Treatment of Dysphagia in Adult

Maria Provencio-Arambula, M.A. Maria H. Provencio-Arambula, M.A., CCC-SLP, graduated from California State University, Fresno (CSU Fresno) with a master's degree in speech-language pathology. She was the recipient of the CSU Fresno Dean's medal. During her studies at CSU Fresno, Maria was a Ronald E. McNair Graduate Equity Fellow. In addition, she completed a Master's degree project on assessment and treatment of dysphagia and helped complete a collaborative study involving CSU Fresno and Children's Hospital, Central California, on treating stuttering in preschool children. Dora Provencio, M.A. Dora Provencio, M.A. graduated from California State University, Fresno (CSU Fresno) with a master's degree in Speech-Language pathology. She currently is an administrative assistant and rehab director for L & J Telesmanic Rehab Systems, Inc., a private practice which has been providing services in the Central California area for over 15 years. In her current position, Dora has trained many speech-language pathologists in assessment and treatment of dysphagia in a variety of patients and regularly supervises services offered to patients with dysphagia. She has extensive experience in varied practice settings, including acute hospital inpatient and outpatient rehabilitation centers, home health, and long-term care facilities. She developed the modified barium videofluoroscopic swallow dysphagia team and procedure at Sierra Kings District Hospital, Reedley, CA, and at Selma Community Hospital, Selma, CA. She is a bilingual speech-language pathologist who is fluent in reading, writing and speaking Spanish. She is co-author of the Spanish Test for Assessing Morphological Production. She regularly guest lectures on dysphagia and multicultural assessment and treatment of speech and language disorders at California State University (CSU Fresno) program in Communicative Disorders She has also taught graduate seminars at CSU Fresno. She has presented seminars and short courses at California State Speech-Language-Hearing Association District 5 Conferences. She is a founding board member and current president of the CSU Fresno Communicative Disorders Alumni Chapter. M. Hegde, Ph.D. M. N. Hegde, Ph.D. is Professor of Speech-Language Pathology in the Department of Communicative Disorders at California State University, Fresno. A highly regarded author in speech-language pathology, his books include leading texts in academic courses and valuable resources for clinicians. His books have been used in worldwide in speech-language pathology programs.

--Katy Higham, B.A., George Washington University, Doody's Review Service, "This excellent resource for beginning clinicians gives detailed instructions for specific dysphagia therapy techniques, as well as evidence supporting each one...This is a comprehensive and easy to understand resource..." Doody Enterprises, Inc.: "* * * * Four stars from Doody's Review Service!"

• Preface Introduction to Dysphagia Treatment Resources and Protocols How to Use the Accompanying CD Section 1. Overview of Management and Treatment of Dysphagia Establishing a Prognosis for Treatment Components of a Dysphagia Treatment Program Preparation for Treatment Varieties of Treatment Section 2. Management and Treatment of Dysphagia General Treatment Procedures Protocol 2.1 (English/Spanish): Cheek Push Strategy Protocol 2.2 (English/Spanish): Mouth Rinse Strategy Protocol 2.3 (English/Spanish): Strong Hold Food Strategy Protocol 2.4 (English/Spanish): Multiple Swallow Strategy Protocol 2.5 (English/Spanish): Alternating Solids and Liquids Strategy Protocol 2.6 (English/Spanish): Empty Mouth Strategy Section 3. Treatment for Oral Preparatory Phase Disorders Overview of the Oral Preparatory Phase of Swallowing and Associated Disorders Increasing Oral Sensitivity Protocol 3.1 (English/Spanish): Cold Lip Rub Protocol 3.2 (English/Spanish): Warm Lip Rub Protocol 3.3 (English/Spanish): Soft Lip Press Protocol 3.4 (English/Spanish): Bitter Press Protocol 3.5 (English/Spanish): Iced Cheek Technique Protocol 3.6 (English/Spanish): Washcloth Rub Protocol 3.7 (English/Spanish): Cold Inner Cheek Rub Protocol 3.8 (English/Spanish): Toothbrush Rub Protocol 3.9 (English/Spanish): Tongue Tickle Protocol 3.10 (English/Spanish): Back Tongue Tickle Improving the Strength and Range of Movement of the Lips and Cheeks Strengthening the Lips Protocol 3.11 (English/Spanish): Lip Squeeze Exercise Protocol 3.12 (English/Spanish): Lip Rub Exercise Protocol 3.13 (English/Spanish): Lower Lip Push-up Exercise Protocol 3.14 (English/Spanish): Close/Open Lip Exercise Protocol 3.15 (English/Spanish): Pucker and Smile Exercise Protocol 3.16 (English/Spanish): Tight Lip Exercise Protocol 3.17 (English/Spanish): Big Smile Exercise Strengthening the Cheeks Protocol 3.18 (English/Spanish): Cheek Puff Exercise Improving Cheek Tension Protocol 3.19 (English/Spanish): Cheek Push-up Exercise Protocol 3.20 (English/Spanish): "Oh" Lips Exercise Protocol 3.21 (English/Spanish): Side Pucker Exercise Protocol 3.22 (English/Spanish): Head Tilt Exercise Improving Tongue Movements Protocol 3.23 (English/Spanish): Side-to-Side Tongue Wag Exercise Protocol 3.24 (English/Spanish): Side Tongue Hold Exercise Protocol 3.25 (English/Spanish): Teeth Sweep Exercise Protocol 3.26 (English/Spanish): Tongue-to-Cheek Push Exercise Protocol 3.27 (English/Spanish): Lateral Tongue Push Exercise Protocol 3.28 (English/Spanish): Lateral Lick Exercise Protocol 3.29 (English/Spanish): Lateral Chew Exercise Protocol 3.30 (English/Spanish): Tongue Press Exercise/Strategy Protocol 3.31 (English/Spanish): Head Tilt Strategy Improving Tongue Tip Elevation Protocol 3.32 (English/Spanish): Tongue Tip Push Exercise Protocol 3.33 (English/Spanish): Toothette Squeeze Exercise Protocol 3.34 (English/Spanish): Anterior Tongue Click Exercise Protocol 3.35 (English/Spanish): Tongue Tip Sound Production Exercise Protocol 3.36 (English/Spanish): Tongue Tip Swipe Exercise Improving Tongue Movement for Bolus Formation Protocol 3.37 (Spanish/English): Chewing Gum or Licorice Exercise Protocol 3.38 (English/Spanish): Lateral Tongue Push Exercise Protocol 3.39 (English/Spanish): Middle Tongue Push Exercise Protocol 3.40 (English/Spanish): Back Tongue Push-up Exercise Improving Range of Tongue Movement Protocol 3.41 (English/Spanish): Circular Dry Gauze Chew Exercise Protocol 3.42 (English/Spanish): Tongue Bowl Lift Exercise Protocol 3.43 (English/Spanish): Tongue Bowl Slide Exercise Protocol 3.44 (English/Spanish): Head Forward Position Strategy Protocol 3.45 (English/Spanish): Food Hold Strategy Section 4. Treatment for Oral Phase Dysphagia Overview of the Oral Phase of Swallowing and Associated Disorders Increasing Oral Sensitivity Protocol 4.1 (English/Spanish): Large Bolus Strategy Protocol 4.2 (English/Spanish): Textured Bolus Strategy Protocol 4.3 (English/Spanish): Sour Bolus Strategy Protocol 4.4 (English/Spanish): Cold Bolus Strategy Protocol 4.5 (English/Spanish): Spoon Press Strategy Protocol 4.6 (English/Spanish): Thermal-Tactile Stimulation Exercise/Strategy Improving Anterior to Posterior Movement of the Bolus Protocol 4.7 (English/Spanish): Tongue Squeeze Exercise Protocol 4.8 (English/Spanish): Modified Tongue Squeeze Exercise Protocol 4.9 (English/Spanish): Swab Swipe Exercise Protocol 4.10 (English/Spanish): Tongue Tip Swipe Exercise Protocol 4.11 (English/Spanish): Middle Tongue Pop Exercise Protocol 4.12 (English/Spanish): Posterior Food Position Strategy Protocol 4.13 (English/Spanish): Dump and Swallow Strategy Protocol 4.14 (English/Spanish): Dump and Swallow with the Supraglottic Swallow Strategy Protocol 4.15 (English/Spanish): Food Hold Strategy Protocol 4.16 (English/Spanish): Midline Food Position Strategy Improving Tongue Base Control Protocol 4.17 (English/Spanish): Back Tongue Push-up Exercise Protocol 4.18 (English/Spanish): /k/ Tongue Production Exercise Protocol 4.19 (English/Spanish): Out/In Tongue Exercise Protocol 4.20 (English/Spanish): Modified Tongue Tip Sweep Exercise Protocol 4.21 (English/Spanish): Big Yawn Exercise Protocol 4.22 (English/Spanish): Dry Gargle Exercise Protocol 4.23 (English/Spanish): Tongue Anchor Exercise/Masako Maneuver Protocol 4.24 (English/Spanish): Mendelsohn Maneuver Exercise/Strategy Protocol 4.25 (English/Spanish): Chin Tuck Strategy Protocol 4.26 (English/Spanish): Reduced Bolus Size Strategy Protocol 4.27 (English/Spanish): Effortful Swallow Exercise/Strategy Protocol 4.28 (English/Spanish): Super-Supraglottic Swallow Strategy Section 5. Treatment for Pharyngeal and Esophageal Phases of Dysphagia Overview of the Pharyngeal Phase of Swallowing and Associated Disorders Treatment for Pharyngeal Phase Dysphagia Improving Initiation of the Pharyngeal Swallow Protocol 5.1 (English/Spanish): Chin Down Strategy Protocol 5.2 (English/Spanish): Thermal-Tactile Stimulation Exercise/Strategy Protocol 5.3 (English/Spanish): Suck Swallow Exercise Protocol 5.4 (English/Spanish): Textured Bolus Strategy Protocol 5.5 (English/Spanish): Sour Bolus Strategy Protocol 5.6 (English/Spanish): Cold Bolus Strategy Protocol 5.7 (English/Spanish): Small Bolus Strategy Reducing Residue in the Valleculae Protocol 5.8 (English/Spanish): Effortful Swallow Exercise/Strategy Protocol 5.9 (English/Spanish): Mendelsohn Maneuver Exercise/Strategy Protocol 5.10 (English/Spanish): Modified Tongue Anchor Exercise Protocol 5.11 (English/Spanish): Supraglottic Swallow Exercise/Strategy Protocol 5.12 (English/Spanish): Lying Down on the Side Strategy Protocol 5.13 (English/Spanish): /k/ Tongue Production Exercise Protocol 5.14 (English/Spanish): Dry Gargle Exercise Protocol 5.15 (English/Spanish): Big Yawn Exercise Reducing Residue in the Pharynx Protocol 5.16 (English/Spanish): Tongue Anchor Exercise Protocol 5.17 (English/Spanish): Lying Down on the Side Strategy Protocol 5.18 (English/Spanish): Head Turn Exercise/Strategy Protocol 5.19 (English/Spanish): Head Tilt Strategy Increasing Laryngeal Closure Protocol 5.20 (English/Spanish): Pulling Exercise Protocol 5.21 (English/Spanish): Pushing Exercise 1**Protocol 5.22 (English/Spanish): Valsalva Maneuver Exercise Protocol 5.23 (English/Spanish): Super - Supraglottic Swallow Exercise/Strategy Protocol 5.24 (English/Spanish): Supraglottic Swallow Exercise/Strategy Protocol 5.25 (English/Spanish): Chin Down Exercise/Strategy Protocol 5.26 (English/Spanish): Head Turn Exercise/Strategy Protocol 5.27 (English/Spanish): Head Turn with Chin Down Exercise/Strategy Increasing Laryngeal Elevation Protocol 5.28 (English/Spanish): Falsetto/Pitch Exercise Protocol 5.29 (English/Spanish): Mendelsohn Maneuver Exercise/Strategy Protocol 5.30 (English/Spanish): Super - Supraglottic Swallow Exercise/Strategy Protocol 5.31 (English/Spanish): Supraglottic Swallow Exercise/Strategy Esophageal Phase Dysphagia Treatment Resource 5.1 (English/Spanish): Recommendations for Preventing Reflux Section 6. Inservice Resources on Staff Education Working with a Dysphagia Multidisciplinary Team Inservice Resource 6.1: Working with a Dysphagia Multidisciplinary Team Posttest: Working with a Dysphagia Multidisciplinary Team Staff Education 1. Safety and Precautions with Feeding Inservice Resource 6.2: Safety and Precautions with Feeding Posttest: Safety and Precautions with Feeding Staff Education 2. Feeding the Disoriented Patient Inservice Resource 6.3: Feeding the Disoriented Patient Posttest: Feeding the Disoriented Patient Staff Education 3. Safe Feeding Techniques and Precautions Inservice Resource 6.4: Safe Feeding Techniques and Precautions Posttest: Feeding Techniques and Precautions Staff Education 4. Documentation for the Restorative Feeding Program Inservice Resource 6.5: Documentation for the Restorative Feeding Program Posttest: Documentation for the Restorative Feeding Program Recording Protocol 6.1: Restorative Feeding Program Initial Assessment 2 Recording Protocol 6.2: RNA Care Plan Recording Protocol 6.3: Restorative Feeding Program Daily Notes Staff Education 5. What Dietary Staff Should Know About Patients on Thick Liquids Inservice Resource 6.6: What Dietary Staff Should Know About Patients on Thick Liquids Posttest: What Dietary Staff Should Know About Patients on Thick Liquids Staff Education 6. Swallowing After Trauma and CVA Inservice Resource 6.7: Swallowing After Trauma and CVA Inservice Resource 6.8: Compensatory Strategies for Safe Swallowing for Patients Who Have Suffered a CVA Staff Education 7. Swallowing Difficulties After Head Trauma Inservice Resource 6.9: Compensatory Strategies for Safe Swallowing for the Patient with Head Trauma Posttest: Swallowing After Trauma and CVA Staff Education 8. Physician Education on the Role of the Speech-Language Pathologist and Swallowing Inservice Resource 6.10: Educating the Physician Posttest: Physician Education Section 7. Therapy Resources for Patients and Nursing Staff and Postings Therapy Resources 7.1a (English): Symptoms of Dysphagia Therapy Resources 7.1b (Spanish): Sintomas de Disfagia Therapy Resources 7.2a (English): Dysphagia Precautions Therapy Resources 7.2b (Spanish): Precauciones de Disfagia Therapy Resources 7.3a (English): Choking Precautions Therapy Resources 7.3b (Spanish): Precauciones de Ahogo Therapy Resources 7.4a (English): Choking on Pills or Medications Therapy Resources 7.4b (Spanish): Ahogo con Pastillas Medicaciones Therapy Resources 7.5a (English): NPO Therapy Resources 7.5b (Spanish): NPO Therapy Resources 7.6a (English): Patient Environment at Mealtimes Therapy Resources 7.6b (Spanish): El Ambiente del Paciente a la Hora de Comer Therapy Resources 7.7a (English): Patient Position During Mealtimes Therapy Resources 7.7b (Spanish): Posicion del Paciente Durante la Hora de Comer Therapy Resources 7.8a (English): Patient Position After Each Meal Therapy Resources 7.8b (Spanish): Posicion del Paciente Despues de Cada Comida Therapy Resources 7.9a (English): Patient's Head Position During Mealtimes Therapy Resources 7.9b (Spanish): Posicion de la Cabeza del Paciente Durante la Hora de Comer Therapy Resources 7.10a (English): Patient's Foot Position During Mealtimes Therapy Resources 7.10b (Spanish): Posicion de los Pies del Paciente Durante la Hora de Comer Therapy Resources 7.11a (English): Checklist for Patient's Head Position During Mealtimes Therapy Resources 7.11b (Spanish): Lista de Marcar la Posicion de la Cabeza del Paciente Durante la Hora de Comer **Therapy Resources 7.12a (English): Clinician's Checklist for Patient's General Position Therapy Resource 7.12b (Spanish): Lista de Marcar del Clinico para la Posicion General del Paciente Therapy Resources 7.13a (English): Liquid Consistency Therapy Resources 7.13b (Spanish): Consistencia de Liquidos **Therapy Resources 7.14a.(English): Diet Consistency Therapy Resources 7.14b (Spanish): Consistencia de Dieta Therapy Resources 7.15a (English): Safe Swallowing Instruction 1 Therapy Resources 7.15b (Spanish): Instruccion para el Tragar Seguro 1 Therapy Resources 7.16a (English): Safe Swallowing Instruction 2 Therapy Resources 7.16b (Spanish): Instruccion para el Tragar Seguro 2 Therapy Resources 7.17a (English): Safe Swallowing Instruction 3 Therapy Resources 7.17b (Spanish): Instruccion para el Tragar Seguro 3 Therapy Resources 7.18a (English): Safe Swallowing Instruction 4 Therapy Resources 7.18b (Spanish): Instruccion para el Tragar Seguro 4 Therapy Resources 7.19a (English): Safe Swallowing Instruction 5 Therapy Resources 7.19b (Spanish): Instruccion para el Tragar Seguro 5 Therapy Resources 7.20a (English): Safe Swallowing Instruction 6 Therapy Resources 7.20b (Spanish): Instruccion para el Tragar Seguro 6 Therapy Resources 7.21a (English): Safe Swallowing Instruction 7 Therapy Resources 7.21b (Spanish): Instruccion para el Tragar Seguro 7 Therapy Resources 7.22a (English): Chewing Problems and Solutions Therapy Resources 7.22b (Spanish): Problemas de Masticar y las Soluciones Therapy Resources 7.23a (English): Food Management Problems Therapy Resources 7.23b (Spanish): Problemas Manejando la Comida Therapy Resources 7.24a (English): Difficulty Removing Food from Utensils Therapy Resources 7.24b (Spanish): Dificultad Quitando la Comida de los Utensilios Therapy Resources 7.25a (English): Difficulty with Food Sticking to the Roof of Mouth Therapy Resources 7.25b (Spanish): Dificultad con la Comida Que Se Pega en el Paladar Therapy Resources 7.26a (English): Holding Food Inside the Mouth Therapy Resources 7.26b (Spanish): Reteniendo la Comida en la Boca Therapy Resources 7.27a (English): Food Is Falling Outside the Patient's Mouth Therapy Resources 7.27b (Spanish): Comida Que Se Sale de la Boca Therapy Resources 7.28a (English): The Patient Will Not Open the Mouth Therapy Resources 7.28b (Spanish): El Paciente Que no Abre la Boca Therapy Resources 7.29a (English): The Patient with a Bite Reflex Therapy Resources 7.29b (Spanish): El Paciente con el Reflejo de Morder Therapy Resources 7.30a (English): The Patient Has Oral Thrush or Sores in the Mouth Therapy Resources 7.30b (Spanish): El Paciente Que Tiene Algodoncillo o Granos en la Boca Therapy Resources 7.31a (English): Working with the Patient Who Has Dementia Therapy Resources 7.31b (Spanish): Trabajando con El Paciente con Demencia Therapy Resources 7.32a (English): The Patient Who Has Had a Stroke Therapy Resources 7.32b (Spanish): El Paciente Que Ha Tenido Accidente Cerebral Therapy Resources 7.33a (English): The Patient's Oral Care Therapy Resources 7.33b (Spanish): El Cuidado Oral del Paciente References Glossary Index