_
Friday: breakfast _, lunch _, dinner_
Saturday: breakfast _, lunch _, dinner_
Sunday: breakfast _, lunch _, dinner_

References
Alghadir, A. H., Zafar, H., Al-Eisa, E. S., & Iqbal, Z. A. (2017). Effect of posture on swallowing. African health sciences, 17(1),
133–137. https://doi.org/10.4314/ahs.v17i1.17
Crary, M.A., & Groher, M.E. (2010). Dysphagia: Clinical management in adults and children,Mosby Elsevier, Maryland
Heights, MO.
Kim, C. K., Ryu, J. S., Song, S. H., Koo, J. H., Lee, K. D., Park, H. S., Oh, Y., & Min, K. (2015). Effects of head rotation and head
tilt on pharyngeal pressure events Using high-resolution manometry. Annals of rehabilitation medicine, 39(3), 425–431.
https://doi.org/10.5535/arm.2015.39.3.425
Roth, F. P., & Worthington, C. K. (2021). Treatment resource manual for speech-language pathology. 6th Edition
Vose, A., Nonnenmacher, J., Singer, M. L., & González-Fernández, M. (2014). Dysphagia Management in Acute and Sub-
acute Stroke. Current physical medicine and rehabilitation reports, 2(4), 197–206. https://doi.org/10.1007/s40141-014-
0061-2