MASH SWALLOW

Myofunktional Exercise  Collection

Application:

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This exercise is counted to the first in the row of exercises in which the complete reflex has to function in one whole continuity. Therefore every one of the detail exercises will have to be worked out successfully. The follow-up of positioning will have to be judged by the therapist as where to put it among the LIQUID SWALLOW and CRUMB SWALLOW finally to be followed by the EAT-(AND DRINK-)EXERCISE in which a predetermined portion of the meal is swallowed with “conscious intention”.

Contents:

Pseudo-manipulated exercise for the swallowing of mashy foodstuff the effect controlled by hand-mirror.

Materials:

Mashy foodstuff as yoghurt or cream, potato mash and a teaspoon.

Procedure:

- Previous exercises:

Depending on the procedure planning the exercises LIQUID SWALLOW and CRUMB SWALLOW are included either before or after the current exercise. (In this context see annotations under Paragraph “Discussion” of the chapter LIQUID SWALLOW).

The detail steps being essential for the swallow process have been successfully trained before.

As a suggestion for the last previous exercise the ,1-2-3’-EXERCISE in its variations might be mentioned (in this connection see also the chapter SWALLOW REFLEX EXERCISES).

-Starting position: Here the PAUSE-POSITION or at lest the ,L-M’-POSITION will be suitable.

- Step-by-step-Description:

-1 About one teaspoon of mush (yoghurt, cream) in the initial phase is put on the rostral half of the tongue, later on taken up in the usual way from the spoon with the lips and

-2 gathered into the DIMPLE.

-3 the, with a variation of the ,1-2-3’-EXERCISE , ,ZIP' , TOUCH-THE-BUTTON and swallow;

thereafter immediately

-4 mouth open and final control. The tongue surface should reveal no food leftovers without the tongue having helped along with any kind of parafunctional movements in cleaning up the mouth.

- Timing:

The chronological arrangement in the general course has been mentioned above. One process makes one sequence. Between three and ten sequences should be combined to one series.

Characteristics:

Function kinetic reflex exercise, habituation, motivation.

Remarks:

Arranging of the exercise succession in respect of the food consistency.

Discussion:

Some ready-made therapy methods claim the CRUMB SWALLOW to be fitted in first as the process of chopping up, agglomerating while cleaning up the oral cavity without parafunctional sweeping about with the tongue and the distinctly discernible retral movement of the bolus might be controlled easier by patient and therapist with the heterostereognostic effect of the prickly crumbs. If, on the other hand, the swallow reflex is to be built systematically up from the rostral end as in the physiological follow-up:

POINTPOSTURE, DIMPLE , MOUSE-SQUEAK , WATER-RETAINER and  ,1-2-3’-EXERCISE, just to name some examples, it rather presents itself to start with the LIQUID SWALLOW , bearing in mind the patient permanently having to deal with the own saliva. The transition to the, here described, MASH SWALLOW and further on to CRUMB SWALLOW might work out easier. Other methods are combining the here discussed exercise with the HOLD THE RING exercises which surely will improve the inspection of the carry-out by patient or therapist though contradicting the physiology of the deglutition act that is to say: During the moving distal of the DIMPLE (bolus) no food residues have to stay anywhere at any place of the oral cavity (thus even no elastics).

The method might be justified by reasoning that the heterostereognostic feeling and ability will be promoted to swallow a bite while a perceived foreign body is retained and, later on, spit out. It would stand as an example a cherry to be eaten swallowing the pulp, later on spitting the stone aimed.

From the physiological point of view justifiable would be the positioning of an elastic on to the tongue tip as it will have to remain unchanged stable at the POINT during the complete reflex course.