Major focus area

Feeding Therapy -> Swallowing

Short description

Compensatory postures and positions are used to facilitate the efficiency and safety of bolus passage through the oral cavity, pharynx, and esophagus. The four postures include: chin down, head back, head tilt, and head rotation. (Swigert, 2007; Logemann, 1998; Cherney, 1994).

Long description

Compensatory postures and positions are used to facilitate the efficiency and safety of bolus passage through the oral cavity, pharynx, and esophagus. The four postures include: chin down, head back, head tilt, and head rotation (Swigert, 2007; Logemann, 1998; Cherney, 1994).

Chin down: This posture serves as an effective airway protective position in appropriate patients who present with delayed initiation of the pharyngeal swallow. When the chin is tucked to the chest, the tongue is drawn forward and the vallecular space is widened. The chin down position is not for all swallowing problems and may even promote aspiration in some cases. The efficiency of the maneuver must also be considered. A chin down posture will result in inefficient oral bolus containment, control, and transport if there is sensorimotor impairment of the lips and tongue.

Head back: This is a less frequently used posture and is for a patient with poor lingual motility for oral bolus transport, but who otherwise exhibits good airway closure and pharyngeal clearance.

Head-tilt and Head-rotation: This is used with patients suffering from unilateral impairment of the pharynx and cervical esophageal swallowing problems. The head-tilt posture involves the patient tipping the head to the unimpaired or less impaired side to provide more complete pharyngeal clearance. Conversely, the head-rotation posture requires that the patient turn the head toward the side of impairment. The aim of the posture is to prevent bolus transport through the weaker side, thereby preventing or decreasing excess pharyngeal residue after the swallow.