Research on the Masako/Tongue-Holding Maneuver

Doeltgen, S. H., Witte, U., Gumbley, F., & Huckabee, M. (2009). Evaluation of manometric measures during tongue-hold swallows. American Journal of Speech-Language Pathology, 18, 65-73. Retrieved April 14, 2009, from ajslp.asha.org/cgi/content/full/18/1/65

The following salient points regarding the Masako/tongue-holding maneuver have been adapted from the above cited article:

         Prior research has noted increased bulging of the posterior pharyngeal wall (PPW) occurring during tongue-hold swallows. (See appendix A for the research establishing this point.) The goal of this study was to determine the immediate effects of the tongue-hold swallow with the hypothesis that it would decrease pharyngeal contact pressures and provide no immediate compensatory effects, despite what prior research suggests. The authors cite the automatic anterior retraction of the base of the tongue (BOT) upon anchoring of the tongue tip as the rationale for this hypothesis.

         The tongue-hold maneuver is intended to aid in the transport of the bolus during the pharyngeal phase of swallowing by increasing pharyngeal pressure. (See appendixes B and C for more information on how the maneuver works.)  

         About neuromuscular exercises in general: May target strength, endurance, or power. Strength is achieved exercises that utilize high levels of resistance. Endurance is achieved through repeated performance of exercises involving low levels of resistance. Power is achieved using exercises that focus on the speed of muscle contraction. 

         The tongue-hold maneuver is performed by holding the tip of the tongue between the teeth while swallowing. Because it includes the functional component of swallowing, the maneuver’s training effects may be more readily transferred to naturalistic environments and conditions. (See Appendix D for similar information from another source.)

         The tongue hold maneuver affects BOT retraction because it involves the anchoring of the tongue tip between the teeth. 

         The study finds that there is no immediate increase in pharyngeal pressure during execution of the tongue-hold maneuver. However, the authors point out that, in relation to the principles of neuromuscular exercise, the maneuver may result in increased strength of the pharyngeal constrictors after repeated executions of the maneuver. Increased pharyngeal pressure may then result from the increased strength of the pharyngeal constrictors. (See Appendix E for additional information regarding strength and resistance training regarding the Masako maneuver.) 

         The authors are careful to mention that use of the maneuver during swallowing of
a real bolus (versus a saliva bolus) has been seen to result in aspiration. (See
Appendix F for information on why aspiration may occur.) 

         In some instances, the tongue-hold maneuver may need to be performed in conjunction with the head-lift exercise to compensate for decreased anterior hyoid movement.

         It may be important to ascertain that the patient is performing the tongue-hold maneuver properly to ensure its success. It has been noted in previous research that males and females may perform the maneuver differently.

These points, along with the points included in the appendixes mentioned, sum up some of the significant information available regarding the Masako/tongue-holding maneuver. This treatment approach, as described above, involves the gentle but firm holding of the tongue tip between the teeth as the patient swallows. This maneuver should not be used when swallowing an actual bolus, as this can lead to aspiration. Questions have been raised about the use of this maneuver in patients with decreased anterior hyoid movement. If used with this population, the maneuver should be coupled with a head-lift exercise. The tongue-holding maneuver can be practiced by patients with difficulties at the pharyngeal phase of swallowing to strengthen the pharyngeal constrictor muscles, thereby strengthening their contraction. The idea is that this will result in better contact between the posterior pharyngeal wall (PPW) and the base of the tongue (BOT). This will in turn help to generate greater pressure at the pharyngeal level to propel the bolus smoothly through and out of the pharynx. 

Efficacy research regarding the tongue-holding maneuver is in some ways contradictory. Logemann and Fujiu, in their 1996 research, indicated that they saw an immediate effect resulting during the performance of this maneuver. Figure 3 in Appendix A shows video images of the PPW bulging that they saw. The 2009 study by Doeltgen, Witte, Gumbley, and Huckabee (2009), however, hypothesized that there would be no immediate effects apparent during the tongue-holding swallow. The results of their study provide evidence that this hypothesis is correct. Doeltgen et al. based their hypothesis on the fact that anchoring of the tongue must necessarily reduce tongue-base retraction since it holds the tongue in an anterior position. This would in turn reduce pharyngeal pressure generated by the BOT. Doeltgen et al. do not, however, neglect the possibility that regular training of the PPW by use of the tongue-holding maneuver may serve to strengthen pharyngeal constrictors over time, eventually leading to a stronger pharyngeal muscle contraction. Increased pharyngeal pressure may thus be ultimately achieved in this manner. 

It is my understanding that the contradictions arising from the combination of the above-mentioned studies results from the different methods used to measure the tongue-holding maneuver’s effectiveness. The Logemann and Fujiu (1996) study relied on visual measures while the study by Doeltgen et al. relied on manometric measures of pressure. Thus, it seems probable that although there were visually apparent results in the 1996 study, they did not occur in conjunction with an increase in pharyngeal pressure as determined by the 2009 study. Nevertheless, though not an immediate result of the tongue-holding maneuver, it is still likely that an increase in pharyngeal pressure may result from regular training of the pharyngeal constrictors via the maneuver. Were this possibility established, speech-language pathologists could use the maneuver with patients that present with pharyngeal muscle weakness and reduced pharyngeal pressure. 

Appendix A: Fujiu and Logemann 1996 Research

Appendix B: How the Maneuver Works- Curfman

Appendix C: How the Maneuver Works- Logemann

Appendix D: Masako Listed as a Maneuver that Uses a Functional Activity

Appendix E: How and When the Masako Strengthens

Appendix F: Message Posted Re Use of the Maneuver When Eating

 

Posted by Nechama Heitler

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