10 Essential Exercises for Treating Dysphagia
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Dysphagia, or difficulty swallowing, is a common issue encountered by speech-language pathologists. Effective management of dysphagia often involves a combination of therapeutic exercises designed to improve swallowing function. In this article, we will explore 10 of these top exercises for dysphagia, including their appropriate use, contraindications, and key considerations for SLPs.
1. Effortful Swallow Exercise
The effortful swallow involves swallowing with maximal effort, squeezing all muscles involved in the swallow as tightly as possible. This exercise is beneficial for patients with reduced tongue base retraction and pharyngeal clearance, helping to increase the strength of the swallow. Ensure patients understand the need to exert maximal effort and practice this exercise under supervision initially. Perform the exercise with food or drink, or with biofeedback as appropriate. This exercise isn’t suitable for patients who can’t follow complex instructions or have significant cognitive impairments.
2. Mendelsohn Maneuver
The Mendelsohn maneuver involves holding the larynx at its highest point during a swallow for a few seconds before releasing. This exercise is appropriate for patients with reduced laryngeal elevation and pharyngeal constriction, helping to improve coordination and prolong UES opening. It requires careful monitoring to ensure correct technique and avoid fatigue. It isn’t recommended for patients with severe cognitive impairments or those who have difficulty with sustained breath holding.
3. Masako Maneuver
Also known as the tongue-hold maneuver, this exercise involves swallowing with the tongue held between the teeth. It’s useful for patients with pharyngeal weakness, as it helps increase posterior pharyngeal wall movement. Emphasize gentle holds to prevent tongue injury and monitor for discomfort. The Masako maneuver shouldn’t be used with patients who have tongue weakness or limited tongue mobility, and shouldn’t be performed with food or liquid.
4. Chin Tuck Against Resistance (CTAR)
CTAR involves tucking the chin to the chest against resistance, often using a rubber ball, towel, or similar prop. This exercise is effective for strengthening suprahyoid muscles, aiding in laryngeal elevation and UES opening. Ensure proper posture and resistance level to prevent neck strain. CTAR isn’t suitable for patients with neck pain or cervical spine issues.
5. Expiratory Muscle Strength Training (EMST)
EMST uses a device to provide resistance during exhalation, strengthening the expiratory muscles. It’s beneficial for patients with reduced cough effectiveness and respiratory support for swallowing. When helping patients perform the exercise, gradually increase resistance and monitor for signs of respiratory distress. Use caution with patients with severe COPD or other respiratory conditions.
6. Shaker Maneuver Exercise
The Shaker exercise involves lifting the head while lying flat on the back, holding it for a set duration, and then lowering it. This exercise helps improve suprahyoid muscle strength, beneficial for patients with reduced UES opening. Start with shorter durations and gradually increase as the patient’s strength improves. Avoid using this exercise with patients who have neck pain or cervical spine issues.
7. Tongue Pressure Resistance
This exercise involves pressing the tongue against a resistance device or the roof of the mouth. It’s suitable for patients with tongue weakness, improving bolus control and pressure generation during swallowing. Use appropriate resistance levels and ensure proper technique to avoid strain. This exercise isn’t ideal for patients with significant oral sensitivity or pain.
8. Pitch Glides
Pitch glides involve gliding the voice from a low to a high pitch. This is useful for patients with reduced laryngeal elevation and vocal fold closure issues. Monitor for vocal strain and encourage gentle, smooth glides. This exercise isn’t recommended for patients with vocal fold pathologies or those who experience pain during phonation.
9. Falsetto Exercise
This exercise involves sustaining a high-pitched “eee” sound, targeting the cricothyroid muscle. It’s beneficial for patients with reduced laryngeal elevation and vocal fold closure. Ensure the patient uses a relaxed vocal technique to prevent strain. Avoid using this exercise with patients who have vocal fold pathologies or discomfort with high pitches.
10. Gargling
Pretending to gargle while holding your tongue back, dry gargling, or gargling with water helps to engage the pharyngeal muscles. This is effective for patients needing increased pharyngeal constriction strength. Supervise patients initially to ensure safe and effective technique. Gargling with liquid is not suitable for patients with aspiration risk or difficulty managing oral secretions.
Final Thoughts
Incorporating these exercises into a dysphagia management plan can help SLPs provide targeted, effective therapy for patients with dysphagia, ultimately improving their swallowing function and quality of life. Always tailor the exercises to individual patient needs, considering their specific impairments, cognitive status, and any contraindications. Regular monitoring and adjustment of the exercises will ensure continued progress and safety.
Looking for more dysphagia resources? Check out our Dysphagia Resource Center, which includes over 60 dysphagia-focused courses plus high-quality home exercises and education to help your patients better manage their condition.