Rehabilitation Strategies for Pharyngeal Phase
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| Falsetto Pitch | for decreased laryngeal elevation. produce /i/ continuously increasing pitch & hold
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| Shaker | Head lift, for decreased laryngeal mvmt, pyriform residue. sustained= lie flat on back, raise and hold head for 1 min., rest 1 min., repeat 2x. repetitive= raise,lower head 30x. increases anterior mvmt of larynx. not for cardiac problems,hypertension
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| pull/push on chair | for decreased laryngeal closure. while seated, hold breath & push/pull on chair
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| glottal attack | for decreased laryngeal closure, produce clear voice5x, repeat "ah" w hard glottal attack
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| Masako (Tongue Hold) | for decreased anterior pharyngeal wall mvmt, decreased posterior base of tongue mvmt. Pt holds tongue between teeth and swallows. supposed to strengthen pharyngeal wall by making it move forward to meet BOT. INDIRECT only, no food.
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| Supraglottic Swallow | for decreased: airway protection, laryngeal elevation, hyoid mvmt, penetration/aspiration before the swallow. Take deep breath, hold, place food in oral cavity, swallow w held breath, cough, swallow again.
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| Super spraglottic swallow | for decreased airway protection, penetration/aspiration before the swallow. Take deep breath, hold, place food in oral cavity, swallow w held breath, cough, swallow again. Use add'l force/musc tension. true&false vocal folds close. decreases UES opening.
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| Effortful swallow | for oral/pharyngeal dysfunction, BOT dysfunction (reduced BOT retraction to the posterior pharyngeal wall), residue in valleculae. squeeze all the swallowing muscles hard when you swallow. this increases pressure in the post. mvmt of BOT & PPW
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| Showa | breath hold+ hard swallow
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| Mendelsohn | for decreased: range/duration hyolaryngeal elevation(resulting in vallecular residue), decreased range/duration cricopharyngeal opening, pharyngeal swallow coordination (decreased BOT/PPW mvmt) May be compensatory & rehabiliatitve.
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| Mendelsohn Compensatory functions | Reduced postswallow residue/ aspiration
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| Mendelsohn Rehab functions | Improved swallowing after use of technique w/o dependence on technique
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| Mendelsohn Steps | 1. Let pt feel elevation of larynx when swallowing. 2. Swallow and when you feel your adam's apple lift, don't let it drop. 3. hold @ peak of our swallow when you feel your adam's apple lifted for several seconds before finishing the swallow.
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| Negative Consequences of Masako | 1.reduced duration of airway closure. 2. increased post-swallow residue 3. increased delay in the initiation of the pharyngeal component of the swallow
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| Rationale of Mendelsohn | 1. increased laryngeal mvmt stretches/opens the CP. 2. prolonging hylolaryngeal elevation keeps the CP open longer.
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| Shaker improves what and how | Improve opening of the PES by increasing the strength of muscle groups that contribute to PES opening.
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