Mendelsohn+Manoeuver

The Mendelsohn Manoeuver consists of requesting patients to prolong their swallow when the larynx is raised (Grohler & Crary, 2010). As Logemann, Pauloski, Rademaker, & Colangelo (1997; p. 536) say patients are asked to "swallow normally and when they feel their 'voice box' or 'Adam's apple' lift to the top of their throat, to keep it lifted for several seconds." The Mendelsohn Manoeuver keeps the larynx elevated while allowing the upper oesophageal sphincter (UES) to close (Kahrilas, Logemann, Krugler, & Flanagan, 1991). This protects the airway which decreases the risk of aspiration.
 * Mendelsohn Manoeuver**

The Mendelsohn Manoeuver has been reported as both a compensatory and rehabilitative technique. Generally the Mendelsohn Manoeuver is considered a compensatory technique as when it is perforemed it eliminates aspiration and the occurrence of residue immediately (Bogaardt, Grolman, & Fokkens, 2009; Lazarus, Logemann, Song, Rademaker, & Kahrilas, 2002; Lazarus, Logemann, & Gibbons, 1993). However, Lazarus //et al.// (1993) found that larynx elevation improved consistently from using the Mendelsohn Manoeuver, making it a rehabillitative technique. They followed a patient who was able to be removed from his gastrostomy and begin eating orally again. While the Mendelsohn Manoeuver did increase the ability of elevation in the larynx, this patient was still required to use the Mendelsohn Manoeuver during every meal. This finding still shows promise for the Mendelsohn Manoeuver to be utilised as a rehabilitative technique.

A difficulty with the Mendelsohn Manoeuver is the complexity and understanding of the directions. As seen with Logemann's //et al.// (1997) directions it requires a high level of cognition to understand. If a patient has a language impairment or cognitively impaired then it may cause problems explaining the Mendelsohn Manoeuver and getting the desired action (Ding, Larson, Logemann, & Rademaker, 2002). One way to neutralise this problem is by using biofeedback. Bogaardt //et al.// (2009) uses biofeedback in the form of surface electromyography (sEMG). The patient is able to watch both their normal swallow and their swallow using the Mendelsohn Manoeuver on a computer screen in real time. This provides a visualisation for the patient and allows the clinician to explain what the patient is doing correctly and what they can change.


 * References:**

Bogaardt, H., Grolman, W., & Fokkens, W. (2009). The use of biofeedback in the treatment of chronic dysphagia in stroke patients. //Folia Phoniatrica et Logopaedica, 61, 200-205.// Ding, R., Larson, C., Logemann, J., & Rademaker, A. (2002). Surface electromyographic and electorglottographic studies in normal subjects under two swallow conditions: Normal and during the Mendelsohn Manoeuver. //Dysphagia, 17, 1-12.// Grohler, M., & Crary, M. (2010). Dysphagia: Clinical Management in Adults and Children. //Maryland Heights, MO: Mosby, Inc.//

Kahrilas, P., Logemann, J., Krugler, C., & Flanagan, E. (1991). Volitional augmentation of upper esophageal sphincter opening during swallowing. //American Journal of Physiology, 260(23), G450-456.// Lazarus, C., Logemann, J., Gibbons, P. (1993). Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. //Head and Neck, 15, 419-424.//

Lazarus, C., Logemann, J., Song, C., Rademaker, A., & Kahrilas, P. (2002). Effects of voluntary maneuvers on tongue base function for swallowing. //Folia Phoniatrica et Logopaedica, 54, 171-176.// Logemann, J., Pauloski, B., Rademaker, A., & Colangelo, L. (1997). Super-supraglottic swallow in irradiated head and neck cancer patients. //Head and Neck, 19, 535-540.//