![]() ![]() ![]() Although this exercise has been found to influence tongue-base retraction, measures of surface electromyography (sEMG) have found activity in the laryngeal elevators to be significantly greater during ES compared to normal swallows. 8 Accordingly, this exercise promotes an overload in the laryngeal elevators through amplified neurological drive (theoretically, increased motor unit recruitment) compared to normal swallowing. It has been suggested that the mechanism for overload during production of ES is this increased volitional effort. To achieve this they are typically prompted to “bear down” or “swallow hard”. The Effortful Swallow (ES) requires a patient to produce maximum effort when initiating a pharyngeal swallow. Clinical outcome studies investigating the MM have demonstrated improvement in laryngeal excursion (extent of movement and duration of movement) in addition to swallow timing and bolus flow. Although progressive loads cannot be applied in this context, the duration of contraction against the resistance can be increased progressively throughout an exercise protocol. When an individual is sitting or standing, hyolaryngeal excursion must also act against another form of resistance – gravity. However, if one considers the ligaments and muscles originating below the hyoid as a band of elastic tissues providing a degree of resistance to contraction, anterior and vertical excursion of the hyoid must pull and maintain contraction against this resistive band. There may be some doubt as to whether this muscular contraction is made against a resistive load (to provide an overload to contraction). 2,6 Even though the MM can be applied as a direct (with food) or indirect (without food) exercise, in both contexts it adheres to the principle of specificity as the exercise is conducted during the act of swallowing. 5 Mendelsohn ManeuverĪ widely known exercise is the Mendelsohn maneuver (MM), which requires the patient to volitionally maintain contraction of the submandibular and other muscles during the pharyngeal stage of swallowing, with the aim of holding the larynx as high as possible for as long as possible. When implementing clinical exercises targeting neuromuscular adaptation it is important for the clinician to choose those tasks which employ principles of strength training and motor learning, including resistance (overload), repetition, and specificity. ![]() 4 As an example, clinical goals for a patient with dysphagia related to reduced hyolaryngeal excursion might include increasing the strength, range, or timing of submandibular muscle function during swallowing. Adaptation occurs when the structural and functional properties of muscles change secondary to some form of stimulation. 1–3 When decreased hyolaryngeal excursion results in dysphagia, clinicians might choose to increase function in laryngeal elevators by incorporating rehabilitative exercises that promote neuromuscular adaptation. During the pharyngeal stage of swallowing contraction of the geniohyoid, mylohyoid, thyrohyoid and anterior digastric muscles (laryngeal elevators) facilitates hyolaryngeal excursion and assists upper esophageal sphincter (UES) dilation. ![]()
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