Compensatory Strategies
Evidence-based compensatory strategies for managing swallowing dysfunction. Select strategies based on identified physiological impairments from the MBSImP assessment.
Tip: Use the MBSImP Scoring tool to identify impairments, and recommendations will be automatically generated. This page provides a complete reference of all available strategies.
Chin Tuck/Chin Down
Positioning the chin toward the chest to widen the valleculae and narrow the airway entrance
Head Turn (Rotation)
Rotating the head toward the weaker side to close off the damaged side and direct bolus down the stronger side
Head Tilt
Tilting the head toward the stronger side to direct bolus down the stronger side using gravity
Head Back/Extension
Tilting the head backward to use gravity to clear the oral cavity
Effortful Swallow
Swallowing with increased effort to increase tongue base retraction and pharyngeal pressure
Supraglottic Swallow
Breath-hold technique to close the vocal folds before and during the swallow
Super-Supraglottic Swallow
Breath-hold with bearing down to close the airway entrance before and during swallow
Mendelsohn Maneuver
Voluntarily prolonging laryngeal elevation during the swallow to increase duration and width of PES opening
Multiple Swallows/Dry Swallow
Taking additional swallows (with or without bolus) to clear residue
Liquid Wash/Alternating Liquids
Using liquid to wash down residue between bites of solid food
Small Bites/Sips
Reducing bolus size to improve safety and control
Throat Clear/Cough
Voluntary cough or throat clear to expel residue from the pharynx or larynx
Bolus/Diet Modification
Changing food textures and liquid thickness to improve swallow safety
Pacing/Slow Rate
Slowing the rate of intake to improve safety and reduce fatigue
Masako/Tongue-Hold Swallow
Holding the tongue between teeth while swallowing to strengthen pharyngeal constrictors (primarily therapeutic, not compensatory)
Clinical Note
Always consider patient-specific factors when selecting strategies. Trial strategies during instrumental assessment when possible to confirm effectiveness. Some strategies may need modification based on individual patient needs and abilities.