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DYSPHAGIA-PREVENTION OF ASPIRATION

Neurology

DYSPHAGIA-PREVENTION OF ASPIRATION

1. Modifications of bolus consistency: thickened fluids, pureed or soft foods in smaller boluses.

2. Parenteral feeding: if clear contraindication for enteral feeding.

COMPENSATORY STRATEGIES
3. Chin tuck: brings the base of the tngue closer to the posterior pharyndgeal wall to prevent entry of bolus into the larynx.

4. Head tilt: uses gravity to guide the bolus into the ipsilateral pharynx.

5. Head rotation: closes the ipsilateral pharynx and forces food down the contralateral side, hence turn the head towards the paretic side.

6. Supraglottic swallow: concomitant breath holding and swallowing closes the vocal folds to protect the trachea.

7. Super supraglottic swallow: adds Valsalva maneuver to maximize vocal fold closing.

8. Mendelsohn maneuver: Patient voluntarily holds the larynx at its maximal height to lengthen the duration of the cricopharyngeal opening.

9. Thermal stimulation: to sensitize the swallowing reflex.

10. Oral/motor exercises: to improve tongue and lip strength, ROM, velocity, and precision, and vocal-fold adduction.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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