The primary goal of the proposed investigation is to determine the effects of the Mendelsohn maneuver (voluntary prolongation of laryngeal excursion at the midpoint of the swallow) on the physiology of the swallow in individuals who have suffered a stroke and exhibit signs of pharyngeal dysphagia. The proposed study is a phase 1 investigation designed to determine whether the treatment can be safely administered to individuals post-stroke and whether the biomechanical measures of choice are reflective of treatment outcomes. This type of phase 1 study aims to provide data which is essential for the development of phase 2 and phase 3 (efficacy) studies, including the treatment dose necessary to produce physiological change. Participants who have suffered a stroke and have pharyngeal dysphagia will be divided randomly into one of two groups. Group 1 participants will receive two weeks of treatment using the Mendelsohn maneuver in conjunction with surface electromyography (SEMG) biofeedback [followed by two weeks of no treatment (BBAA)]. Group 2 participants will be placed in a no-treatment period for two weeks and will then receive two weeks of treatment using the Mendelsohn maneuver in conjunction with SEMG biofeedback (AABB). Participants will be assessed with videofluoroscopy at the initiation of the study and after each week of the study. [After the 4 weeks of participation (AABB or BBAA) are complete, all participants will be discharged from treatment and will be brought back to the clinic for a final VFS evaluation after 2 additional weeks of no-treatment.] Specific Aim 1: To determine the effect of the Mendelsohn maneuver on the biomechanics of the pharyngeal swallow (i.e., measures of swallowing extent and duration).
Specific Aim 2 : To determine the effect of the Mendelsohn maneuver on measures of bolus flow (i.e., pharyngeal residue and penetration/aspiration).
Specific Aim 3 : To determine the effect of the Mendelsohn Maneuver on an overall dysphagia severity scale (Dysphagia Oral Severity Scale - DOSS).
Specific Aim 4 : To determine the most appropriate dose of treatment.
|McCullough, Gary H; Kim, Youngsun (2013) Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke. Dysphagia 28:511-9|
|McCullough, Gary H; Kamarunas, Erin; Mann, Giselle C et al. (2012) Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil 19:234-43|