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The target population is patients with abnormal pharyngeal transit and post‐deglutitive aspiration. The patient is instructed to generate a sustained laryngeal and hyoid bone elevation following the swallow [88]. The desired effect is to prolong UES opening and thus enhance pharyngeal emptying.

Table 3.3 Postural techniques and swallowing maneuvers and exercises.

Desired effect
Postural changes Chin tuck Tilting head to stronger side Head rotation to affected side Chin up	Positions bolus anteriorly and narrows airway entrance Gravitational forces direct bolus to stronger side Takes advantage of stronger muscles on unaffected side to improve pharyngeal transfer Improves posterior movement of the bolus
Swallowing maneuvers Multiple swallows Supraglottic swallow Effortful swallow Mendelsohn’s maneuver	Residue is cleared with repeated effort Closes the true vocal cords and arytenoids and approximate the adducted arytenoids to the base of the epiglottis in order to prevent aspiration. The subsequent cough expels any contents that potentially may have penetrated the airway Increases posterior tongue thrust Prolongs upper esophageal sphincter (UES) opening and laryngeal elevation, thus improving pharyngeal clearance
Strengthening exercises Shaker exercise Swallowing Against Laryngeal Restriction	Increases cross‐sectional area of UES opening Improves pharyngeal clearance and reduces/eliminates post‐deglutitive aspiration Increases maximum UES opening, superior and anterior laryngeal excursion, posterior pharyngeal wall thickness, and deglutitive pharyngeal contractile integral Reduces/eliminates post‐deglutitive aspiration