Major focus area

Feeding Therapy -> Swallowing

Short description

Facilitation techniques are used by the SLP to improve the function of the pharyngeal swallow and include but not limited to the following: laryngeal adduction, valsalva maneuver, falsetto/pitch exercises, Masako, tongue base retraction, Shaker Maneuver and suck-swallow (Swigert, 2007; Logemann, 1998).

Long description

Facilitation techniques are used by the SLP to improve the function of the pharyngeal swallow and include the following: laryngeal adduction, valsalva maneuver, falsetto/pitch exercises, Masako, tongue base retraction, and suck-swallow (Swigert, 2007; Logemann, 1998).

Laryngeal adduction: These are the same exercises used in voice therapy to achieve better laryngeal closure. They include pushing, pulling and hard glottal attack. Pushing and pulling causes the patient to bear down and tighten closure at the level of the vocal folds. While the patient is pushing and pulling have them phonate a vowel sound. Hard glottal attack involves having the patient take a breath and then forcefully say a vowel or a word beginning with a vowel.

Valsalva maneuver: This is a breath-hold technique where the patient is asked to take a breath and hold it tightly for several seconds with their mouth open.

Falsetto/Pitch: Falsetto exercises are designed to improve elevation of the larynx. Better elevation means there will be better airway closure and less residue in the pyriform sinuses. Ask the patient to produce /i/ in a continuous note as they increase their pitch until they reach the falsetto and hold it. Some patients may have more success with simple pitch change activities when asked to sing up the scale.

Masako/Tongue Hold: This technique is designed to increase the forward movement of the posterior pharyngeal wall as it moves forward to meet the base of the tongue. The patient protrudes their tongue slightly and holds it between their teeth while they swallow. This technique is done with saliva swallows as it is difficult to control a food bolus while performing this technique.

Tongue base retraction: The patient pulls the base of their tongue toward the posterior pharyngeal wall with lots of effort and holds it there for several seconds. This technique develops strength in the base of the tongue to reduce vallecular residue. If the patient tries to curl the tip of the tongue back, hold the tip of the tongue and ask the patient to pull back against the resistance.

Shaker Maneuver: This technique is designed to increase forward movement of the hyoid bone, which actually helps the entire hypolaryngeal complex move forward. The result is the cricopharyngeus opens more widely and stays open longer, which should allow more residue to drain from the pyriform sinuses. The exercise has 2 parts; sustained and repetitive. For each, the patient lies flat on a bed or on the floor with no pillow under their head.

Sustained: Patient lifts their head (keeping shoulders on the surface) and looks at their toes, holding the position for 60 seconds. Repetitive: Patient is in the same position and will raise and lower their head 30 times in a row.

Suck-Swallow: This technique can increase the speed of the pharyngeal swallow. It also draws saliva to the back of the mouth, which may increase sensory input for the swallow. Ask patient to pretend they are sucking something very thick up through a very narrow straw for 2-3 seconds and then have the patient swallow.