Feeding Interventions - Nbcot Registered Occupational Therapists Otr

Identify the best intervention when coughing occurs only with thin liquids but not with puree.

Thicken liquids (nectar or honey as indicated). Increasing viscosity controls flow rate, addressing dysphagia specific to fast-moving thin liquids without affecting solids.
Which cup modification is best to reduce head extension and improve bolus control during drinking?

Nosey cup. Cut-out design enables drinking without posterior head tilt, maintaining neutral posture for better swallow control.
Which environmental modification best supports safe feeding for a client distracted by noise and movement?

Reduce environmental stimuli during meals. Minimizing distractions enhances attention to swallowing cues, improving safety for those with sensory processing issues.
Which oral motor intervention targets reduced tongue lateralization for managing textured foods?

Tongue lateralization exercises with graded textures. Progressive exercises build lateral tongue mobility, essential for manipulating and propelling varied food textures safely.
Which intervention is indicated for weak bite strength and poor jaw stability during chewing?

Jaw stabilization techniques and graded chewing practice. Support and progressive resistance build mandibular control, enabling effective mastication and bolus breakdown.
Which compensatory strategy helps clear oral residue after each swallow?

Alternate bites and sips. Interspersing liquids with solids washes away residue, minimizing post-swallow accumulation and aspiration potential.
Which utensil adaptation is indicated to reduce rapid bolus delivery in a client who takes too large bites?

Small spoon with portion control. Limited volume per spoonful prevents overload, allowing controlled intake for clients with impulsivity or poor judgment.
Which option is best when a child has poor trunk control and slides in the chair during meals?

Provide pelvic support and foot support for stable sitting. Stabilizing the base enhances postural control, preventing compensatory movements that disrupt safe swallowing.
What is the primary purpose of external pacing during bottle or cup drinking?

To regulate suck-swallow-breathe coordination. Controlled flow timing synchronizes these actions, preventing overload and aspiration in clients with coordination deficits.
Which positioning is best to support midline head control and safe swallowing during meals?

Upright $90^{\circ}$ hips, knees, ankles with neutral head/neck. Optimal alignment promotes trunk stability, midline orientation, and efficient swallowing mechanics while minimizing aspiration.
Which posture is used to direct a bolus down the stronger side with unilateral pharyngeal weakness?

Head turn toward the weaker side. Turning the head closes off the weaker pharyngeal side, channeling the bolus toward the stronger side for safer swallowing.
Identify the best next step when signs of aspiration occur despite compensatory strategies.

Stop feeding and refer for instrumental swallow evaluation. Persistent signs warrant advanced assessment to identify underlying issues and guide appropriate interventions safely.
Identify the best strategy when a client shows wet vocal quality after swallowing.

Cue throat clear and reswallow. Prompted actions dislodge pharyngeal residue, indicated by gurgly voice, to prevent silent aspiration.
Which intervention is most appropriate for a client with oral defensiveness limiting acceptance of utensils?

Systematic desensitization with graded oral input. Gradual exposure reduces hypersensitivity, increasing tolerance to oral stimuli and utensil use in defensive clients.
Which intervention is indicated for pocketing in the lateral sulcus due to reduced cheek tone?

Buccal strengthening and cheek sweep training. Strengthening buccinators and teaching clearance techniques address tone deficits, reducing residue and choking risk.
Which intervention is indicated when a client aspirates with head extension while drinking?

Avoid head extension; use neutral head with chin-tuck as needed. Neutral positioning protects the airway, countering the widened entrance caused by extension during liquid intake.
Which feeding strategy is indicated when a client fatigues quickly and shows reduced endurance for meals?

Smaller, more frequent meals with rest breaks. Dividing intake reduces fatigue-related risks like aspiration, maintaining nutritional needs without overwhelming endurance.
Which option is best when a client has left facial weakness and food collects in the left cheek?

Place food on the right (stronger) side. Targeting the unaffected side leverages residual strength, minimizing pocketing and promoting efficient clearance.
Which strategy is indicated to manage impulsive eating with rapid rate and poor self-monitoring?

External pacing with timed prompts. Structured timing slows intake, enhancing self-regulation and reducing risks from hasty bolus management.
Which intervention is indicated to reduce aspiration risk for thin liquids due to poor airway closure?

Chin-tuck posture. This posture narrows the airway entrance and widens the valleculae, protecting against aspiration from inadequate closure.
Which option is best when a client cannot maintain alertness for a full meal due to sedation?

Hold oral feeding until adequately alert. Withholding feeding prioritizes safety, as decreased alertness impairs swallow coordination and increases aspiration risk.
Which cueing approach is most appropriate for apraxia affecting oral motor planning during feeding?

Consistent, simple verbal cues with visual modeling. Multi-modal cues facilitate motor sequencing and execution in apraxic clients, supporting consistent feeding actions.
Which intervention is best for poor lip seal with anterior loss of food or liquid?

Lip closure exercises and oral containment strategies. These methods strengthen perioral muscles and contain bolus, preventing spillage from inadequate seal during feeding.
What is the safest initial liquid consistency for a client with delayed swallow initiation?

Nectar-thick liquids. Thickened liquids slow bolus transit, allowing time for swallow initiation and reducing aspiration risk in delayed cases.
Which strategy is most appropriate to improve sensory awareness for a client with reduced oral sensation?

Thermal-tactile stimulation. Cold or textured stimuli heighten oral sensory input, facilitating swallow trigger in hyposensitive individuals.

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