Oral Phase Compensatory Strategies
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| Downward Pressure on Tongue (w/spoon) | To treat reduced oral sensation, delayed oral/pharyngeal swallow. Improves oral sensory awareness.
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| Sour & Cold Bolus | To treat reduced oral sensation, delayed onset of swallow, pharyngeal delay. Improves oral sensory awareness. Put in mesh cloth if swallowing not wanted.
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| Thermal Tactile Swallow | Treats delayed initiation of pharyngeal aspect of swallowing. Improves oral sensory awareness. Stroke anterior faucial pillars w cold stimulus. Effect continues for several swallows after. Not permanent.
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| Bolus requiring chewing & Large Volume & Suck-Swallow | treats reduced oral sensation, delayed oral/pharyngeal swallow. Improves oral sensory awareness.
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| Tactile + Proprioceptive Input from | bolus requiring chewing
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| Increased tongue elevation from | Suck-Swallow
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| Other compensatory strategies | multiple swallows, small sips/amounts, modifying food presentation
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| Liquid Wash | immediately following pudding/solid if its getting stuck (oral/pharyngeal residue)
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| 3 second prep | from neurological/psychological research, preparing to swallow mentally
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| External support | external pressure to weaker cheek, labial & chin support
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| Intraoral prosthetics | For tongue resection, palatal work, lower palatal work, helps swallow
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| Most Invasive Strategy | Changing food consistency
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| Thickened Liquids | Treats oral tongue dysfunction, delayed pharyngeal swallow
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| Purees | Treats delayed pharyngeal swallow, reduced laryngeal closure
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| Rehabilitative Strategies for Oral Phase | Stretch Reflex, OM exercises, resistance, bolus propulsion, ROM exercises (passive & active), lifting back of tongue,
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| Stretch Reflex- rehab strategy | for oral weakness
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| OM exercises- rehab strategy | for Oral weakness, drecreased ROM, therapist initiated (passive) lip stretches, patient initiated (active)=pucker/release,close lips smack hard, smack,retract/hold,puff cheeks,resist ext. pressure
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| Resistance- rehab strategy | for oral weakness/decreased ROM. Push against tongue depressor.
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| Bolus Manipulation- rehab strategy | for decreased ROM. therapist holds bolus in mesh on string and pt moves it around
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| Bolus Propulsion- rehab strategy | for decreased ROM. Juice in gauze, pt squeezes juice out and swallows
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| ROM exercise- rehab strategy | for decreased ROM. Elevate anterior/posterior tongue and hold. side to side. pull tongue back/hold.
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| Lift back of tongue- rehab strategy | for decreased lingua velar seal, not base of tongue. Hard /k/ words
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| protocol recommendations- how many trials a day? | 25
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| protocol recommendations- how many days a wk? | 6
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| protocol recommendations- how many wks? | 8
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