Modeling of the task is usually required. With each contraction of orbicularis oris or the buccinator muscles and surrounding musculature, the patient will see a slope in the receiving, feedback line. The goal for treatment is to shape the hemiparetic side to match the stronger, intact side of the face. Intermittent tactile stimulation may be applied by the therapist to increase sensitivity and response between volitional exercise. One triode surface electrode is placed vertically under the chin.
Palpation is required for accurate placement.
Weakness of these muscles results in post-swallow pharyngeal residual of the bolus, placing the patient at risk for post swallow aspiration. A modified valsalva swallow, or hard swallow can be used as a compensatory strategy to aid pharyngeal clearing during a meal and also as an indirect exercise for increasing pharyngeal constriction. The superior, middle and inferior constrictors are internal pharyngeal muscles that are not easily accessible by surface electrode. Direct EMG measurement of these muscles is not feasible. Although further investigation is required to specifically document the correlation, clinical practice demonstrates a functional relationship between increased pharyngeal constriction and contraction of the submandibular musculature.