Specific information regarding the Communication Sciences and Disorders' Acute Care Speech Language Pathology practicum led by Carley Evans MS CCC SLP. Carley is a medical speech pathologist at the Evelyn Trammell Institute for Voice and Swallowing of the Medical University of South Carolina in Charleston. If you are new to this practicum, start with the oldest post listed in Archive.

Monday, April 14, 2008

Masako and Effortful Swallow Maneuvers

Catriona M. Steele writes:

The Masako maneuver is described as a technique to enhance closure of the pharyngeal lumen at the level of the tongue base, however it works by eliciting greater movement of the posterior pharyngeal wall. To my knowledge, no one has yet shown that the tongue base moves more with the maneuver, and, indeed, the intention of the maneuver is to anchor the tongue further forward in the mouth to mimic a tongue base resection (the original maneuver was something observed as a spontaneous
compensation in patients with oral cancer). Additionally, as described
in the original articles by Masako Fujiu and Dr. Logemann, the Masako maneuver is recommended only as an exercise (with saliva swallows) and not advised with a bolus (because the tongue is anchored, the maneuver was reported to increase vallecular residue with a bolus). Fujiu M & Logemann JA. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. American Journal of Speech-Language Pathology, 5(1):23-30, 1996.

...you might find some articles on the effortful swallow quite interesting with respect to addressing tongue base issues and vallecular residue. There are series of articles coming out of Dr. Maggie-Lee Huckabee's lab that suggest that the effortful swallow can address weakness in the region of the tongue base, and that by instructing the patient to emphasize a tongue-palate "press" at the beginning of an effortful swallow you get a greater increase in the resulting pharyngeal pressures.

- Huckabee ML, Hiss SG, Barclay M, Jit S: The relationship between submental semg measurement and pharyngeal pressures during normal and effortful swallowing. Arch Phys Med Rehabil 86(11):2144-2149, 2005
- Hiss SG, Huckabee ML: Timing of pharyngeal and upper esophageal sphincter pressures as a function of normal and effortful swallowing in young healthy adults. Dysphagia 20:149-156, 2005
- Huckabee, M.L. & Steele, C.M. (2006). An Analysis of Lingual Contribution to Submental sEMG Measures and Pharyngeal Biomechanics during Effortful Swallow. Archives of Physical Medicine and Rehabilitation, 87, 1067-1072.
- Steele, C.M. & Huckabee, M.L. (2007). The influence of oro-lingual pressure on the timing of pharyngeal pressure events. Dysphagia, 22(1), 30-36.

...it is really important to remember that excessively increased pharyngeal pressures may not be something you want to contribute to in a patient with a Zenker's. I don't have my fingers on specific references in this regard, but I would recommend an article by Jane Garcia and colleagues, that shows how effortful swallow can sometimes have an undesirable outcome:

Garcia, J. M., Hakel, M., & Lazarus, C. (2004). Unexpected consequence of effortful swallowing: Case study report. Journal of Medical Speech-Language Pathology, 12(2), 59-66.

Catriona M. Steele
Ph.D., M.H.Sc., S-LP(C), CCC-SLP, Reg. CASLPO

* Research Scientist, Toronto Rehabilitation Institute
* Corporate Practice Leader for Speech-Language Pathology and Audiology, Toronto Rehabilitation Institute
* CIHR New Investigator in Aging
* Assistant Professor, Department of Speech-Language Pathology, University of Toronto
* Coordinator, Special Interest Division 13 (Swallowing and Swallowing Disorders), American Speech-Language Hearing Association

Monday, April 7, 2008

References: MBS, modified Evans Blue Dye, FEES

Ajemian, M. S., Nirmul, G. B., Anderson, M. T., Zirlen, D. M., & Kwasnik, E. M. (2001). Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Archives of Surgery., 136, 434-437.

Belafsky, P. C., Blumenfeld, L., LePage, A., & Nahrstedt, K. (2003). The accuracy of the modified Evan's blue dye test in predicting aspiration. Laryngoscope., 113, 1969-1972.

Brady, S. L., Hildner, C. D., & Hutchins, B. F. (1999). Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: An evaluation of blue dye visualization in cases of known aspiration. Dysphagia., 14, 146-149.

Cameron, J. L., Reynolds, J., & Zuidema, G. D. (2007). Aspiration in patients with tracheotomies. Surgical Gynecology and Obstetrics, 136, 68-70.

deLarminat, V., Montravers, P., Dureuil, B., & Desmonts, J. M. (1995). Alteration in swallowing reflex after extubation in intensive care unit patients. Critical Care Medicine, 23, 486-490.

Donzelli, J., Brady, S., Wesling, M., & Craney, M. (2001). Simultaneous modified Evans blue dye procedure and video nasal endoscopic evaluation of the swallow. Laryngoscope., 111, 1746-1750.

Donzelli, J., Brady, S., Wesling, M., & Theisen, M. (2005). Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES). Dysphagia, 20, 283-289.

O'Neil-Pirozzi, T. M., Lisiecki, D. J., Jack, M. K., Connors, J. J., & Milliner, M. P. (2003). Simultaneous modified barium swallow and blue dye tests: a determination of the accuracy of blue dye test aspiration findings. Dysphagia., 18, 32-38.

Peruzzi, W. T., Logemann, J. A., Currie, D., & Moen, S. G. (2001). Assessment of aspiration in patients with tracheostomies: comparison of the bedside colored dye assessment with videofluoroscopic examination. Respiratory Care, 46, 243-247.