Which is a rehabilitative dysphagia strategy?

• A. Postures and bolus changes (compensatory strategies).
• B. Interventions that permanently change the substrates underlying deglutition.
• C. Tube feeding.
• D. Pharmacologic enhancement.

Answer: (B)

The main idea here is distinguishing strategies that try to restore the swallow itself from those that only work around the problem or support the patient. A rehabilitative (restorative) approach targets the underlying biology of swallowing—changing the substrates involved, such as the muscles, nerves, or anatomical structures—so the swallow can work more normally over time. This contrasts with compensatory strategies, which don’t fix the swallow mechanism but help by altering how the swallow is performed (like changing head position or modifying the food texture) to keep swallowing safe without altering the underlying impairment.

Interventions that permanently change the substrates underlying deglutition fit this rehabilitative goal because they aim to restore or improve the actual physiologic ability to swallow. In contrast, postures and bolus changes are compensatory and designed to bypass or compensate for the deficit, not to permanently alter the swallowing substrates. Tube feeding provides nutrition without addressing the swallow mechanism, and pharmacologic enhancement, while potentially helpful, typically does not constitute a rehabilitative change to the substrate of swallowing.