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Regardless of what research you cite or conduct, the supraglottic swallow
will remain a technique that must be objectively validated with each patient
for whom it is considered. As for specifying the patients for whom it is
indicated, why need we go beyond observing that the patient has difficulty
protecting the airway, typically at the level of the epiglottic seal? Many
different types of patients have such difficulties.
As for whether or not spontaneous recovery vs. the technique is responsible
for establishing a safe swallow, is this not evident from watching a patient
aspirate or nearly aspirate without using it, and then observe that they
swallow safely while using it? I follow up all my recommendations with
follow up videos to see if the swallow has improved and what, if any
techniques continue to be required.
As for how to instruct the patient to apply the technique, I don't know
anyone personally who suggests use of the supraglottic swallow...or any other
technique for that matter, for the purpose of clearing saliva. Do you?
I don't understand your intent here.
Gerard B. Brooks, MA, CCC
Center for Neurologic Communication Disorders