10 Essential Strategies for Managing Dysphagia

Effective management of dysphagia is crucial to prevent complications such as aspiration pneumonia, malnutrition, and dehydration. As SLPs, it is essential to equip ourselves with a range of strategies to tailor interventions to each patient’s unique needs.

In this article, we will explore ten key strategies for managing dysphagia, along with considerations for their appropriate use and how they can help prevent potential complications.

1. Chin Tuck

The chin tuck is a strategy where the patient tucks their chin toward their chest while swallowing. This maneuver helps widen the vallecula and may reduce the risk of aspiration by improving the patient’s ability to protect their airway.

This technique is beneficial for patients who experience premature spillage into the pharynx or have difficulty with airway protection during swallowing. However, the chin tuck may not be appropriate for patients with significant neck stiffness or those who have difficulty coordinating the movement. 

For patients with severe pharyngeal constriction, the chin tuck may not effectively reduce aspiration risk. However, this strategy can help prevent aspiration pneumonia by enhancing airway protection during swallowing.

2. Head Turn

The head turn technique involves rotating the head to one side (usually the weaker or affected side) during swallowing. This helps redirect the bolus away from the weaker side of the pharynx, aiding in bolus clearance and easing the swallowing process.

This method is especially beneficial for patients with unilateral pharyngeal weakness or reduced laryngeal closure. However, it should not be used for patients with bilateral pharyngeal weakness or severe neck limitations, as it may not achieve the intended result. 

An effective exercise you can pair with this technique is the Mendelsohn Maneuver, which focuses on increasing the duration and extent of laryngeal elevation. This is crucial for protecting the airway and enhancing the efficiency of the swallow. This exercise supports the head turn strategy by ensuring better coordination and clearance of the bolus.

3. Bolus Hold

The bolus hold technique involves the patient holding the bolus in their mouth until they are ready to swallow, which aids in better preparation and coordination. This strategy is ideal for patients with delayed pharyngeal swallow initiation or reduced oral control. 

However, it is not recommended for patients with severe oral sensory deficits or difficulty maintaining bolus control, as they may struggle to hold the bolus without premature spillage. For these patients, improving oral motor control and sensory awareness can enhance swallowing safety and prevent aspiration.

4. Double Swallow

The double swallow strategy involves taking two swallows per bite or sip to ensure that all remnants of the bolus are cleared from the pharynx. This strategy is effective for patients with pharyngeal residue or incomplete bolus clearance. 

The double swallow may be challenging for patients with severe fatigue or those unable to perform repeated swallows, making it essential to assess each patient’s endurance and capability. 

To enhance the effectiveness of the double swallow strategy, you can incorporate the Masako Maneuver (or Tongue-Hold Maneuver) into a patient’s exercise regimen. This exercise strengthens the posterior pharyngeal wall and improves pharyngeal constriction, facilitating more complete bolus clearance. By performing the Masako Maneuver, patients can better manage pharyngeal residue and reduce the risk of aspiration and choking, thereby improving the overall safety and efficiency of swallowing.

5. Small Bites/Sips

Encouraging patients to take smaller bites or sips can help manage bolus size, making it easier to control and swallow safely. This strategy is useful for patients with reduced oral or pharyngeal control or those prone to aspiration. 

While generally safe and widely applicable, this strategy may not be sufficient alone for patients with significant dysphagia, who may require additional interventions such as diet modifications, swallowing exercises, or the use of compensatory techniques to ensure safe swallowing.

6. Liquid Wash/Alternate Liquids and Solids

Alternating sips of liquid with taking bites of solid food helps clear the pharynx of residue and ensures better bolus clearance. This is especially helpful for patients experiencing pharyngeal residue or those with dry mouth. 

This approach can prevent malnutrition and dehydration by ensuring more complete clearance of food residues, making swallowing more efficient and comfortable. However, you should be cautious with patients at high risk of aspiration, particularly with thin liquids, as they may still aspirate despite the alternating strategy. 

One exercise that can effectively complement this strategy is the Supraglottic Swallow. This exercise is designed to protect the airway during swallowing by closing the vocal folds before and during the act. By doing so, it prevents food or liquid from entering the airway, making it particularly useful for patients at risk of aspiration. The Supraglottic Swallow involves holding the breath tightly, swallowing while holding the breath, and then immediately coughing after the swallow to expel any residue. This ensures that any potential aspiration risks are minimized, enhancing the safety and efficiency of the liquid wash technique.

7. Sit Upright

Maintaining an upright posture during and after meals helps reduce the risk of aspiration and supports gravity-assisted bolus transit. This is a fundamental recommendation for all dysphagia patients, especially those with gastroesophageal reflux or delayed gastric emptying. 

While there are few contraindications with the sit upright strategy, patients with certain postural restrictions may need modifications to achieve the best possible positioning. For example, patients with spinal deformities or severe kyphosis may benefit from using supportive cushions or adaptive seating to maintain an appropriate and safe eating posture.

8. Slow Rate

Slowing the rate of intake can help patients manage swallowing more effectively, reducing the risk of aspiration. This strategy is appropriate for patients with cognitive impairments, impulsivity, or those who tend to overfill their mouths. 

The slow rate approach is broadly applicable and safe, though it may not be effective on its own for severe dysphagia and may need to be integrated with other methods. Approaches such as diet modification, chin tuck, and head turn can help protect the airway and facilitate safer swallowing. Additionally, you can prescribe specific swallowing exercises to strengthen the muscles involved in swallowing.

9. No Straws

Avoiding straws can help reduce the risk of aspiration by minimizing the volume and force of liquid entering the mouth. This strategy is particularly useful for patients who aspirate thin liquids or have difficulty controlling liquid boluses. 

For patients with severe oral control issues, simply avoiding straws might not be enough. To further improve swallowing safety, you should consider additional interventions, such as recommending thickened liquids. This combination helps reduce the risk of aspiration and gives patients better control over their liquid intake, providing a safer and more manageable swallowing experience.

10. Diet Modification (Thicken Liquids/Soften Foods)

Modifying the consistency of liquids and solids to match the patient’s swallowing abilities is a crucial part of dysphagia management. Thickened liquids and softened foods can make swallowing safer and easier. This approach is essential for patients at risk of aspiration with thin liquids or those who have difficulty chewing.

However, relying too much on thickened liquids can lead to reduced hydration and potential quality-of-life concerns, highlighting the importance of using the least restrictive diet necessary. Proper diet modification can help prevent aspiration, malnutrition, and dehydration, supporting patients’ overall health and well-being.

Integrating Strategies with Dysphagia Exercises

Combining these ten dysphagia strategies with targeted dysphagia exercises can enhance treatment outcomes. For example, exercises that improve lingual and pharyngeal muscle strength can enhance overall swallowing function. An integrated approach, such as pairing the chin tuck or head turn with exercises to strengthen the suprahyoid muscles, can support improved airway protection during swallowing. This comprehensive approach ensures a tailored management plan that addresses each patient’s specific needs, optimizing both safety and quality of life. 

Implementing Effective Dysphagia Management Strategies

When implementing these strategies, it’s crucial to conduct thorough assessments to determine the most appropriate techniques for each patient. You should always consider the patient’s overall health, cognitive status, and specific swallowing impairments. While these strategies can significantly improve swallowing safety and efficiency, they should be integrated into a comprehensive dysphagia management plan, often in conjunction with other therapeutic interventions and regular monitoring.

For a deeper dive into dysphagia management, explore our Dysphagia Resource Center, where you can access over 60 specialized courses, high-quality home exercises, and educational materials designed to help your patients effectively manage their condition.