Pediatric Dysphagia 

The patient will complete the masako strengthening technique to improve oral motor weakness, tongue base retraction, hyolaryngeal excursion, airway protection, and/or clearance of the bolus through the pharynx with min verbal, visual and tactile cues as observed by SLP data.

Masako: 

Improved posterior pharyngeal wall bulging could increase pharyngeal pressure generation by making contact with base of tongue (Fujiu et al., 1996).

 May be increased pharyngeal constrictor strength after regular training of the Masako Maneuver (Doeltgen et al., 2009).

Shaker: 

Increase strength of submental muscles to create greater traction force during hyolaryngeal excursion, thereby assisting opening of the UES (Ferdjallah 2000, Shaker 2002).

• Shaker (Head Lift) 

Purpose: Strengthen muscles and improve the patients' ability to swallow.

How to:  Lie patient flat on his or her back and  direct them to raise their head slightly off the ground. The patient should have his or her head raised high enough so that eyes are fixated on their toes. Hold position for a few seconds and then place head back down.

 Repeat exercise 3-6x throughout the day. 

• Masako (Tongue Hold)

 Purpose: To strengthen the base of the tongue.

How to: Hold tongue between your teeth to add resistance to your tongue and swallow.

Include:

Observation of client performance, expected outcomes that were and were not achieved, and difficulties encountered or symptoms reported by the client during the task.

Include the following:

– Name of strengthening strategy used

– Number of repetitions, sets and duration of hold completed

– Any difficulties experienced and/or monitoring requirements

– Required re-positioning, assistance or any equipment used while eating/drinking

– Observed signs of aspiration, oral pooling, or choking and action taken

– Ability to clear the oral cavity and any strategies required

(Queensland health, 2019)