Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Dysphagia Exercises


photo of a caution sign that has an exclamation mark in the center

Retrieved from flickr.com by fs999

Please read the disclaimer before reading any of the exercises below.  Please work directly with a licensed medical professional before implementing any of the following therapy exercises.  This information is for educational purposes only!

A Beginning List of Dysphagia Exercises that Have Evidence Base

I collected and typed these exercises up from the handouts that we had at work (thanks to Jamie Pulliza for supplying them).  Also, much thanks to whomever compiled these with references in the beginning.  I’m indebted to your original hard work!  I want anyone with experience with these exercises and others that have evidence base (even referenced directly from seminars would be nice) to help add to this list and refine it if you see errors.  Thanks for your help!

I will also be adding a special section for exercises that use some sort of device to assist with the swallow.  I will even list Vital Stim, when I have a good reference list available.  While this one is a polarizing treatment method, I will list it because there is evidence for and against it.  I’ll let my readers judge which evidence is more compelling.

An additional reference was pointed out by Michelle Skelley Ashford (a fellow SLP), and it’s a fantastic systematic overview of many of the exercises found below.  Check it out here:  http://www.rehab.research.va.gov/jour/09/46/2/index.html

Walt Greenslade, M.S., CCC-SLP

SUPRAGLOTTIC SWALLOWING MANEUVER

PURPOSE

To close the airway at the vocal fold level before and during the swallow and to clear residue after the swallow.

APPLICABILITY

Patients who have delayed airway closure, reduced airway closure, delayed pharyngeal swallow, poor oral control of liquids with premature loss into the pharynx. Patients who can follow a series of commands.

___ Only saliva swallow

___ Food/Liquid swallow

INSTRUCTIONS

1. Take a breath in.

2. Hold your breath after you inhale (lightly cover your tracheostomy tube, if present).

3. Keep holding your breath while you swallow.

4. Clear your throat immediately after swallow before breathing.

5. Swallow again.

Perform with each food/liquid swallow.

Perform ___ times throughout the day.

WARNING

Patients with uncontrolled high blood pressure should not use this maneuver; bearing down may raise blood pressure. Talk with your Doctor before beginning any exercise regimen.

References

Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral

cancer patient. Head and Neck, 15, 419-424.

Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three 

breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.

McConnel, F.M., Mendelsohn, M.S., & Logemann, J.A. (1987). Manofluorography of deglutition after supraglottic

laryngectomy. Head and Neck Surgery, 5, 142-150.

SUPER-SUPRAGLOTTIC SWALLOWING MANEUVER

PURPOSE

To close the airway at the vocal fold level before and during swallow, to increase tongue base retraction and pressure generation, and to clear residue after the swallow.

APPLICABILITY

Patients who exhibit penetration into the airway with aspiration after the swallow. Patients who can follow multistep directions.

___ Only saliva swallow

___ Food/Liquid swallow

INSTRUCTIONS

1. Hold your breath very tightly, bearing down (lightly cover your tracheostomy tube, if present).

2. Continue to hold your breath tightly while swallowing. Swallow hard.

3. Clear your throat/cough immediately after swallowing.

4. Swallow again.

___Perform with each food/liquid swallow.

Perform ___ times throughout the day.

WARNING

Patients with uncontrolled high blood pressure should not use this maneuver; bearing down may raise blood pressure. Talk with your Doctor before beginning any exercise regimen.

References

Martin, B.J.W., Logemann, J.A., Shaker, R., & Dodds, W.J. (1993). Normal laryngeal valving patterns during three

breath-hold maneuvers: A pilot investigation. Dysphagia, 8, 11-20.

Ohmae, Y., Logemann, J.A., Kaiser, P., Hanson, D.G., & Kahrillas, P.J. (1996). Effects of two breath-holding maneuvers on 

oropharyngeal swallow. Annals of Otology, Rhinology, and Laryngology, 105, 123-131.

HARD / EFFORTFUL SWALLOW

PURPOSE

To increase tongue base retraction and pressure during the pharyngeal phase of the swallow and reduce the amount of food residue in the valleculae of the throat.

APPLICABILITY

Patients who exhibit residue in the valleculae after the swallow.

SUPPLIES

___ Only saliva swallow

___ Food/Liquid swallow

INSTRUCTIONS

Swallow normally but squeeze very hard with your tongue and throat muscles throughout the swallow. Excess effort should be clearly visible in your neck during the swallow.

Perform with each food/liquid swallow.

Perform ___ times throughout the day.

References

Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral

cancer patient. Head and Neck, 15, 419-424.

Shanahan, T.K., Logemann, J.A., Rademeker, A.W., Pauloski, B.R., & Kahrillas, P.J. (1993). Chin down posture effects on

aspiration in dysphagic patients. Archives of Physical Medicine and Rehabilitation, 74, 736-739.

TONGUE HOLD EXERCISE

PURPOSE

To increase the tongue base and throat muscles range of motion.

APPLICABILITY

Patients who exhibit reduced tongue base/pharyngeal wall movement.

SUPPLIES

___ Only saliva swallow

___ Liquid swallow between repetitions

INSTRUCTIONS

1. Protrude your tongue slightly from your mouth. Keeping your mouth moist is helpful for this exercise.

2. Hold the tongue gently with your teeth.

3. Swallow while keeping your tongue protruded.

Perform ___ times throughout the day.

References

Fujiu, M., & Logemann, J.A. (1996). Effect of a tongue holding maneuver on posterior pharyngeal wall movement during

deglutition. American Journal of Speech Language Pathology, 5, 23-30.

Fujiu, M., Logemann, J.A., & Pauloski, B.R. (1995). Increase postoperative posterior pharyngeal wall movement in

patients with anterior oral cancer. Prelminary findings and possible implications for treatment. American Journal

of Speech Language Pathology, 4, 24-30.

Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral

cancer patient. Head and Neck, 15, 419-424.

MENDELSOHN MANEUVER

PURPOSE

To accentuate and prolong laryngeal elevation and thereby increase the extent and duration of cricopharyngeal opening.

APPLICABILITY

Patients who exhibit reduced laryngeal movement and consequent reduced cricopharyngeal opening.

SUPPLIES

___ Only saliva swallow

___ Food/Liquid swallow

INSTRUCTIONS

1. Swallow normally. Feel the larynx (voice box) lift during the swallow.

2. On the next swallow, feel your larynx (voice box) elevating and hold it up with your neck muscles. Do not try to lift the larynx early. Let the larynx lift normally and then hold it up so that it does not drop for ___ seconds. Complete the swallow.

Perform with each food/liquid swallow.

Perform ___ times throughout the day.

References

Kahrilas, P.J., Logemann, J.A., Krugler, C., & Flanagan, E. (1991). Volitional augmentation of upper esophageal sphincter 

opening during swallowing. American Journal of Physiology, 260, G450-456.

Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral

cancer patient. Head and Neck, 15, 419-424.

Logemann, J.A., & Kahrilas, P.J. (1990). Relearning to swallow post CVA: Application of maneuvers and indirect

feedback: A case study. Neurology, 40, 1136-1138.

HEAD LIFTING MANEUVER

PURPOSE

To strengthen muscles of the neck in order to facilitate opening of the bottom of the throat (e.g.- upper esophageal sphincter) for food passage.

APPLICABILITY

Patients who exhibit reduced upper esophageal sphincter opening and who demonstrate food residue in the pyriform sinuses.

SUPPLIES

None

INSTRUCTIONS

Part one: Sustained Hold

1. Lie flat on your back with no pillow under your head.

2. Lift your head to look at your toes.

3. Keep your shoulders flat on the floor / bed.

4. Hold this position for ___ seconds.

5. Release. Repeat 3 times and rest 1 minute between repetitions.

Part two: Lift and Lower (same starting position as sustained hold)

1. Lift your head and look at your toes.

2. Let your head go back down with control.

3. Repeat 30 times.

4. Rest in between as needed.

5. Repeat 3 times a day.

WARNING Patients with neck problems (e.g.- arthritis) may not be able to perform this exercise.

References

Easterling, C., Kern, M., Nitschke, T., Grande, B., Kazandjian, M., Dikeman, K., Massey, B.T., & Shaker, R. Restoration of

oral feeding in 17 tube fed patients by the Shaker Exercise. Dysphagia, 15: 105, 2000.

Shaker, R., Kern, M., Bardan, E., Taylor, A., Stewart, E., Hoffmann, R.G., Arndorfer, R.C., Hoffmann, C., & Bonnevier, J.

Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. AJR, 272: G1518-1522,

1997.

JAW-OPENING EXERCISE

PURPOSE

To improve upper esophageal sphincter (UES) opening during the swallow.

APPLICABILITY

Patients that have poor hyoid elevation and/or poor UES opening as a result of the decreased hyoid elevation.

SUPPLIES

Mirror if biofeedback is needed.

INSTRUCTIONS

1. Hold the jaw in the maximally opened position for 10 seconds.

2. Rest for 10 seconds.

3. Repeat 5 times.

4. Do two sets a day.

WARNING: “When the jaw is closed, the superior head of the lateral pterygoid muscle maintains contraction in order to properly position the articular disk. When the jaw is fully open, however, the superior head is controlled in a relaxed position. Thus, this exercise is probably safer when patients open their jaw to the fullest extent. However, dislocation of the mandibular joint could occur if aging has caused some wear of the articular fossa or condyle, or degeneration of the articular disk. Accordingly, patients with a history of mandibular joint dislocation should not perform this exercise” (Wada, et al 2012).

References

Satoko Wada, Haruka Tohara, Takatoshi Iida, Motoharu Inoue, Mitsuyasu Sato, Koichiro Ueda, Jaw-Opening Exercise for Insufficient Opening of Upper Esophageal Sphincter, Archives of Physical Medicine and Rehabilitation, Available online 10 May 2012, ISSN 0003-9993, 10.1016/j.apmr.2012.04.025.

 

 

TONGUE MOVEMENT EXERCISES

PURPOSE

To improve tongue control for food and liquid bolus manipulation, mastication, and front to back bolus movement.

APPLICABILITY

Patients who exhibit reduced tongue range of motion.

SUPPLIES

Mirror

INSTRUCTIONS FORWARD / BACKWARD MOVEMENT

Stick your tongue out as far as you can and hold for 5 seconds. Relax. Try to keep your tongue in the middle. Use a mirror for visual feedback.

Pull your tongue back as far as you can. Hold for 5 seconds. Relax.

SIDE-TO-SIDE MOVEMENT

Put the tip of your tongue in your right cheek, as far back as you can, and hold it. Relax. Repeat with the tip of the tongue in the left cheek.

Smile. Put the tip of the tongue in the corner of your lips on the right, then move it to the left.

Perform the exercise(s) ___ times a day, ___ repetitions each time.

References

Logemann, J.A., (1998). Evaluation and Treatment of Swallowing Disorders. Austin, TX: Pro-Ed. Second Edition.

Logemann, J.A., Pauloski, B.R., Rademaker, A.W., & Colangello, L. (1997). Speech and swallowing rehabilitation in head

and neck cancer patients. Oncology, 11(5), 651-656, 659.

TONGUE RESISTANCE EXERCISES

PURPOSE

To improve tongue strength and endurance for food and liquid bolus manipulation, mastication, and front to back bolus movement.

APPLICABILITY

Patients who exhibit reduced tongue strength.

SUPPLIES

Tongue depressor or spoon

INSTRUCTIONS

Stick your tongue out as far as you can and push a tongue depressor / spoon against the tip of your tongue. Hold for 5 seconds. Relax.

Stick your tongue out as far as you can. Place a tongue depressor / spoon along the side of the tongue. Push against it with your tongue. Hold for 5 seconds. Relax.

Perform the exercise(s) ___ times a day, ___ repetitions each time.

References

Logemann, J.A., (1998). Evaluation and Treatment of Swallowing Disorders. Austin, TX: Pro-Ed. Second Edition.

Logemann, J.A., Pauloski, BR, Rademaker, AW, & Colangello, L. (1997). Speech and swallowing rehabilitation in head and

neck cancer patients. Oncology, 11(5), 651-656, 659.

CLOSURE OF THE LARYNX

PURPOSE

To improve airway closure and prevent aspiration.

APPLICABILITY

Patients who exhibit laryngeal aspiration with liquids and foods during the swallow.

INSTRUCTIONS

Breath Hold / Valsalva Maneuver

Take a breath. Bear down and hold your breath. You should not hold your breath with your lips, but in your throat, like you do if you are trying to lift something very heavy. Hold for ___ seconds. Relax. Repeat ___ times, ___ a day.

Push – Pull with Breath Hold

Place one or both hands under your chair and pull as if you are trying to lift your chair up with you in it. (You can also do it by standing up and pushing against the wall). Hold your breath tightly. Relax. Repeat ___ times a day.

Head Rotation with Phonation

Turn your head to the left / right. Hold your breath tightly. Let go of your breath and say “ahh”. Perform this exercise ___ times a day, ___ repetitions each time.

References

Logemann, J.A., (1998). Evaluation and Treatment of Swallowing Disorders. Austin, TX: Pro-Ed. Second Edition.

Logemann, J.A., Pauloski, B.R., Rademaker, A.W., & Colangello, L. (1997). Speech and swallowing rehabilitation in head

and neck cancer patients. Oncology, 11(5), 651-656, 659.

BASE OF TONGUE EXERCISES

PURPOSE

To improve base of the tongue movement and strength in order to better propel the bolus (food / liquid).

APPLICABILITY

Patients who exhibit reduced tongue base / pharyngeal wall movement and vallecular residue.

INSTRUCTIONS

Gargle with Water / Pretend to Gargle

Look up toward the ceiling. Gargle for ___ seconds. Relax. Repeat ___ times. Gradually increase duration of gargling time. Perform the exercise ___ times a day ___ repetitions each time.

Pretend to yawn

Open your mouth wide. Start to yawn. You will feel all the muscles open wide in your throat. Relax. Repeat ___ times throughout the day.

Tongue Base Retraction

Pull the back of your tongue as far back as you can. Pretend you are trying to scratch the back wall of your throat with the back of your tongue. Hold for ___ seconds. Repeat ___ times, ___ times a day.

References

Lazarus, C., Logemann, J.A., & Gibbons, P. (1993). Effects of maneuvers on swallow functioning in a dysphagic oral

cancer patient. Head and Neck, 15, 419-424.

Pouderoux, P., & Kahrilas, P.J. (1995). Deglutitive tongue force modulation by volition, volume, and viscosity in

humans. Gastroenterology, 108, 1418-1426.

 

55 comments on “Dysphagia Exercises

  1. Heather Garrabrant
    June 11, 2012

    Thanks. This is great!

  2. Admin
    July 9, 2012

    Your welcome!

  3. Dr.Manish
    October 7, 2012

    very informative
    manish

  4. atklingensmith
    October 7, 2012

    Thanks so much for putting this together! It’s great to have the exercises compiled all in one place!!!

  5. Venkatesh
    October 7, 2012

    The information provided was really very helpful as the exercises are compiled together thank you and my regards

  6. headneckcancerindia
    October 14, 2012

    Great info. I can direct my patients to your blog. Thanks!

  7. Pingback: Evidence-based Dysphagia Exercises | Disfagia Brasil

  8. Lin
    December 27, 2012

    Great cheat sheet! Thx

  9. A. Moad, MCD, CCC-SLP
    January 17, 2013

    This is great!! Thanks for sharing!!

  10. Pingback: Care after total laryngectomy | delhi head neck surgery

  11. Susan
    January 23, 2013

    I know every patient is different, but I’m wondering how long do you usually encourage these daily exercises before you suspect they will not be effective? Two weeks maybe? When do you generally begin to see improvement? Thx!

    • Admin
      January 23, 2013

      Thanks for the question Susan. Based on my readings regarding exercise physiology and on expert opinion at swallowing conferences, I usually shoot for 3-4 specific exercises 90-120 reps a day for a minimum of 4-6 weeks (5/7 days a week). Following this protocol, I expect better neural recruitment of existing muscles within 1-2 weeks and actual muscle hypertrophy (bigger muscle tissue) within 4-6 weeks. This also seems to hold true in most cases in my own practice, but not all cases are the same and getting feedback from a certified SLP/SLT that knows the specifics of your case is critical. Hope that wasn’t too long winded!

      -Walt G.

  12. wawan
    March 26, 2013

    Wonderful…
    thanks…

  13. drdhirenpatel
    March 31, 2013

    a great compilation of all dysphagia exercises
    dr dhiren patel – cardiologist

  14. Pingback: Dysphagia Resources -- Speechy Musings

  15. Hesham kamel
    July 14, 2013

    Thanks for this highly informative effort, i wonder if there are passive excercices( like tongue holding etc..)for patients who suffer weak tongue and pharyngeal muscles who are not totally cooperative like some patients of dementia , regards, H.Kamel

    • Admin
      August 2, 2013

      Good question Hesham. My experience and research point to the need for muscle hypertrophy or at least some increase in neural recruitment through effort (which occurs before the musculature gets stronger/bigger) to effect real functional change in the swallow system. While I don’t know that there is a lot of clear-cut support for it, e-stim could provide improvement for the types of patients that you are describing. If the dementia is that severe, however, there are some ethical questions to be answered by the provider and the caregivers: 1. Does this improve quality of life for the patient? 2. Is this being done to satisfy the urge to “help” on the part of the caregiver and/or clinician? 3. Does the patient tolerate the necessary frequency and intensity of electric stim? (typically 1 hour a day 5 x a week)

      Just some things to consider.

      Walt

      • Jose Pons
        August 7, 2013

        I’m going to try these exercises….Thank You.

      • Admin
        August 7, 2013

        I’m glad you’ve found these exercises. Please make sure you only use these under the supervision of a licensed healthcare provider (Dr. And SLP). Some of these exercises have risks that should be managed through the MD/SLP team. Thanks for commenting and good luck with your therapy!

  16. kimcookeslp
    November 18, 2013

    This is a wonderful resource and I will be using these with my home health patients! Thank you so much for taking the time to put this together and including references!

    • kimcookeslp
      November 18, 2013

      I should add that I will be using these under the supervision of a doctor =) I recently had a patient whose doctor requested tongue base retraction exercises based on the results of the patients MBSS.

    • Admin
      November 18, 2013

      Thanks for your kind words. I’m glad that these have garnered some real interest, and hope to continue to add more content that helps both patients and clinicians.

  17. suzanne abt
    September 15, 2014

    great compilation of excercises, thanks

  18. Hadasah Chapman
    October 7, 2014

    This is an incredible compilation, thank you! As a student, I find this very helpful and I appreciate the time it must have taken to put all of this together.

  19. Janet
    October 11, 2014

    I am an experienced clinician in Pediatrics, adding adults to my caseload. I just “followed” you and am looking at your site – thank you for a job well done!

    I would also like to express my gratitude that you added references on this page. Its a big help to be able to pull up additional/deeper info quickly.

  20. TThomasyne E Hill
    October 25, 2014

    Thank you for the help with putting all resources for adults in one area.

    • Admin
      October 25, 2014

      You are very welcome. Thanks for visiting the site.

  21. Pingback: CLIENT/FAMILY MATERIALS AND RESOURCES | everything SLP

  22. Brianna
    November 14, 2014

    This list is amazing! I use a lot of these exercises with my TCU clients on a near-daily basis, but it’s wonderful to have them compiled along with links to research. It’s also nice to have the little reminder about what is being targeted by each exercise :)

  23. Randi
    December 12, 2014

    Thought this was phenomenal! Do you know how long you can live with dysphasia and swallowing
    Exercises before you need surgical correction
    (anterior vertebral osteophyte)

    • Admin
      December 13, 2014

      Good question regarding osteophytes. In my experience doctors have not elected to do surgery for osteophytes. This coild be due to the risks involved, the lack of expertise in my area of the country, or the prevelance of using PEG tubes in cases of intractable dysphagia.
      Each case will be different, and exercises won’t change an anatomical abnormality of the c spine. Compensations may be more beneficial (specific compensations should be tried with a MBSS). If there is also muscular dysfunction, then exercise will be of help.

  24. murderball
    January 18, 2015

    Hello, I am a C6 Tetraplegic/Quadriplegic who has been dealing with problems swallowing and aspirating for the last 5 years. My swallowing difficulties improved with time however I recently had a pneumonia due to aspiration (and am currently recovering from it) and now my difficulty swallowing has increased since the onset of my pneumonia. I am definitely going to try these exercises as they seem to make a lot of sense. Thanks so much for sharing!

    • Admin
      January 18, 2015

      Thanks for visiting the sote, and I’m glad you found the exercises. Please use these as directed under the care of a well trained SLP and under a doctor’s order/supervision. You will get the most out of these this way. Thanks again, and best of luck!

  25. Lara
    March 13, 2015

    Hello, I think you have the wrong reference listed under the tongue hold, as the article listed does not discuss tongue hold. I believe you meant to select a similarly-titled article “Effects of voluntary maneuvers on tongue base function for swallowing” by Lazarus et. al.

  26. mona
    April 5, 2015

    more informative :)

  27. Karen Hicks
    April 21, 2015

    So helpful having these all in one place. Very clear instructions to remind me how to do them (CADASIL patient)

  28. maira
    May 24, 2015

    Thank u.. U did awesome job.. Their r few exes that I have not seen before

  29. Debbie Secrest
    June 21, 2015

    Thank you very much for compiling so many effective exercises. Specific exercises, tailored to specific dysphagia areas of concern, have proven very helpful. I greatly appreciate your assistance.

  30. Pramod
    August 20, 2015

    If the swallowing improves after 4-6 weeks of doing the exercise, how much of the exercise do we need to do to maintain the muscles in the throat.

    • Admin
      August 20, 2015

      The safe thing, in my opinion, would be to maintain the regimen. I’m unaware of any research that indicates a solid answer for you. Maybe someone out there reading this can chime in with a more research based answer?

  31. Billie McFarland
    August 26, 2015

    I have a 4 year daughter we are adopting she has just be diagnosed with a newly founded genetic malformation, KCNQ2. She has to still drink a bottle with Necter thick drink, she cannot hold up head , speak , set up ! And cannot understand instructions! Her doc has just ordered to start Vital Stem with her swallow, but forgot to ask does this help her to hold up head? Thanks

    • Admin
      August 26, 2015

      Vital Stim is approved for use on the anterior neck only; shouldn’t be used on the neck below the level of the cricoid cartilage and I can’t see how the laryngeal muscles and superficial muscles of the front part of the neck will do much for head stability.

      I would consult your child’s PT and MD on ways to help strengthen the neck if that is possible.

      Hope that helps and best of luck in therapy.

    • Bec
      March 20, 2016

      Billie-
      I urge you to research the effectiveness of Vital Stem- as it has no supportive evidence at this point in time. There is actually published research that indicates it may prove to be a hinderance.

      Please ask your doctor for a peer-reviewed article that supports this practice before you allow your daughter to engage in this therapy.

  32. Brenda Smith
    September 14, 2015

    Such a practical and detailed description of swallowing exercises. Great to save to iPad for your dysphagia patients. Thanks a million!

  33. carina
    September 20, 2015

    Laryngeal exercise

  34. mousumi ASLP
    September 29, 2015

    very informative pages..thanks to writer..

  35. Allison Westbrook
    October 21, 2015

    I’m looking for words for my mother in laws speech therapy. She had throat cancer and had a trach. I had a worksheet, but lost it. If you have any helpful worksheets that would be great. Thank you.

  36. Debra Jonston
    March 14, 2016

    I, too, was given a list of words by my speech pathologist to exercise the pharyngeal aspect of my diagnosed swallowing problems but have misplaced them. Many had hard or double g’s and k’s in the middle of words. I did these as prescribed and my swallow improved. Then I slacked off and stopped doing them. I really do not recall if I was instructed to continue them or not or, if so, how often. I have MS and the poor swallow was not recognized as a problem until testing and therapy in rehab after I suffered aspiration pneumonia from inhaling a bite of steak at a restaurant. Anyway, are you familiar with this type of exercise and can you recommend a resource to me? I have noticed the difficulties I used to have prior to my near fatal steak inhalation have started to recur.Your help would be appreciated.

    • Bec
      March 20, 2016

      Debra-

      Although the “k” and “g” do involve movement of the back of the tongue, it will not transfer to swallowing due to the principle of neuroplasticity- specificity- which states that the nature of the training experience dictates the nature of the plasticity. In other words, this exercise involves speech movement, not swallowing movement, so it will not transfer. I have seen this practice used in many skilled nursing facilities by speech-language pathologists, however there is no evidence to support this. Instead, therapy should involve facilitating an actual swallow. There are many safe exercises that involve this.

  37. Kelly McGrath
    May 17, 2016

    Question! As an SLP, I was just given a pt who had an MBS completed, andis aspirating thin liquid at the esophageal phase, but evidenced no other weakness at any point during the study. The referring SLP noted to “continue diet as tolerated” and to refer to a GI doctor…..as the SLP for this new pt, should I continue thin liquids and apply exercises or change to nectar thickened and work on exercises until GI doc takes a look? I can’t see into the esophagus to know when or if this pt will be able to intake thin liquids safely at any time, given the silent aspiration, so I am thinking nectar only for now.. Any recommendations for this in terms of the appropriate exercises to try, given the specificity of which part of the esophageal phase hindered was not noted?

    • Admin
      May 20, 2016

      Sorry for the slow reply, Kelly. My advice would be to clarify the results via phone with the SLP that did the study. Were there consistencies trailed during the MBSS that were tolerated without aspiration after the swallow (from your description it sounds like they were refluxed back up)?? Whatever was tolerated without aspiration would seem like a good place to start with a p.o. diet.

      I’d also discuss the clarified results with the doctor in charge, the patient and or family to come up with a plan together that is safe and fits the patient’s needs.

      I know of no exercises that will benefit the esophagus. The shaker can help with UES opening, but a GI consult also sounds very appropriate here and needed soon.

      Hope that helps.

      Walt

  38. Jean
    June 16, 2016

    Hi There,

    I recently came across a patient who had been advised to gargle as a swallow exercise. I had not come across this before and my Google search led me here.

    I notice that you reference 2 articles in the section where gargling exercises are described, however neither article discusses gargling at all.

    Is there an evidence base for this and what level of breakdown is it designed to target?

    Many thanks

    Jean

  39. Mandy Gibson
    July 15, 2016

    Wow – these exercises are impressive. I’m surprised that we do not incorporate these exercises for everyone even in school and at gyms as part of our daily routine. After all the muscles in out neck and mouth are very important and we use them very day. Why not put for some effort to keep them strong and active as well.

  40. Safia nazeer khan
    September 22, 2016

    Informative post

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