CRUMBSWALLOW

Myofunktional Exercise  Collection

Application:

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This exercise stands as the first link in the string of those exercises for the adjustment of the swallow reflex in which the entire (restored) reflex is running continuously. For this purpose all detail exercises have to be practised successfully. Among these exercises the training procedure mostly will be started with the training of LIQUID SWALLOW (see there) as with WATER CARRIER and the like; moving on the next step will be MASH SWALLOW followed by CRUMB SWALLOW . After this phase there should follow the EAT-(AND DRINK-)EXERCISE in which at the respective occasion part of the meal will be swallowed deliberately ( see also notes in “Discussion”). (Anatomy: The physical aspect is so complex in the succession of reflex chains that it is no use mentioning single involved muscles ; see I, 3/6, page 25a).

Contents:

Pseudo manipulated exercise implying  crumbly chewing stuff monitoring its effect by hand-mirror control.

Materials:

Brittle sugarfree crackers as saltsticks or the like; hand-mirror.

Procedure:

- Previous exercises: All the detail steps should have been successfully practiced . As a proposal for an exercise to be practiced previously there should be mentioned  the ,1-2-3’-EXERCISE (about this matter see also chapter SWALLOW REFLEX EXERCISES):

-Starting position: Here the RESTING POSITION or else the  ,L-M’-POSITION will be suitable.

- Step-by-step-description:

-1 A cherry-sized piece of pastry is chewed as intensely as to leave crumbs still  being felt.

-2 “Speedily” in a preferably rapid movement sequence the chewing stuff is collected on the tongue while trying to load the DIMPLE.

-2a  At this stage there may follow an interim control with the hand-mirror.

Open the mouth, stick out the tongue just a bit and show the crumbs in the dimple.

-3 Followed by ,ZIP’, TOUCH-THE-BUTTON (see under respective chapter) and swallow. Immediately thereafter:

-4 Open mouth for end control. The tongue surface has be crumb free without the help of any parafunctional  action..

-Timing: About the chronological order in the overall progression has been discussed above; the exercise is mostly positioned within the end phase of the therapy during the habituation.

One run means one sequence. There may be composed three to ten sequences to one series.

Characteristics:

Function kinetic reflex exercise, habituation, motivation.

Remarks:

In repeated practicing the trainee may get short of saliva ; there should be a drink in between but not during the running movement as to wash down the chewing stuff!

Discussion:

Details worth mentioning have been described above in the text. Some authors suggest the practicing to be done with the aid of MEMOS like the LIPS OPEN or ELASTIC. This is not just physiologic but may be left in its employment to the therapist especially for exceptional cases.

Likewise in the discretionary decision lies the succession of the deployment of the swallow exercises with the different qualities of foodstuff  (bolus qualities) liquid, mushy or crumbly ( see annotations in “Discussion” of the chapter LIQUID SWALLOW ).

Instructions:

Now follows the completely correct swallow with all the details practiced up to now when swallowing crumbly food. First of all we have to chew up the pastry – for example a cracker – in the way we have worked out. Chew at the rear, chew left, right but do not chew into too small crumbs and not to soggy; the crumbs should still be felt.

All crumbs are now collected into the dimple at the front of the tongue. Next ‘touch the button’ and swallow once. We have run through all the details together before!

Now open the mouth and look into the mirror to see whether everything is emptied up. But do not try to clean up with the tongue sweeping about! If the mouth is still full of crumbs we will have to do the next try very conscientiously through all the single steps. If it works out all right go through five to ten biscuits (or as much as we came about) chewing one after the other.