Effortful Swallow

Effortful Swallow (Valsalva maneuver)

Description: a compensatory swallowing strategy designed to increase the function of supra-hyoid/pharyngeal musculature, resulting in increased tongue base retraction.  The valsalva maneuver will increase orolingual pressure in the upper phayrnx and improve tongue base retraction. 

Impairment targeted: Decreased laryngeal elevation and/or pharyngeal contraction

Swallowing Stage: Pharyngeal

Example of Goal: Johnny will safely drink single cup sips of thin liquids without sign/symptoms of aspiration in 80% of opportunities given minimal verbal cues for use of strategies in order to increase ability to consume the least restrictive diet within two weeks.

Good for patients experiencing:

• Poor tongue base retraction

• Incomplete epiglottic inversion

• Decreased laryngeal elevation

• Decreased PES opening

• Reduced PES opening due to reduced laryngeal elevation

CAUTION with cardiac patients (can increase vascular pressure)

Hierarchy cueing system: (min/moderate/max) visual, verbal, modeling, and physical cues

Evidence-Based Practice: Effortful swallow has been proven to be an effective compensatory swallowing strategy for patients with dysphagia challenges (Roth & Worthington, 2021)

Reference:

Roth, F. P., & Worthington, C. K. (2021). Treatment resource manual for speech-language pathology.