Intervention+using+postural+adjustments

=**INtervention using Postural Adjustments**= Postural adjustments are simle techniques designed to alter the bolus flow, ( Crary et al 2010). these stratgeies should be introduced during the videofluroscopy examination to determine the effectiveness of the strategy prior to implementatio, ( Byron,2006).Some of the following postural adjustments may be useful in patients who have had a partial glossectomy.Obviously the clinicician must use her/his own clincal judhement to picck th most suiyable 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 ha d a partial glossectomy as it improves base of tongue contact with the posterior pharyngeal wall and puts the larynx in a more protected position, ( Zydam et al,2000). This position has been shown too reduce and eliminate aspiration in patents who use it, ( Shanahan et al ,1993).

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


 * __Head Extension__** is when the patient raises the chinn, 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 mouth into pharynx when lingual deficits are present, (partial glossectomy) ( Crary, 2010).

__**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,2006).It uses gravity to propel the bolus out of the cavity and into the pharynx.\this type of diffculty is frequantly observed in oral cancer patients with impaired tongue movement, but it should be used with caution bacause it can cause patients to aspirate, ( Byron, 2006).

__**Head rotation**__ is a useful technique for indiviuduals who demonstrate unilateral muscular disorders, ( Byron,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 wold have to use clinical judgement to detemine the relevance /effectiveness of the posture.

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