Major focus area

Feeding Therapy -> Swallowing

Short description

Indirect management strategies are the proper positioning and handling of a patient during mealtime that is an essential part of the treatment program and includes postural techniques, sensory stimulation, and equipment adaptations (Swigert, 2007; Logemann, 1998; Cherney, 1994).

Long description

Indirect management strategies are the proper positioning and handling of a patient during mealtime that is an essential part of the treatment program and includes postural techniques, sensory stimulation, and equipment adaptations (Swigert, 2007; Logemann, 1998; Cherney, 1994).

Postural techniques: The optimal body position to facilitate organized and coordinated oral-motor activity for a patient includes the following: neck elongation with neutral head flexion, shoulders even and down, symmetrical trunk elongation, neutral position of the pelvis, hip stability with neutral abduction and rotation, feet flat on a surface. Some patients will assume compensatory postures for feeding to control head and neck position, compensate for limiting tone and movement patters, compensate for respiratory difficulties, and to protect their airway from aspiration. These compensatory postures include head or neck hyperextension, head turning, shoulder elevation, feeding in prone or supine, and leaning forward, backward, or to a particular side.

Sensory stimulation: The specific sensory properties of a food may facilitate more normal oral movements during feeding. A change in food consistency, texture, temperature, and/or taste may be recommended to improve the patient’s ability to bite, chew, and propel a bolus through the oropharynx. Examples: soft solid is easier to bite but may be more difficult to chew because chewing skills require increase and coordinated tongue movement patterns that are not required for biting. Thicker, heavier foods provide more tactile and proprioceptive cues and may facilitate more active jaw, tongue, and cheek/lip movements in chewing and bolus formation. Moistened solids may be used for patients who have difficulty controlling foods that crumble during chewing because of movement dysfunctions of the lips/cheeks, tongue, or jaw. When a solid food is moistened, it tends to “clump” thus assisting with bolus formation. Changing the temperature of the bolus can be effective for patients with a pharyngeal swallow trigger delay. When the bolus is changed from room/warm temperature to chilled the patient will have greater awareness within the oral cavity, facilitating a swallow that is initiated with great speed. Modifying the taste of the foods may be beneficial for patients who demonstrate hyper- or hyposensitivity. Enhancing flavor of a food may result in better bolus formation and quicker bolus propulsion since the patient is more aware that food is in their mouth. Using moderate amounts of salt, pepper, spices, and imitation flavored extracts are useful for enhancing flavor. Be careful with sensory stimulation and provide the patient with foods that are pleasurable. If the patient perceives food as noxious, refusal to eat, gagging, spitting, or vomiting may occur.

Equipment adaptations: This is the types and sizes of utensils used in feeding. Careful selection may assist with bolus formation and reduce the “flow” of the bolus. Example: slow-flow nipples, different size, shape, texture of nipple, cut-out cups, small bowled spoons, different shaped spoons, later-covered spoons, and Maroon spoons.