The Mendelsohn maneuver is a technique used to treat dysphagia after stroke. It involves voluntarily prolonging the elevation of the hyolaryngeal complex during swallowing. The goals are to increase the extent and duration of hyolaryngeal elevation, widen the cricopharyngeal opening, reduce pooling in the pyriform sinuses, and improve swallow coordination. Treatment involves multiple swallowing sessions utilizing the maneuver over 1-2 weeks to provide intensive rehabilitation and improve swallow strength and coordination. Studies have found benefits of this approach for chronic dysphagia after brainstem stroke.

1. MENDELSOHN MANEUVER
FOR DYSPHAGIA AFTER STROKE
Ade Wijaya, MD – February 2018

2. SWALLOWING PHYSIOLOGY

3. INTRODUCTION
 Voluntary prolongation of hyolaryngeal elevation at
the peak of the swallow
 Has been used for many years
 A compensatory strategy to help the bolus pass
more efficiently through the pharynx
 A rehabilitative exercise program
McCullough, G. H., Kamarunas, E., Mann, G. C., Schmidley, J. W., Robbins, J. A., & Crary, M. A. (2012). Effects of Mendelsohn Maneuver on Measures
of Swallowing Duration Post-Stroke. Topics in Stroke Rehabilitation, 19(3), 234–243. http://doi.org/10.1310/tsr1903-234

4. GOALS
 To increase the extent of hyolaryngeal elevation
during the swallow
 To increase the width and prolong the
cricopharyngeal opening
 To reduce pooling in the pyriform sinuses.
 To improve coordination of the whole swallow
sequence
Medical Speech & Swallowing Disorders San Jose State University-California

5. Duration of UES opening ↑
Increase
laryngeal
elevation
Maximal
hyoid
superior
displacement
McCullough, G. H., Kamarunas, E., Mann, G. C., Schmidley, J. W., Robbins, J. A., & Crary, M. A. (2012). Effects of Mendelsohn Maneuver on Measures
of Swallowing Duration Post-Stroke. Topics in Stroke Rehabilitation, 19(3), 234–243. http://doi.org/10.1310/tsr1903-234

7. PROCEDURE
 Take a small bite of food or sip of liquid.
 Hold the food in your mouth.
 Position index finger and thumb around your
Adam's apple.
 Swallow.
 Feel the upward movement (the elevation) of the
Adam's apple (thyroid notch) when you swallow
 When the Adam's apple (larynx) reaches its highest
point of elevation, hold it up with your muscles for 5
seconds.
 Release.
 Repeat steps 1-7 with each swallow
Medical Speech & Swallowing Disorders San Jose State University-California

8. TREATMENT SESSIONS
Session 1
• 45-60 minutes
• Defining and
demonstrating
procedure
Session 2
• 30-40
swallows per
session
utilizing
Mendelsohn
Maneuver
McCullough, G. H., Kamarunas, E., Mann, G. C., Schmidley, J. W., Robbins, J. A., & Crary, M. A. (2012). Effects of Mendelsohn Maneuver on Measures
of Swallowing Duration Post-Stroke. Topics in Stroke Rehabilitation, 19(3), 234–243. http://doi.org/10.1310/tsr1903-234

9.  Mendelsohn maneuver have reported success with
sessions once or twice daily over a 1 to 2 week
period providing intense neuromuscular
rehabilitation in an effort to improve both the
strength and coordination of the swallow
 Swallowing post-stroke can become not only weak
but discoordinated
 More coordinated “patterns” of swallowing activity
occur with more intensive treatment
Bryant M. Biofeedback in the treatment of a selected dysphagic patient. Dysphagia. 1991;6:140–4.
Huckabee ML, Cannito MP. Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: a retrospective evaluation. Dysphagia. 1999;14:93–109.
Crary MA, Carnaby GD, Groher ME, Helseth E. Functional Benefits of Dysphagia Therapy Using Adjunctive sEMG Biofeedback. Dysphagia. 2004;19:160–4.