SLP Praxis: Swallow Techniques

Physiology: Increases posterior tongue base movement to facilitate bolus clearance

Hard/Effortful Swallow

Physiology: Horizontal glottal closure protects the airway to prevent aspiration

Supraglottic Swallow

Voluntarily moves the arytenoids anteriorly, closing the entrance to the laryngeal vestibule before and during the swallow; Horizontal and anteroposterior glottal closure

Super-Supraglottic Swallow

Elevates the larynx and opens the esophagus (relax the UES) during the swallow to prevent the bolus from entering the airway

Mendelsohn Maneuver

Moves the base of tongue (BOT) and posterior pharyngeal wall (PPW) closer together and forces them to work harder during the swallow

Masako Maneuver/ Exercise

Facilitates increased opening of the UES through increased hyoid and laryngeal anterior & superior excursion

Shaker Exercise/ Head Lifting Exercise

Brings the BOT closer to the PPW, narrowing the opening to the airway and widening the vallecular space

Chin Tuck

Directs the bolus to the stronger of the lateral channels of the pharynx by making the stronger side wider and the weak side narrow

Head Rotation

Patient is instructed to swallow and push hard with the tongue against the hard palate

Hard/ Effortful Swallow

Technique: Patient is instructed to hold their breath just before swallowing to close the vocal folds; the swallow is followed immediately by a volitional cough

Supraglottic Swallow

The patient is instructed to hold their breath just before swallowing to close the vocal folds; the swallow is followed immediately by a volitional cough + using a hard/ effortful swallow; involves increased effort during the breath hold before the swallow

Super-Supraglottic Swallow

The patient holds the larynx in an elevated position at the peak of hyolaryngeal elevation for 3 seconds

Mendelsohn Maneuver

The patient holds their tongue forward between the teeth while swallowing saliva; does NOT use food or liquid

Masako Maneuver/ Exercise

The patient rests in a supine position and lifts their head to look at their toes

Shaker Exercise/ Head Lifting Exercise

Chin is tucked down toward the neck

Chin Tuck

Chin is tilted up

Chin Up/ Head Back

The head is turned toward the damaged/ weak side

Head Rotation

When to use:

- Aspiration during or after the swallow

- Increased stasis at valleculae, pyriform sinuses, aryepiglottic folds and/or posterior pharyngeal wall

Hard/ Effortful Swallow

When to use:

Aspiration during the swallow if doing a hard/effortful swallow doesn't work

Supraglottic Swallow

When to use:

Aspiration during the swallow if supraglottic swallow does not work

Super-Supraglottic Swallow

When to use:

- Use as direct therapy for reduced laryngeal elevation

- Use as a compensatory strategy to open/ relax the UES

- Residue in the pyriform sinuses or pharyngeal residue in general

- Aspiration during the swallow

Mendelsohn Maneuver

For patients who present with BOT weakness

Masako Maneuver/ Exercise

When to use:

- Premature spillage to hypopharynx

- Delayed pharyngeal swallow

- Aspiration before the swallow

Chin Tuck

When to use:

- Reduces ROM for lingual elevation

- Increased stasis in the valleculae

Chin Up/ Head Back