The+Mendelsohn+Maneuver.+The+Effortful+Swallow+.+The+Masako+Maneuver

=  The Mendelsohn Maneuver. The Effortful Swallow. The Masako Maneuver =

//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 **__ THis technique 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 let it go down , hold it for three counts and then let it go ", (Pauloski,2008). Studies have shown that in patients treated for head and neck cancer ,swallows performed with the mendelsohn maneuver were shown 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 useful maneuver in patients who have had oral cancer,(Lazarus,1998; Pauloski,2008). In treated head and neck cancer patients, the effortful swallow is associated with higher pharyngeal pressure amplitudes and longer pressure durations then swallows with no maneuvers.Lazarus,(2002) found that when compareed to other manueuvers tested it seemed to provide the highest pharyngeal pressure and resulted in less pharyngeal residue.

__**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).