McCullough GH; Kamarunas E; Mann GC; Schmidley JW; Robbins JA; Crary MA
Top Stroke Rehabil; 19(3): 234-43, 2012 May-Jun.
PURPOSE: The purpose of this pilot study was to determine whether intensive use of the Mendelsohn maneuver in patients post stroke could alter swallow physiology when used as a rehabilitative exercise. METHOD: Eighteen outpatients between 6 weeks and 22 months post stroke were enrolled in this prospective study using a crossover design to compare 2 weeks of treatment with 2 weeks of no treatment. Each participant received an initial videofluoroscopic swallow study (VFSS) and an additional VFSS at the end of each week for 1 month for a total of 5 studies. During treatment weeks, participants received 2 treatment sessions per day performing Mendelsohn maneuvers with surface electromyography for biofeedback. Measures of swallowing duration, penetration/aspiration, residue, and dysphagia severity were analyzed from VFSS to compare treatment and no-treatment weeks. RESULTS: Significant changes occurred for measures of the duration of superior and anterior hyoid movement after 2 weeks of treatment. Improvements were observed for duration of opening of the upper esophageal sphincter (UES), but results were not statistically significant. Measures of penetration/aspiration, residue, and dysphagia severity improved throughout the study, but no differences were observed between treatment and no-treatment weeks. CONCLUSIONS: Intensive use of the Mendselsohn maneuver in isolation altered duration of hyoid movement and UES opening in this exploratory study. Results can guide future research toward improved selection criteria and exploration of outcomes. Larger numbers of participants and variations in treatment duration and intensity will be necessary to determine the true clinical value of this treatment.