The efficacy of the Masako (tongue-hold) maneuver
Pisegna, Jessica Maxham
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Purpose: Clinicians commonly recommend the tongue-hold maneuver, also called the Masako, as an exercise to strengthen swallowing muscles. Although this exercise is widely used, limited empirical data support this maneuver as an effective exercise. The goal ofthe present study is to observe, over multiple sessions, the effects ofthe tongue- hold maneuver as a 6-week exercise in subjects with dysphagia. The results ofthis study will help to address whether the tongue-hold maneuver is beneficial and, if so, which muscle groups are strengthened by this exercise. Methods: Five subjects with dysphagia and one healthy adult performed a set oftongue- hold maneuvers 3 times a day, 5 days per week, for 6 weeks. The number o f repetitions per set was individually calculated based on 80% of the maximal repetitions until fatigue. At baseline and 6 weeks, 4 measures were observed: a subject-reported quality-of-life swallowing scale, lingual strength, the amount of residue in the valleculae, and the pressures generated by pharyngeal muscles during a normal swallow. Four healthy adults who did not perform the tongue-hold maneuver were used as controls for the lingual measures, completing the measures of lingual strength at baseline, 3 weeks, and 6 weeks. Results: No overt trends in the subject-reported swallowing scale were noted; after 6 weeks of exercise, about half ranked their swallowing as worse and half ranked their swallowing as better. The treatment group demonstrated a non-significant overall2.3% increase in anteromedian lingual strength and 8.4% increase in posteromedian lingual strength. These changes did not set the treatment group apart from the control group, who demonstrated an increase of3.8% and 6.3% in the anteromedian and posteromedian positions, respectively. Regarding pharyngeal residue, 2 subjects did not show any changes in residue scores. However, the other 3 subjects demonstrated reduced residue in the valleculae with a cracker bolus. Out ofthe 3 subjects who were measured with manometry, 2 demonstrated higher oropharyngeal pressures on normal swallows after 6 weeks of exercise, although great variability was present. These results are limited by the small sample size and heterogeneity of the treatment group, as well as high variability in instrumental measurements. Conclusion: This study investigated the tongue-hold maneuver as an exercise and provides preliminary support for its use, with caution. Specifically, clinicians should be sure to prescribe regimens that fatigue swallowing muscles and push them past normal use. When using the Iowa Oral Performance Instrument (IOPI) as a tool, clinicians should also keep in mind that a learning effect is likely to occur over the first few trials. This pilot study suggests that clinicians should continue to prescribe the tongue-hold maneuver as an exercise with caution, as some patients may benefit from it while others may not. Further investigation is required.
Thesis (M.S.)--Boston University