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_
Widens the oropharynx
Uses gravity to move bolus downward through the oral cavity to the pharynx.
MUST have adequate pharyngeal function and airway protection
Typically used with patients who have dysphagia due to oral tongue function (Crary & Groher, 2010; Roth & Worthington, 2021). .
e.g. Glossectomy, ALS
Narrows the oropharynx
Decreases the distance between the hyoid bone and larynx
Improves laryngeal vestibular closure
Degree of chin tuck will have varying impact on swallow anatomic/physiologic changes
Typically used with patients who have dysphagia due to a tongue base disorder, a pharyngeal phase delay, or compromised airway protection (Crary & Groher, 2010).
Caution: This head posture may increase the duration of swallow apnea when combined with reclined posture (60 degrees), resulting in respiratory stress in some patients.
Turn head TOWARDS the WEAKER side
Narrows and closes the swallowing tract on the side in which the head is turned.
Allows patient to isolate and utilize the stronger side.
Used for unilateral pharyngeal deficit (Crary & Groher, 2010; Roth & Worthington, 2021).
Tilt TOWARDS the HEALTHY side (45 degrees)
Food flows toward the direction of the head tilt (towards the stronger side)
Used for unilateral oral or pharyngeal weakness (Crary & Groher, 2010; Roth & Worthington, 2021).
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