Bolus+control+techniques

Bolus Control Techniques
=__**Modify Bolus Size**__= After a partial glossectomy the patient may loose some sensaion in the tongue, ( Groher& Crary,2010). In irradiated patients it is also not uncommon for the tongues sensation to be effected. Larger bolus volumes may povide a greater sensory input and increase awareness of the bolus in the oral cavity (Lazarus, Logemann, Rademaker, Kahrilas, Pajak, Lazar, Halper,1993). Conversely, patients who have difficulty using the tongue to clear residue from the oral cavity may benefit from smaller bolus volumes (Logemann ,1999).



__Heightened Sensory Stimulation:Thermile Tactile Stimulation__
Thermile Tactile Stimulation is designed to stimulate the swallow reflex by stroking the anterior faucial pillar with a cold stimulis ( Groher & Crary,2010).This technique is primarily used with patients who demonstrate delayed initiation of the pharyngeal aspect of swallowing ( Groher & Crary,2010). The motor and sensory aspects of the tongue most likely will be affected post surgery /radiation and this could make triggering the pharyngeal swallow difficult.The clinician can perform the technique on the patient and also show how him/ her how to do it at home. Instructions given would be to "dip a laryngeal mirror into a cup of ice and ice water for ten seconds,rub firmly up and down on the anterior faucial arch, approximately five times on each side, making sure that the metal side of the miror is against the tissue" (Pauloski,2008). While Thermile Tactile Stimulation is widely practiced in dysphagia management (Groher & Crary,2010), there is not much published data demonstrating the efficacy of this technique with treated head and neck cancer patients ( Pauloski,2008).



__﻿____Bolus Placement__
The patient will often find it difficult to manipulate food in the oral cavity. Controlling the bolus and propelling the bolus backwards can be difficult for patients to manage ( Groher & Cary,2010).Assisstive oral feeding devices such as syringes and glossectomy spoons can be utilised for food placement when needed ( Casper & Colton ,1993).



__Adapt Rate of Intake__
When the mobility of the tongue is effected small bites of food are actually safer then larger ones (Pauloski,2008). This is especially true with liquids which can quickly move to the back of the mouth before the patient is ready to swallow ( Groher & Crary,2010). It can sometimes help to alternate small bites and sips as the liquid can help to clear any food residue that could otherwise be aspirated ( Groher & Crary,2010).