Dysphagia Rehabilitation Management
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Introduction[edit | edit source]
Positioning[edit | edit source]
Position during eating and drinking[edit | edit source]
Body position:
- 30 degrees reclining position:[1]
- raises the front of the oral cavity and lowers the back
- facilitates bringing a food bolus from the oral cavity to the throat for patients with difficulties sending a food bolus into the pharynx
- raises the respiratory tract and lowers the oesophagus making its easier to slide the bolus down the posterior wall of the pharynx, thus minimising aspiration.
- 60 degrees or higher position is needed for independent feeding[1]
- Maintaining a seated position for 2 hours after eating may prevent gastroesophageal reflux and reduce risk for aspiration [2]
Chin tuck (chin down):
- the chin down position may involve head flexion, neck flexion, or a combination of both
- the head flexion involving the upper cervical spine is effective when food residue is stuck in the epiglottic vallecula
- the neck flexion involving the middle and lower cervical spine is effective the initiation of swallowing reflex is poor.
- the effectiveness of each position should be verified by a Videofluoroscopic Swallowing Study or by a video-endoscopic examinations
Chin-up:
- the chin-up posture involves the head and neck extension and lifting of the chin before initiation of the swallow.
- the head and neck extension facilitates posterior bolus transit using the force of gravity
- patient with reduction in base of tongue movements due to oral pain, mucositis, fibrosis caused by radiation, and chemoradiation and patients with prolonged oral transit time and reduced tongue strength may benefit from this posture [3]
helpful in patients where there is difficulty in protrusion of the tongue and this leads to an impaired pressure, known as the lingual pressure, created around the tongue.
Exercises[edit | edit source]
Guidelines for Exercises in Dysphagia[edit | edit source]
Determinants of dose for exercise prescriptions dysphagia should include: (1) duration or length of the programme, (2)intensity (% of max), (3)repetitions (number of actions per set), and (4) frequency (number of sets/day, number of days/week).
Factors Affecting Outcomes[edit | edit source]
- poor compliance with swallow exercises reported with patients treated for head and neck cancer
- pre-treatment depression correlates with poor compliance with exercises
- timing and type of exercises. Lazarus et al.[4] found that one month post-radiotherapy for patients treated for head and neck cancer may be too soon to initiate a swallow therapy programme.
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 Hitoshi Kagaya H, Inamoto Y, Okada S, Saitoh E. Body Positions and Functional Training to Reduce Aspiration in Patients with Dysphagia. JMAJ 2011; 54(1): 35–38.
- ↑ Matsui T, Yamaya M, Ohrui T, Arai H, Sasaki H. Sitting position to prevent aspiration in bed-bound patients. Gerontology. 2002 May-Jun;48(3):194-5.
- ↑ Banerjee S. Dysphagia Rehabilitation Management. Plus Course 2024
- ↑ Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, Lee N, Ho M, Ganz C, Smith B, Sanfilippo N. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Surg. 2014 May;43(5):523-30.
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