This is the third and final installment of our “Exercise in Swallowing Therapy” series. This article will examine some commonly used interventions in light of exercise principles. But first, a quick review. In order to be considered an exercise the activity must meet certain criteria (for more information refer to the two previous articles).
In the first installment of “Exercise in Swallowing Therapy” the roles of overload and adequate
duration of therapy were discussed. In this second installment, additional exercise principles of intensity progression and repetition are described.
Recently I was engaged in a conversation related to the ability of a speech pathologist to clinically determine swallowing pathophysiology. A therapist responded she had paid a great deal of money for her degree and if she could not rely on her “clinical judgement” to accurately diagnose patients with dysphagia she had wasted her money. I was not sure how to respond. However, after some reflection, here is my thoughtful response.
Swallowing interventions take several forms. One tool in the Speech Language Pathologist (SLP) toolbox is compensation, postural and behavioral interventions that impact the kinematics of the swallow. The most common compensatory technique is the chin down posture. An example of adaptation would be, the patient consumes a pureed diet due to dysphagia. Instead of fixing the problem, the environment or stimulus remains indefinitely modified. The most valuable tool, and often the most under-utilized item, in the therapist’s toolbox is rehabilitation.
The treatment of any disorder relies on the ability to recognize when an impairment exists. This can be problematic when it comes to swallowing as the understanding of “normal” continues to evolve. This article will discuss some often outdated notions concerning the swallow.