Postural+Adjustments

= Intervention using Postural Adjustments  = ==== Postural adjustments are simple techniques designed to alter the bolus flow ( Groher & Crary 2010). These stratgeies should be introduced during the videofluroscopy examination to determine the effectiveness of the strategy prior to implementation (Byro et al., 2006). ==== ==== Some of the following postural adjustments have been identified as being useful in patients who have had a partial glossectomy (Groher& Crary, 2010 ;Pauloski,2008). The clinician must use her/his own clincal judgement to pick the most suitable postural adjustment for the presenting aetiology. ====

**Head flexion** otherwise known as **chin tuck** is a technique that helps improve airway protection in patients who demonstrate particular deficits in airway protection during swallowing ( Ekberg,1986). It can be a useful position for patients who have had a partial glossectomy as it improves base of tongue contact with the posterior pharyngeal wall and puts the larynx in a more protected position ( Zuydam,Rogers, Brown,Vaughan,Magennis, 2000). This position has also been shown to reduce and eliminate aspiration in patents who use it, ( Shanahan ,Logemann, Rademaker,Pauloski & Kahrilas,1993).

**The Head Tilt** is when the head is tilited to the unimpaired or stronger side to allow the bolus to clear the oral cavity and pharynx on the stronger side. This position can aid bolus transport in patients after a partial glossectomy ( Byron et al.,2006).

**Head Extension** is when the patient raises the chin, using gravity to move the bolus towards the pharynx. This movement results in widening the oropharynx and it can be helpful when trying to move a bolus from the mouth into the pharynx when lingual deficits are present (Groher & Crary, 2010).

**The Head Back Posture** can be useful for patients who have significant problems propeling the bolus out of the oral cavity and into the pharynx (Byron et al.,2006). It uses gravity to propel the bolus out of the cavity and into the pharynx.This type of diffculty is frequently observed in oral cancer patients with impaired tongue movement, but it should be used with caution bacause it can cause patients to aspirate ( Byron et al., 2006).

**Head Rotation** is a useful technique for indiviuduals who demonstrate unilateral muscular disorders ( Byron et al.,2006). While this position is usually advocated in patients who have a unilateral pharyngeal weakness, surgery to the tongue and and a course of radiotherapy may alter the functional ability of the pharynx. Again, like all other postures the clinician would have to use clinical judgement to detemine the relevance/effectiveness of the posture.

**The Side Lying Posture** is used when pharyngel clearance is reduced, (Byron et al.,2006). If the base of tongue is overtly affected post surgery/during radiotherapy this could affect its ability to propel food adequately which would negatively impact on pharyngeal clearance ( Groher & Crary,2010).The patient must lie down on his/ her side with the head propped up at an angle. Residue will still remain but will do so on the lateral pharyngeal wall and should be cleared by subsequant dry swallows ( Byron et al.,2006).