Efficacy of the Mendelsohn maneuver combined with repetitive facilitation principles in poststroke dysphagia: A randomized controlled trial based on videofluoroscopic swallow study.
The Mendelsohn maneuver combined with repetitive facilitation principles provided additional benefits over conventional therapy for swallowing safety and overall swallowing function in poststroke dysphagia, though effects on pharyngeal residue were inconsistent and no significant differences were found in upper esophageal sphincter opening or nasogastric tube removal.
Key Findings
Results
Both the experimental and control groups showed improvement in swallowing function following their respective interventions.
All 56 randomized participants completed treatment and posttreatment assessment, indicating no dropout.
The control group received conventional indirect swallowing therapy; the experimental group received the Mendelsohn maneuver combined with repetitive facilitation principles.
Training was delivered for 20 minutes per session, 5 times weekly, for 4 weeks.
Treatment duration and therapist contact were matched between groups.
Results
The experimental group had lower Penetration-Aspiration Scale scores at Day 28 compared to the control group.
The Penetration-Aspiration Scale (PAS) was assessed via videofluoroscopic swallow study.
The between-group difference in PAS scores favored the experimental group at the Day 28 posttreatment assessment.
The PAS measures the depth to which material passes relative to the airway and whether it is expelled, reflecting swallowing safety.
Lower PAS scores indicate less penetration or aspiration.
Results
The experimental group showed greater improvement in Dysphagia Outcome and Severity Scale (DOSS) scores compared to the control group.
The DOSS was used as an outcome measure reflecting overall swallowing function and severity.
Improvement in DOSS scores was greater in the experimental (combined intervention) group than in the control group.
The DOSS is a functional severity scale used to rate dysphagia and guide diet recommendations.
This finding suggests the combined intervention conferred additional benefit for overall swallowing function beyond conventional therapy.
Results
Findings for pharyngeal residue were inconsistent between the two residue sites assessed.
Vallecular residue change favored the experimental group over the control group.
However, posttreatment vallecular residue scores did not differ significantly between groups.
No significant difference was found in pyriform sinus residue change between groups.
The authors note that pharyngeal residue findings 'should be considered exploratory' due to inconsistency across measures.
Results
No significant group differences were observed in upper esophageal sphincter (UES) opening diameter improvement.
UES opening diameter was measured via videofluoroscopic swallow study.
The between-group comparison for improvement in UES opening diameter did not reach statistical significance.
Both groups were treated for the same duration and frequency, making it unlikely the null result was due to exposure differences.
Results
No significant group difference was found in nasogastric tube removal rates between the experimental and control groups.
Nasogastric tube removal was included as a clinically meaningful outcome measure.
The rate of nasogastric tube removal did not differ significantly between the combined intervention group and the conventional therapy group.
This suggests the combined intervention did not produce a detectable additional benefit for this functional feeding outcome within the 4-week treatment period.
Methods
The study enrolled 56 eligible participants out of 60 assessed, randomized into two groups for a prospective, assessor-blinded randomized controlled trial.
60 patients were assessed for eligibility; 56 were randomly assigned to a control or experimental group.
The trial design was prospective and assessor-blinded.
Participants had poststroke dysphagia.
Outcome measures included the Penetration-Aspiration Scale, pharyngeal residue (vallecular and pyriform sinus), UES opening diameter, Dysphagia Outcome and Severity Scale, and nasogastric tube removal.
What This Means
This research suggests that combining the Mendelsohn maneuver — a technique where patients consciously hold their throat muscles elevated during swallowing — with repetitive facilitation principles (a structured approach to repeated practice) may offer additional benefits over standard swallowing therapy for stroke survivors who have difficulty swallowing. In a 4-week trial with 56 participants receiving therapy five days a week, those in the combined treatment group showed better swallowing safety (fewer instances of food or liquid entering the airway) and better overall swallowing severity scores compared to those receiving conventional therapy alone. Both groups improved, but the combination approach appeared to provide an extra edge in these specific areas.
However, the benefits were not uniform across all measures tested. Results for residue left behind in the throat after swallowing were mixed depending on the location measured, and there were no significant differences between groups in how much the upper esophageal sphincter (the muscular opening to the esophagus) widened, or in how many patients were able to have their nasogastric feeding tubes removed. This means the combined therapy did not clearly outperform conventional therapy on every swallowing-related outcome within the study's timeframe.
This research suggests that adding the Mendelsohn maneuver combined with repetitive facilitation to standard care may be a promising way to improve swallowing safety and functional swallowing ability in stroke patients, but clinicians should interpret results cautiously given the inconsistent findings across outcomes and the relatively small sample size. Further research with larger groups and longer follow-up would help clarify which patients benefit most and whether these gains are sustained over time.
Jia W, Cui C, Qin L, Sun J, Wan C. (2026). Efficacy of the Mendelsohn maneuver combined with repetitive facilitation principles in poststroke dysphagia: A randomized controlled trial based on videofluoroscopic swallow study.. Medicine. https://doi.org/10.1097/MD.0000000000050466