Question
I am currently a Graduate Student who is working on a report concerning the efficacy of the Mendelsohn Maneuver. I have found a few articles about this topic, but I am interested in hearing first-hand from an expert who has administered this maneuver, to
Answer
The Mendelsohn maneuver is a swallowing maneuver which was designed to treat both reduced laryngeal excursion and limited cricopharyngeal opening. This maneuver is performed by having the patient hold the larynx up, either using the muscles of the neck or with the hand, during the swallow for an extended period of time. The premise behind this technique is that if the extent and duration of laryngeal elevation could be increased, there would be a reciprocal increase in the extent and duration of the cricopharyngeal opening. It is important to note that this technique is used only briefly while the patient's swallow reflex returns to original state. This should not be viewed as permanent solution to dysphagia. Also, the clinician should seek medical clearance from the physician before attempting these techniques with patients as the individuals suffering from these types of problems often have multiple diagnoses.
In order to effectively use the Mendelsohn swallow maneuver, the patient must meet several requirements. First, the patient must have a sufficient amount of language ability to follow directions, which can be somewhat abstract. Therefore, a patient with severe language impairment would not be a good candidate. Second, patients must have intact cognitive abilities in that they must be able to understand what they are doing and why they are doing it. More importantly, these patients must have the ability to remember to do it each and every time they swallow, which can even be a problem for those individuals without memory impairment. Finally, patients who attempt this maneuver must be in good physical condition as it requires increased muscular effort, which results in fatigue. These requirements can be viewed as limitations in many ways as patients who do not meet them cannot effectively use the maneuver.
In my clinical experience, which has mostly been in either long term or an acute care setting, the patients were either too debilitated medically or cognitively to use this maneuver. Therefore, these individuals were referred to an ENT for dilation of the cricopharyngeus, which offered a much more permanent and reliable solution to the problem. The outcomes from this procedure seemed to be positive overall with many patients returning to normal p.o. intake. For the patients who did learn this maneuver, most were younger, cognitively intact individuals who had experienced minor strokes or oropharyngeal cancer. However, even these patients had some difficulty learning exactly what to do and remembering to do it each time. Most required consistent cuing throughout the course of a meal.
Therefore, swallowing maneuvers, specifically the Mendelsohn maneuver, can be used effectively treat different aspects of a patients swallow. However, these maneuvers can be difficult to teach due to abstract directions, difficult to follow due to memory limitations and difficult to consistently use due to the effects of fatigue.
Dr. Amy Ogburn Yeager is an assistant professor at Auburn University Montgomery and is on the Advisory Board for SpeechPathology.com. Currently, she resides in Montgomery, Alabama and can be reached at ayeager@mail.aum.edu.