Swallowing is a complex process involving over 50 pairs of muscles and multiple cranial nerves working in rapid sequence. When this sequence is disrupted, a person may experience difficulties that compromise their ability to eat safely. Swallowing therapy focuses on rehabilitating these functions through targeted exercises and strategies. Among the active techniques used to improve muscular control and coordination is a specific method known as the Mendelsohn Maneuver. This technique requires the patient to consciously intervene in the natural flow of the swallow to achieve a more efficient and safe result.
Defining the Mendelsohn Maneuver
The Mendelsohn Maneuver is a specific, active technique taught by a Speech-Language Pathologist (SLP) and is categorized as a swallowing exercise. It involves the voluntary interruption and holding of the swallow at its peak to alter the mechanics of the throat. This maneuver requires the patient to use conscious effort to sustain a physical position that is normally fleeting. It is designed to be both a rehabilitative exercise to strengthen swallowing muscles and a compensatory strategy to be used during mealtimes. The technique’s success relies on the patient’s ability to internalize and reproduce a specific muscular contraction.
The Physiological Goal
The primary mechanical goal of this maneuver is to increase the extent and duration of the upward and forward movement of the hyolaryngeal complex. The hyolaryngeal complex includes the hyoid bone and the larynx. During a normal swallow, this upward motion helps to invert the epiglottis, which closes off the airway, and also pulls on the Upper Esophageal Sphincter (UES). The UES, a ring of muscle at the top of the esophagus, must relax and open to allow the food bolus to pass into the stomach. By voluntarily holding the larynx in its highest position, the patient prolongs the opening of the UES. This extended opening time creates a wider passage for food or liquid to travel through the throat. A wider and more sustained opening allows the material to clear the pharynx more completely, reducing the chance of residue remaining in the throat after the swallow.
Application and Indication
The Mendelsohn Maneuver is prescribed for individuals experiencing dysphagia, or swallowing difficulty, specifically when the impairment affects the pharyngeal phase of the swallow. Patients who benefit demonstrate reduced laryngeal elevation or poor coordination in the opening of the UES. Both of these deficits can lead to two main problems: post-swallow residue and aspiration. Post-swallow residue refers to food or liquid that remains in pockets of the throat, such as the pyriform sinuses, after the swallow is seemingly complete. Aspiration occurs when this residue or the initial bolus enters the airway below the vocal folds. By improving laryngeal excursion and UES opening, the maneuver helps to clear the pharynx more effectively. This technique is reserved for patients who have the cognitive capacity to understand and consistently execute the multi-step instructions.
Step-by-Step Execution
Learning to perform the Mendelsohn Maneuver correctly begins with the patient locating their larynx, often referred to as the Adam’s apple, on the front of the neck. The patient is first instructed to perform a normal swallow and notice how the larynx rises and then quickly falls back down. The next step involves initiating a swallow, but consciously interrupting the natural sequence at the apex of laryngeal movement.
- The patient must “catch” the larynx at its highest point and actively hold it there for a short duration, typically between two and three seconds.
- This sustained hold is achieved by squeezing the muscles of the throat and tongue.
- Once the hold time is reached, the patient relaxes the muscles to complete the swallow.
A Speech-Language Pathologist will initially supervise practice sessions using only saliva, or “dry swallows,” before introducing small amounts of food or liquid. This foundational practice ensures the patient masters the muscular control before attempting to use the technique safely during a meal.