Version May 2024
| Technique | Execution, rationale | Indication |
| Dietary modification | ||
| Thickened liquids |
Reduced tendency to spill over tongue base Preswallow spill/aspiration |
Disordered tongue function Impaired laryngeal closure Weak pharyngeal contraction |
| Thin liquids | Offers less resistance to flow | Reduced cricopharyngeal opening |
| Maneuvers | ||
| Supraglottic swallow | Breath hold, double swallow, forceful expiration (closes vocal folds before and during swallowing) | Aspiration: reduced/late vocal fold closure |
| Super-supraglottic swallow | Effortful breath hold (closes vocal folds before and during swallow) Increased anterior tilting of arytenoids |
Aspiration (poor closure of laryngeal introitus) |
| Effortful swallow | Effortful tongue action (increases posterior motion tongue base) | Poor posterior tongue base motion |
| Mendelsohn maneuver | Prolong hyoid excursion guided by manual palpation (prolongs UES opening) | Poor pharyngeal clearance and laryngeal movement |
| Postural adjustments | ||
| Head tilt | Tilt posteriorly at swallow initiation (gravity clears oral cavity) | Poor tongue control |
| Tilt laterally to unaffected side (directs bolus down stronger side) | Unilateral pharyngeal weakness | |
| Chin tuck | Chin down (widens valleculae, displaces tongue base and epiglottis posteriorly) | Aspiration, delayed pharyngeal response, reduced posterior tongue base motion |
| Head rotation | Rotate head to affected side (isolates damaged side from bolus path, reduces LES pressure) | Unilateral pharyngeal weakness |
| Head rotation | Rotate head to affected side with extrinsic pressure on thyroid cartilage (increases adduction) |
Unilateral laryngeal dysfunction Unilateral pharyngeal dysfunction |
| Lying on side, elevation | R or L lateral (bypass laryngeal introitus) | Aspiration, bilateral pharyngeal impairment or reduced laryngeal elevation |
| Facilitatory techniques | ||
| Strengthening exercises | Various | Nonprogressive disease |
| Biofeedback | Augment volitional component | Poor pharyngeal clearance |
| Thermal stimulation | Cold, tactile stimulation to anterior faucial pillar | Delayed/absent swallow response |
| Gustatory stimulation | Sour bolus (facilitates swallow response) | Huntington's chorea, stroke |
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