Full Goal

Given an instrumental-evaluation finding of reduced hyolaryngeal excursion and/or reduced UES opening, with patient education and verbal/visual cueing for the technique, patient will execute the Mendelsohn maneuver — initiating swallow, sustaining laryngeal elevation at peak for 2-3 seconds via voluntary submental muscle hold, then releasing — across saliva swallows and graded bolus trials with correct technique on 8 of 10 trials per session across 3 consecutive sessions, with at least one session including bolus trials at the patient’s recommended consistency, as measured by SLP palpation of submental musculature, surface electromyography (sEMG) biofeedback if available, and clinician observation of swallow timing; periodic instrumental re-evaluation to assess physiologic change.

Individualization Guidance

Before using this goal, verify:

• Instrumental indication is documented. The Mendelsohn maneuver targets specific physiologic problems: reduced hyolaryngeal excursion, reduced UES opening, prolonged pharyngeal transit. Without MBSS or FEES evidence of these specific impairments, the maneuver is not indicated. Citing “decreased swallow function” is not sufficient.
• Rehabilitative vs. compensatory framing. The Mendelsohn maneuver can be used as a within-meal compensatory technique (patient performs each swallow with the maneuver) OR as a rehabilitative exercise (patient performs sets/reps to drive physiologic change over time, independent of meal use). This goal is the rehabilitative version. Compensatory use is a separate goal.
• Cognitive prerequisites. The maneuver requires understanding of the verbal instruction, ability to attend to the submental musculature, and motor control to sustain the hold voluntarily. Patients with significant cognitive impairment or aphasia may need adapted instruction or may not be candidates.
• Cardiovascular and respiratory screening. Holding a swallow extends apnea duration. Patients with severe cardiopulmonary compromise may not tolerate prolonged breath-hold. Coordinate with the medical team before initiating.
• sEMG biofeedback when available. Surface EMG over the submental triangle provides immediate visual feedback on muscle activation duration. It improves training efficiency and provides objective trial-by-trial data. Document whether sEMG is being used and the threshold values targeted.
• Bolus integration. Saliva-only trials confirm technique acquisition. Bolus trials confirm the patient can execute the maneuver while managing a swallow load. Both must be included before the goal can be considered functionally met.
• Dose-response considerations. The published evidence for Mendelsohn focuses on within-session execution; the longer-term physiologic-change literature is less developed than for Shaker, EMST, or Masako. Set expectations accordingly with the team and family.

Clinical Notes

The 8-of-10-with-correct-technique criterion is set at the trial level rather than as a percentage across sessions because individual trials are the unit of motor learning. A patient can hit “80% across the session” by performing the maneuver well at the start and poorly at the end, which obscures fatigue effects — the most clinically relevant signal in dysphagia rehab.

“Correct technique” should be operationally defined: (a) swallow initiated, (b) laryngeal elevation reached, (c) submental musculature contraction sustained for ≥2 seconds, (d) release without compensatory secondary swallow. Score each component, not a holistic “technique” judgment.

Periodic instrumental re-evaluation is the only way to confirm that the rehabilitative exercise is driving physiologic change. Surface-level technique compliance does not equal physiologic improvement. Cite the planned instrumental re-evaluation interval (typically 3-6 weeks) in the treatment plan.

The Mendelsohn maneuver is increasingly compared against other exercises (Shaker, EMST, Masako) in head-to-head studies. Treatment selection should be matched to the specific impairment pattern, not to clinician familiarity. Document why this exercise was selected over alternatives.

For CMS skilled-service documentation: the clinician’s judgment about technique correctness, fatigue management, dose progression, and integration with diet decisions is the skilled component. Untrained personnel cannot administer this exercise safely; that is part of why it requires SLP service.

This is one of the higher-stakes goals in the goal bank because the rationale rests on instrumental evidence and the outcome affects swallowing safety. Document carefully.

Related Goals

• Diet Advancement to IDDSI Level 6 — Minimal Cueing — outcome-level goal that rehabilitative exercise like Mendelsohn may support
• Thin Liquids with Chin Tuck — Moderate Cueing — compensatory-strategy goal for contrast with this rehabilitative goal