• Aspiration Precaution Education

  The SLP provides patient and caregivers with aspiration precaution education by defining aspiration, helping them to identify overt s/s of aspiration, understanding silent aspiration, the need for radiographic studies and understanding the risks associated with aspiration. Signs and symptoms of aspiration can include coughing before, during, or after a swallow; frequent coughing at the end or immediately after a meal: gurgly voice quality, watery eyes, runny nose, changes in respiration, fever spike after meals, complaints of food/drink going the wrong way (Logemann, 1998).

• Beckman Oral Motor Program

  The Beckman Oral Motor Program is a group of strategies that provide assisted movement to activate muscle contraction and to provide movement against resistance to build strength. The focus of these interventions is to increase functional response to pressure and movement, range, strength, variety and control of movement for the lips, cheeks, jaw and tongue.

  Interventions are determined by an assessment, the Beckman Oral Motor Protocol, which uses assisted movement and stretch reflexes to quantify response to pressure and movement, range, strength, variety and control of movement for the lips, cheeks, jaw, tongue and soft palate. There is a specific training course for this method (Beckman, et al., 2004).

• Behavioral Feeding Techniques

  Behavioral feeding techniques are used by the SLP for the treatment of insufficient food and liquid intake. Behavioral feeding techniques can include but are not limited to food chaining, reinforcements, skill acquisition techniques.

  1. Food chaining is a method for teach sequential skills for eating and drinking. Backward chaining involves reinforcing links in the chain, beginning at the back end of the chain and working toward the beginning. This done so that in the initial stages of training, the final step is preformed and a conditioned reinforcer is delivered. The SLP then requires more and more steps to be performed. Forward chaining involves teaching the first step with conditioned reinforcement following that first link. The SLP guides the patient through the remaining not-yet-learned steps in the task.

  2. Reinforcements can be positive or negative. Positive reinforcement involves adding something to the patient’s environment that was not present before. Patient takes a bite of food a consequence added so that the patient is more likely to open his mouth for more food. Negative reinforcement gets a patient out of a negative situation. It involves taking away something that is negative for the patient that leads to the avoidance or an escape from a situation or stimulus. Patient takes a bite and then is allowed to leave the table after taking a bite which is a negative reinforcement. Because the patient was reinforced she is more likely to eat the predetermined amount of food again the next time.

  3. Skill acquisition techniques are designed to help patients learn specific behaviors needed to be successful eaters which they have not learned due to lack of experience (patient who has been NPO). They include prompting, modeling, and shaping a behavior.

  (Swigert, 1998; Lazarus, et al., 1986; Lazarus & Logemann, 1987; Logemann, et al., 1989; Lazarus, et al., 1993).

• Chewing Hierarchy Program

  Chewing hierarchy program is an intervention utilizing sequenced progression of treatment exercises to initiate and strengthen mandibular function needed for successful mastication skill. There are different programs which use chewy tubes. The SLP increases chewing function through the use of chewy tubes and then moves into real foods. The goal is to teach a graded, lateral chew with tongue-tip dissociation and movement across midline. Use a thin bolus such as a “veggie stick”, thin pretzel or crunchy Cheetos. The following are a couple of chewing programs.

  1. The Jaw Rehabilitation Program is a patented series of goals and objectives designed to develop biting and chewing skills for successful feeding. Key strategies to initiate the pattern of up/down jaw movement are presented in an easy to follow format. All exercises are conducted with Chewy Tubes, eliminating the need to use actual food in treatment.

  2. TalkTools: Use "Bite Tubes" that comes with instructions to use them in a hierarchy of increasing difficulty for development of jaw stability.

• Compensatory and Facilitation Techniques

  Compensatory and facilitation techniques are not only airway protective swallowing maneuvers but they also help facilitate the return of pharyngeal function. These techniques can be used with patients who understand the rationale for the maneuver, follow two- to three-step instructions, and retain instructions over time.

  There are 4 compensatory/facilitation swallowing maneuvers that have been shown to improve airway protection and the efficiency of bolus passage through the aerodigestive tract: Supraglottic swallow, Super-supraglottic swallow, effortful swallow and Mendelsohn maneuver (Swigert, 2007; Logemann, 1998; Huckabee and Steele, 2006).

  Supraglottic swallow: This is indicated for patients who cannot attain laryngeal closure or airway closure prior to and during a swallow. It works to provide five areas of approximating laryngeal valving sufficient to achieve strong laryngeal closure prior to and during the swallow. The supraglottic swallow involves the following steps:

  1. Take and hold a breath.
  2. Place food or liquid in the mouth.
  3. Swallow (once or twice, depending on the efficiency of pharyngeal clearance.)
  4. Clear your throat.
  5. Swallow again. The patient is instructed not to breath at any point during the sequence to prevent inhalation of pharyngeal stasis or residue. SLP must be careful to instruct patient to clear the throat “out” rather than to cough, because many patients will attempt to inhale before a coughing maneuver.

  Super-supraglottic swallow: This follows the identical sequence to the supraglottic swallow, but the patient is instructed to use additional force during the sequence to provider greater muscular tension. Studies show the super-supraglottic swallow improves the rate of laryngeal elevation and improves movement of the tongue base.

  Effortful Swallow: This is used with a patient who presents with incomplete pharyngeal clearance resulting from incomplete tongue base retraction. The patient is instructed to swallow hard or with effort and attempt to feel the backward motion of the tongue. By telling the patient to put emphasis on the tongue base pushing against the palate more pressure in the upper pharynx will be created.

  Mendelsohn Maneuver: This is effective in patients with incomplete opening or premature closing of the UES. If a patient voluntarily maintains the larynx in its elevated /anteriorly displaced position, at the height of the swallow, the cricopharyngeaus (UES) increases the duration of its opening, duration of laryngeal closure and tongue base retraction. Patients who are taught to do this will have more complete pharyngeal clearance. The SLP instructs the patient to perform a dry swallow or 1-mL of water and hold the larynx in the elevated position for 3 to 5 seconds. This is typically prescribed when a patient is demonstrating aspiration after the swallow from the residue in the pyriform sinuses.

• Compensatory Postures and Positions

  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.

• Compensatory Techniques

  Compensatory techniques are used by the SLP during therapeutic feedings to compensate for deficits. The SLP determines the use of these techniques by the swallowing deficits and include; oral sensitivity training, food placement, external pressure to the cheek, labial and chin support, food presentation, multiple swallows, and thermal-tactile application (Swigert, 2007; Logemann 1998; Cherney, 1994).

  Oral Sensitivity Training: Patients who aren’t eating by mouth may show educed sensitivity to material in the oral cavity. Position the patient upright and then use a toothette or swab to moisten the oral cavity. Adequate saliva is essential for a patient to be able to form a good bolus. If the patient is able to complete such a maneuver, you may even have him swish and spit some liquid from their mouth. Some patients may benefit from presentation of a sour bolus, like lemon juice. This can significantly improve the onset of the oral and/or pharyngeal phases of the swallow.

  Carbonation and other chemesthesis: Studies have found that moderate sucrose, high salt and high citric acid elicited significantly higher lingual swallowing pressures compared to pressures generated with water. High salt and citric acid elicit chemesthesis mediated by the trigeminal nerve therefore chemesthesis may play a crucial role in swallowing physiology. If true, trigeminal irritants like carbonation may be beneficial to individuals with dysphagia.

  Food placement: Patients usually do best if food is placed at the midline of the tongue. Some patients do better if placed is placed on the stronger side, especially if it is food that needs to be chewed.

  External pressure to the cheek: Placing pressure on the affected cheek may also assist a patient with oral cavity weakness. The benefits for the patient are that pressure decreases the amount of material falling into the weaker lateral sulcus and helps the tongue action in the formation of a cohesive bolus. The tactile cue also reminds the patient to check the buccal pocket for residue. This technique compensates for decreased muscle tone.

  Labial and chin support: Place your finger under the chin or lower lip to help maintain closure of the mouth. For a patient with a labial droop, fingertip support may be sufficient to provide lip closure to keep the material in the oral cavity. This technique is helpful for thin liquids maintenance. For more severely involved patients to support both labial and jaw weakness position the thumb along the mandible with your index finger beneath the lower lip and your middle finger beneath the patient’s chin.

  Food presentation: This is recommending different ways for food to be presented depending upon the patient’s difficulties. Bolus control deficits can be compensated by all presentations being made from a spoon or only a small amount placed in a cup. Straws help some patients maintain a chin-down position. Alternating solids and liquids is another food presentation compensation method.

  Multiple swallow: This is a simple, yet effective compensatory technique that involves directing the patient to swallow two or three times per bolus (e.g., after wet swallows with subsequent dry swallows.) The number of repetitive dry swallow will vary with the size of the bolus, bolus texture, and severity of impairment. This is used with patient who has incomplete pharyngeal clearance during the initial swallow for a variety of reasons that may include decreased tongue base retraction, reduced laryngeal elevation with accompanying reduction in the extent and duration of pharyngo-esophageal segment opening, and weak contraction of the pharyngeal musculature. The second swallow is also beneficial for patient who present with oral residue.

  Thermal-Tactile application: This is also called thermal stimulation and is used for patients who show a delay of greater than two seconds in initiating the swallow response or who aspirate during the delay. The stimulation does not cause the response to happen but heightens the awareness of that region in the mouth to increase the likelihood that a swallow will occur. To date there is no evidence that thermal-tactile application effects are long-lasting.

  Method: Generally a double 00 laryngeal mirror is used. Hold the mirror like a pencil so you can easily rotate it in your hand. Dip it in ice and rub it up and down five times on one of the patient’s anterior faucial arches. Then dip it back into the ice quickly, rotate it so the flat head of the mirror is facing in the other direction, and rub it on the other faucal arch. Instruct the patient to swallow so that the voluntary component of the swallow is invoked.

• Deep Pharyngeal Neuromuscular Stimulation (DPNS)

  DPNS is a systematized therapeutic method for pharyngeal dysphagia which utilizes eleven specific stimulation techniques within the oral/pharyngeal areas. The SLP needs to have direct training from another SLP with this specific skill set and knowledge (Sheppard, 2008; Logemann, 2007).

• Direct Management Techniques

  Direct management techniques are hands on oral-motor methods used to facilitate jaw, lip, cheek, and tongue stability and mobility to facilitate swallowing (Cherney, 1994).

  Jaw Stability and Mobility The jaw is the foundation of support for the tongue, lips, and cheek mobility. If the jaw is unstable with ungraded jaw movement then it is difficult to suck, bite, chew, and swallow. Provide external jaw stability through oral control during bottle feeding, spoon feeding, and cup drinking, biting, and chewing using 2 basic hand positions. Oral control from the side: The SLP may hold the patient or the patient may be positioned in a small seat at the side of the SLP. The SLP uses one hand to hold the utensil/food item and the other arm is positioned around the back of the patient with the hand positioned as follows.

  1. The fleshy bottom portion of the midfinger is placed horizontally across the tongue base under the jaw. The midfinger movement is vertical and dynamic allowing for improved jaw gradation. Its dynamic movement may also provide for improved tongue mobility because it is placed horizontally across the tongue base. If the midfinger is placed posteriorly to the tongue base, it may case tongue retraction as it moves against the hyoid. If placed too far forward, this finger would be positioned on the anterior portion of the mandible, usually providing very little support to the jaw.
  2. The index finger is placed horizontally across the indentation below the lower lip. Index finger movement is inward and dynamic, allowing for improved lower lip stability and mobility. Movement of the midfinger under the chin and movement of the index finger occur independently of each other.
  3. The thumb is tucked away to and does not push on the cheek and forcing the patient’s face to one side. Oral control from the front: The SLP is positioned in front of the patient, fact to face. This position provides less control than the side position, but it is effective in providing improved jaw stability, jaw gradation, and tongue mobility.

  1. Index finger is crooked under the patient’s chin, the front portion at the tongue base.
  2. The thumb, in a vertical position, is placed at the indentation beneath the lower lip. Inward pressure of the thumb facilitates lower lip stability. Lip-Cheek Stability and Mobility Place hands directly on patient’s cheeks, and provide direct and dynamic inward pressure to the cheeks as the bolus is being moved within the oral cavity. This inward pressure to the cheeks as the bolus is being moved should be varied from the corners of the mouth toward the molar area in a wave-like fashion in response to bolus formation and movement. You can also place the thumb under the patient’s jaw, together with external support to the lips-cheeks.

  Tongue Stability and Mobility When providing oral control, stability is added at the tongue base, allowing the tongue to move actively and independently from the jaw. When the jaw is stable you can improve active mobility of other tongue movement patterns including: tongue extension, tongue retraction, and tongue elevation. Using variations of spoon feeding, cup drinking, biting, and chewing you can affect tongue movement. If you use a spoon that has a deep bowl with a patient who has poor lip and cheek activity you will see atypical tongue movements. By using an appropriate sized spoon placed directly on the tongue with slight downward pressure, lateral tongue elevation or tongue cupping can be facilitated. You can also facilitate tongue cupping by slowly sweeping forward with slight downward pressure on the central portion of the tongue toward the lips, using a gloved finger or a swab with a handle. Cup placement for patients requiring greater jaw stability should be placed on the lower lip toward the corners of the mouth. As the patient gains jaw gradation ability you can move the cup forward on the lower lip.

• Facial Molding/Massage Program

  Most patients with feeding/swallowing disorders can tolerate some form of stimulation done in conjunction with feeding or without. Techniques to stimulate the facial muscles and lip musculature include use of broad smiling, tight frowning, alternating lip movements between pursing and retracting, and use of resistive sucking through a pinched straw. The use of an intraoral massage can increase oral awareness and improve the patient’s response to sensation. The use of facial molding helps to reduce muscle tongue and provides tactile stimulation to the face with the use of general massage to the face and gently molding the facial structure toward a closed month or lip position. Gum massagers and other utensils may stimulate an increase with salivary secretions.

• Facilitation Techniques

  Facilitation techniques are used by the SLP to improve the function of the pharyngeal swallow and include the following: laryngeal adduction, valsalva maneuver, falsetto/pitch exercises, Masako, tongue base retraction, and suck-swallow (Swigert, 2007; Logemann, 1998).

  Laryngeal adduction: These are the same exercises used in voice therapy to achieve better laryngeal closure. They include pushing, pulling and hard glottal attack. Pushing and pulling causes the patient to bear down and tighten closure at the level of the vocal folds. While the patient is pushing and pulling have them phonate a vowel sound. Hard glottal attack involves having the patient take a breath and then forcefully say a vowel or a word beginning with a vowel.

  Valsalva maneuver: This is a breath-hold technique where the patient is asked to take a breath and hold it tightly for several seconds with their mouth open.

  Falsetto/Pitch: Falsetto exercises are designed to improve elevation of the larynx. Better elevation means there will be better airway closure and less residue in the pyriform sinuses. Ask the patient to produce /i/ in a continuous note as they increase their pitch until they reach the falsetto and hold it. Some patients may have more success with simple pitch change activities when asked to sing up the scale.

  Masako/Tongue Hold: This technique is designed to increase the forward movement of the posterior pharyngeal wall as it moves forward to meet the base of the tongue. The patient protrudes their tongue slightly and holds it between their teeth while they swallow. This technique is done with saliva swallows as it is difficult to control a food bolus while performing this technique.

  Tongue base retraction: The patient pulls the base of their tongue toward the posterior pharyngeal wall with lots of effort and holds it there for several seconds. This technique develops strength in the base of the tongue to reduce vallecular residue. If the patient tries to curl the tip of the tongue back, hold the tip of the tongue and ask the patient to pull back against the resistance.

  Shaker Maneuver: This technique is designed to increase forward movement of the hyoid bone, which actually helps the entire hypolaryngeal complex move forward. The result is the cricopharyngeus opens more widely and stays open longer, which should allow more residue to drain from the pyriform sinuses. The exercise has 2 parts; sustained and repetitive. For each, the patient lies flat on a bed or on the floor with no pillow under their head.

  Sustained: Patient lifts their head (keeping shoulders on the surface) and looks at their toes, holding the position for 60 seconds. Repetitive: Patient is in the same position and will raise and lower their head 30 times in a row.

  Suck-Swallow: This technique can increase the speed of the pharyngeal swallow. It also draws saliva to the back of the mouth, which may increase sensory input for the swallow. Ask patient to pretend they are sucking something very thick up through a very narrow straw for 2-3 seconds and then have the patient swallow.

• Indirect Management Strategies

  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.

• Motor Learning Approach

  Motor learning approach takes the process of oral motor skill acquisition and considers the applicability of motor learning concepts for advancing swallowing and feeding capabilities in patients.

  Method:
  1. Improve sensory tolerances for learning to eat. Activities include sitting up in a well-fitting chair at a table and keeping plate, cup, and utensils in front of the patient.
  2. Precursors to feeding: Example: licking tastes of milk or something the patient likes from a spoon.
  3. Eating from a spoon: Start with small slow bites of puree to practice routines emphasizing upright head alignment with chin down posture. Increase amounts of puree accepted and the rate of intake. Introduce one new food at a time. Viscosity is increased gradually to allow time for the acquisition of motor capabilities for swallowing more viscous foods.
  4. Advancing skills for swallowing increased texture and viscosity: Introduce grainy then mashed consistencies. Initially foods can be moist and as ability increases added moisture can be reduced gradually.
  5. Self-feeding, biting, and chewing, and drinking from a cup.
  6. Advancing skills for biting and chewing: Self-feed or SLP feeds patient to train them to bite off small pieces. Chewing skills are targeted by placing foods on preferred side for chewing. Tactile and verbal cues can be used increase patient awareness of food in mouth.
  7. Drinking from an open cup and straw: Teach sequence to sip from cup and to swallow with cup in his mouth. Move to teaching sip and swallow sequentially. Move to teaching how to sip and swallow with a straw.
  8. Transition to self feeding.

  (Sheppard, 2008)

• Neuro-Developmental Treatment (NDT)

  Neuro-Developmental treatment is an advanced hands-on therapeutic approach used when working with patients who have central nervous system insults that create difficulties in controlling movement. An SLP using NDT has completed advanced training in NDT.

• Neuromuscular Electrical Stimulation (NMES)

  Neuromuscular Electrical Stimulation is an adjunctive modality to traditional exercise that unites the power of electrical stimulation with the benefits of swallowing exercises. Combining NMES and traditional therapy allows clinicians to accelerate strengthening, restore function, and help the brain remap the swallow. Research has demonstrated that combining these therapies results in better outcomes than using either one alone. The SLP must be trained and certified to provide NMES (Freed, 2001; Carnaby-Mann & Crary, 2007; Blumenfeld, et al., 2006; Shaw, et al., 2007).

• Oral Motor Control Exercises

  Treatment of swallowing problems using exercises designed to improve the strength and coordination of oral muscles without the use of food.

  1. Labial exercises: Stretch/pucker lips, close lips around an object and hold.
  2. Lingual exercises: Range of motion and lingual resistance exercises.
  3. Buccal Tension: Stretch lips to say “e”, round to say “o”, and alternate.
  4. Mandible: range of motion and resistance exercises.
  5. Manipulating materials in the mouth from one side to the other.
  6. Manipulate a bolus in the mouth from side to side, cup the tongue around the bolus, and then expectorate the bolus once the task is finished. SLP checks for residue.

• Sensory-Motor Integration Procedure

  Sensory-Motor Integration procedures involve techniques to increase oral sensory stimulation prior to the patient’s swallow attempt. These techniques are considered compensatory or can be therapeutic. This procedure is for a patient with reduced recognition of food in the mouth or very slowed oral transit abilities (Logemann, 1998; Robbins, et al., 2008).

  Method:
  1. Increasing downward pressure of the spoon against the tongue as the bolus is delivered into the mouth.
  2. Introducing a bolus with increase sensory characteristics, such as a cold bolus or a textured bolus or a bolus with a strong flavor.
  3. Providing a bolus requiring chewing so that the mastication provides preliminary oral stimulation.
  4. Thermal-tactile stimulation to the anterior faucial arches prior to the swallow.
  5. Providing a larger volume bolus.

• Straw Hierarchy Program

  Straw hierarchy program is an intervention utilizing gradated straws to address specific components of oral movement for feeding and swallowing. Straw are used to target lip rounding, insufficient tongue base retraction, and velo-pharyngeal insufficiency (Rosenfeld-Johnson, 1999).

• Dysphagia Treatment Strategies 0
  www.amyspeechlanguagetherapy.com

  Author: Amy Speech & Language Therapy, Inc. - Dysphagia Treatment is decided upon once a diagnosis is confirmed however many facets should be involved in that determination The clinician will choose a treatment program, based on the etiology, mental and physical capacity, and quality of life. They should discuss the treatment protocol with the patient and their family; how it will help them achieve the safest and least restrictive diet, what's happening to them anatomically, etc., and present all treatment options available for their specific swallowing problem.
• Beckman Oral Motor Evaluation Protocol 0
  www.beckmanoralmotor.com

  Author: Debra Beckman - PDF of the Beckman Oral Motor Evaluation Protocol
• An Overview Of Assessment And Management Of Dysphagia Within The Pediatric Population 0
  opensiuc.lib.siu.edu

  Author: Erica C. Yording - It is estimated that adults swallow up to 2,400 times per day, while children are estimated to swallow between 600 and 1,000 times a day (Arvedson & Brodsky, 2002). During the span of a lifetime, swallowing difficulties may arise as a result of numerous etiologies. Dysphagia may result from neurological, genetic, or structural etiologies (e.g., apraxia, cerebral palsy, Down syndrome, cleft palate, autism spectrum disorder) (Sheppard, 2008). Thus, when these challenges occur, limitations, pain, and frustration may be some of the common feelings that affected individuals and their family experience.
• Articles Citing Beckman Oral Motor Intervention 0
  www.beckmanoralmotor.com

  Author: Debra Beckman - Articles Citing Beckman Oral Motor Intervention
• A Little PEP Goes a Long Way In the Treatment of Pediatric Feeding Disorders 2
  pubs.asha.org

  Author: Teresa Boggs and Neina Ferguson - Feeding disorder in young children is a growing concern, particularly feeding challenges with sensory and/or behavioral underpinning. These feeding disorders are characterized by food refusal, anxiety when presented with novel foods, failure to advance to textured foods, and inappropriate mealtime behaviors. The Positive Eating Program (PEP) was developed to remediate feeding disorders by providing rich experiences in food vocabulary, positive sensory nonfood and food activities, and structured and predictable through trials

• 

  Chew and Swallow Food 0

• Swallowing disorders - Having trouble swallowing (dysphagia) is a symptom that accompanies a number of neurological disorders. The problem can occur at any stage of the normal swallowing process as food and liquid move from the mouth, down the back of the throat, through the esophagus and into the stomach.
• Feeding disorders - A feeding disorder, in infancy or early childhood, is a child's refusal to eat certain food groups, textures, solids or liquids for a period of at least one month, which causes the child to not gain enough weight, grow naturally or cause any developmental delays.

• 

  Bedside Dysphagia

  During this portion of the evaluation, the patient's history is reviewed for possible etiologic factors that may contribute to swallowing disorders.

Therapists who selected this major focus area as their top area of expertise.

• 

  Bailey Morgan

  CCC-SLP

  Bailey Morgan, MA, CCC-SLP is a New York State licensed Speech-Language Pathologist who specializ...

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