Swallowing stages, Dysphagia symptoms, Compensation, Maneuvers

Shaker exercise - physiological targets

Poor UES opening resulting in post swallow residue

Masako Maneuver physiological targets

Weak pharyngeal constriction, posterior pharyngeal wall movement, pharyngeal residue

Masako Maneuver procedure

Swallow initiated with tongue between teeth. Practice contracting posterior pharyngeal wall (cannot be used with bolus)

Shaker exercise procedure

Head raising exercise to strengthen suprahyoid muscles involved

Tongue strengthening physiological targets

Poor bolts formation, premature spill, oral residue, poor base of tongue retraction, pharyngeal residue

Tongue strengthening procedure

Resistance provided by pressure sensing device or tongue depressor during lingual movements

Expiratory Muscle Strength Training (EMST) physiological target

Weak cough, poor respiratory support, poor hyolaryngeal elevation

Expiratory Muscle Strength Training (EMST) procedure

Breathing exercises into hand held valve device designed to exercise the expiratory muscles

NMES

Electrical current stimulates swallowing muscles

Effortful pitch glide physiological targets

Poor pharyngeal constriction, poor laryngeal elevation

Effortful pitch glide procedure

Phonates low to high glide with effort. Elevated larynx and constricts pharynx

Effortful swallow physiological targets

Significant post swallow residue, poor pharyngeal constriction, poor base of tongue to posterior pharyngeal wall

Effortful swallow procedure

"As you swallow, squeeze hard with all of your muscles". targets strength & endurance. Compensatory strategy for clearing residue. Need to test under fluoro

Mendelsohn Maneuver physiological targets

Early UES closure, incomplete UES opening, poor pharyngeal constriction, post swallow residue

Mendelsohn Maneuver procedure

Needs to be tested under fluoro. Prolongs elevation of larynx during swallow to increase displacement and duration of hyolaryngeal excursion.

Supraglottic swallow physiological targets

premature spill, delayed swallow initiation, delayed/poor laryngeal closure

Supraglottic swallow procedure

Closing airway prior to bolus entry into pharynx and remain closed during bolus transport. Cue pt to hold breath with bolus in mouth. Tested under fluoro

Super Supraglottic swallow physiological targets

premature spill, delayed swallow initiation, delayed/poor laryngeal closure, difficulty with VF closure

Super supraglottic swallow procedure

Supraglottic swallow plus increased effort of airway closure ("bear down like you are about to lift something heavy")

What structures & cranial nerves are involved in oral prep stage

lips, buccal & mastication muscles, tongue, soft palate. CN V, VII, XII

What structures & cranial nerves are involved in oral transport stage

tongue, faucial pillars.

What happens in pharyngeal initiation

laryngeal hyoid elevation, velopharyngeal closure, epiglottis contracts to cover laryngeal vestibule

What happens in pharyngeal phase

tongue root posterior movement & superior pharyngeal wall constricts.

Toothpaste movement of pharyngeal wall peristalsis to transport bolus down to UES.