Swallowing exercise references

https://medicalspeechpathology.wordpress.com/swallowing/dysphagia-exercises/

Also Chin Retracted Posture to reduce diameter of the pharynx

Compare to these from May 2014 class:

Swallow Maneuver	Problem for Which it Was Designed	Possible MBSS Findings	Rationale	Most Common Contraindication(s)
Chin Tuck	Premature spillage to the valleculae	Will see spillage to the valleculae before swallow is initiated	Supposed to help widen the space of the valleculae, thus protecting the airway	Cervical Spinal Injury
Chin tuck + head tilt	Unilateral pharyngeal wave contraction weakness	A-P view stasis on one side versus the other	Close off the weaker side so that bolus goes down stronger side – turn toward affected side	Cervical Spinal Injury
Supraglottic Swallow	Reduced or late vocal fold closure Delayed pharyngeal swallow	Premature spillage to the level of pyriforms Penetration	* Voluntary breath hold usually closes vocal folds before and during swallow * Closes vocal folds before and during delay.	COPD, heart problems, high blood pressure
Super-supraglottic Swallow	Reduced closure of airway entrance	Penetration	Effortful breath hold tilts arytenoid forward, closing airway entrance before and during swallow	COPD, heart problems, high blood pressure
Effortful Swallow (THINK Swallow)	Reduced posterior movement of the tongue base	Stasis in the pharynx and residue in the valleculae	Effort increases posterior tongue base movement	None
Mendelsohn maneuver	Reduced laryngeal movement Discoordinated swallow	Reduced elevation of the hyo-laryngeal component; Residue at the UES Prolonged laryngeal elevation	* Laryngeal movement opens the UES; prolonging laryngeal elevation prolongs UES opening * Normalized timing of pharyngeal swallow events	Patient who fatigues easily (as in progressive neurological disorders)
* Shaker  (exercise – not for direct therapy)	Reduced pharyngeal wave contraction	Stasis in the pharynx	Strengthens pharyngeal musculature	Cervical Spinal Injury, patients who fatigue easily
* Masako (an exercise, not recommended for direct therapy)	Reduced tongue base movement** Reduced pharyngeal wall movement	Residue at tongue base, in valleculae, maybe in pharynx Stasis in the pharynx	* Increases tongue base strength * Increases pharyngeal pressure	Anyone with reduced anterior hyoid movement

** also for Tongue Base Weakness, can try IOPI 

http://www.speakingofspeech.info/april16/AdultGoalsandObjectives.pdf