Swallowing+Maneuvers

= Swallowing Maneuvers  = 

====A basic principal of rehabilitation is that the best therapy for any impaired activity is the activity itself. For instance walking is the best activity to improve ambulation skills. Similarly swallowing is generally the best therapy for swallowing disorders, ( Palmer, Drennan, & Baba ,2000). ====

====__**The Mendelsohn maneuver**__ is a voluntary prolongation of laryngeal excursion at the midpoint of the swallow, intended to increase the extent and duration of laryngeal elevation, therefore increasing the duration of cricopharyngeal opening (Kahrilas,Logemann, Krugler,Flanagan ,1991).Clinicians instruct the patient to "swallow normally and when they feel their voice go up , grab it with your throat muscles and dont lt it go down , hold it for three counts and then let it go " (Pauloski, 2008). ==== ====Patients could practice this maneuver without food first and then introduce some consistencies when it is deemed safe to do so. Resection of the tongue and radiation will have changed the anatomy and swallowing mechanics of the tongue to some extent. Studies have shown that in patients treated for head and neck cancer that swallows performed with the mendelsohn maneuver have shown been to exhibit higher tongue base pressure amplitudes and longer pressure durations as well as less pharyngeal residue when compared to swallows when the maneuver was not implemented,( Kahrilas et al.,1991). ====

__**The Effortful Swallow**__ This is a technique which requires the patient to increase the force applied to the bolus from the structures within the swallowing mechanism ( Groher & Crary, 2010). It is designed to increase tongue base retraction and pharyngeal pressure during the swallow in order to improve bolus clearance from the valleculae (Logemann, 1998). Studies have shown that it might be a useful maneuver in patients who have had oral cancer(Logemann,1998 ; Pauloski,2008). In treated head and neck cancer patients,(which includes patients with a partial glossectomy), the effortful swallow was associated with higher pharyngeal pressure amplitudes and longer pressure durations then swallows with no maneuvers. tested it seemed to provide the highest pharyngeal pressure and resulted in less pharyngeal residue,when compared to other maneuvers (Lazarus, 2002).

__**Masako Maneuver **__
====This is a relatively new maneuver and it is used primarily for patients with tongue base retraction difficulties. It involves protruding the tongue between the front teeth and anchoring the tongue in that forward position while swallowing. It increases the base of tongue movement required to contact the posterior pharyngeal wall. This maneuver has been shown to be a useful maneuver for people who are recovering from tongue cancer (Luanne, Poertner, Coleman, 1998). ====

Compensatory Techniques