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Choosing Exercises for Dysphagia Treatment: An Evidence-Based Approach

By Tiffani L. Wallace, MA, CCC-SLP, BCS-S

on February 3, 2021

Categories: Dysphagia , Patient Engagement , Speech Pathology

Helping to rehabilitate someone with dysphagia so the person can eat and drink safely and in the most effective means can be quite a rewarding experience.

When choosing the most appropriate exercise routine or plan of care for each patient, we have to keep several things in mind. First, we need an accurate assessment to determine the physiology and dysfunction of the swallow. This includes a complete clinical swallow evaluation with a complete history and chart/records review, brief cognitive exam , oral motor exam, and a thorough cranial nerve exam .

We can then make the appropriate recommendation for an instrumental exam , whether it be FEES or VFSS to determine the pharyngeal physiology.

The Principles of Neuroplasticity

When we are creating a dysphagia treatment plan, we need to be mindful not only of the swallowing physiology and dysfunction—whether it be sensory or motor driven—but we also need to remember the principles of neuroplasticity and exercise physiology.

The principles of neuroplasticity should drive our therapy plan. These principles include:

• “Use it or lose it”
• “Use it and improve it”
• Experience specificity
• Patient’s age
• Transference
• Interference

We also need to be mindful that when we are rehabilitating the swallow, we need to have the patient practice swallowing. This means including exercises that are swallow-driven. Exercises such as repeating words that begin with /k/ or /g/ or tongue movements are not swallow-driven.

We also need to make sure that we are increasing the repetition and intensity of the prescribed exercise. Think about the principle of “use it or lose it” and how it relates to those patients who are strict NPO.

The Principles of Exercise Science

When we prescribe exercises for our patients, are we using exercise science? Exercise science principles include:

• Individuality
• Trainability
• Specificity
• Progression
• Reversibility
• Maintenance

Not every patient will require exercises for strengthening since not every patient with dysphagia has a strength issue. But when you are working to strengthen swallowing muscles, you should incorporate the following in your exercise plan:

Exercises need to progress and require resistance and intensity to increase strength. Simple range-of-motion exercises such as sticking out your tongue with no resistance do not lead to increased swallow strength.

Exercise Plans for Swallowing Concerns

Often, exercise programs or pages of exercises are passed down in a facility and used for years with no adaptation to current evidence or changes to individualize the exercises to suit the patient’s needs.

Try these exercise plans for the following swallowing issues, featuring exercises available in MedBridge’s HEP library .

Sensory Aspect of Swallowing

• Carbonated beverages, which may increase speed of the swallow through sensation
• Changes in flavor, which may increase sensory input of the swallow, driving the motor output
• External pressure to the cheek or to the tongue, for example by using a spoon
• Changes in temperature
• Changes in texture
• Changes in the size of the bolus, which may increase load of the bolus, thereby increasing the sensory component of the swallow, which many elderly patients need. Increased bolus size may also help to drive the UES opening.

Decreased Labial Closure

• Labial press, by holding a tongue depressor between the lips during swallowing exercises
• Straw drinking, decreasing the size of the straw to make the task more difficult

Decreased Lingual Control

• Lingual exercises with resistance using the IOPI, the Tongue-O-Meter, or tongue depressors
• Effortful swallow, in which the patient swallows as hard as they can while squeezing the pharyngeal muscles as tightly as possible
• Base-of-tongue exercises, including yawning, pretending to gargle, pulling the tongue straight back in the mouth
• Lingual exercises with resistance, such as pushing the tongue out, up, and to each side against a tongue depressor

Reduced Velopharyngeal Closure

• Expiratory muscle strength training (EMST) using a pressure threshold device, such as the EMST 150, in which the patient follows a protocol provided with the device

Reduced Hyolaryngeal Excursion

• Chin tuck against resistance (CTAR) using a 12-cm ball, the Phagiaflex, or a rolled towel. Have the patient push their chin down against the tool and hold for one minute, then rest for one minute, and repeat this three times. You can also have the patient push down repetitively 30 times.
• Shaker maneuver, in which the patient lies flat on their back and holds their head up, holding the pose for one minute, resting for one minute, and repeating this three times. The patient can also repetitively lift their head 30 times.
• Effortful swallow
• Mendelsohn maneuver, by having the patient hold their Adam’s apple up for as long as possible after completion of the swallow to keep the airway closed after the swallow. View this during VFSS to ensure accuracy of completion of the exercise.
• Jaw opening against resistance (JOAR), in which a tool is held in CTAR or the patient holds their hand under their jaw. Have the patient open their mouth as wide as possible for a count of 10 and then close the mouth for a count of 10. Complete five repetitions, two times a day, for four weeks.
• Pitch glide, in which the patient starts at a low pitch and slowly increases their pitch to the highest level and holds for several seconds

Reduced Laryngeal Closure

• Super supraglottic swallow, in which the patient takes a deep breath, holds their breath after the inhale, and bears down while swallowing hard and coughing immediately following the swallow

Reduced Pharyngeal Contraction

• Mendelsohn maneuver

Reduced UES/PES (Pharyngoesophageal segment) Opening

There are also several treatment protocols requiring specialized training that will guide you in decision making as to when to use the protocol and who would most benefit from it. These programs include:

• The Effective Swallowing Protocol™ by Ampcare
• Lee Silverman Voice Treatment
• The McNeill Dysphagia Therapy Program
• Neuromuscular electrical stimulation (VitalStim, Guardian, eSwallow)

There is also research supporting Pharyngocise for patients with head and neck cancer.

Regularly addressing and updating your exercise prescription techniques based on the most current evidence will help keep you practicing at the top of your license and providing your patients with the best chances to regain lost function.

Tiffani L. Wallace, MA, CCC-SLP, BCS-S

Tiffani L. Wallace, MA, CCC-SLP, BCS-S, has been treating patients with dysphagia for over 17 years. She has worked in various facilities, including schools, SNFs, outpatient and acute care, and home health, and she currently owns a mobile FEES company. Tiffani is the creator of www.dysphagiaramblings.com as well as creator and administrator of the Dysphagia Squad on Facebook. She is a co-author of the Dysphagia2Go app by SmartyEars, author of iScreen Aphasia by SmartyEars, and co-author of Dysphagia Therapy by Tactus. Tiffani is also a co-author of the book The Adult Dysphagia Pocketguide: Neuroanatomy to Clinical Practice by Plural Publishing. Tiffani has travelled internationally, speaking on the topic of dysphagia.

• Burkhead, L. M. (2009). Applications of exercise science in dysphagia rehabilitation. Perspectives on Swallowing and Swallowing Disorders (Dysphagia) , 18 (2), 43–48.
• Burkhead, L. M., Sapienza, C. M., & Rosenbek, J. C. (2007). Strength-training exercise in dysphagia rehabilitation: Principles, procedures, and directions for future research. Dysphagia, 22 (3), 251–265.
• Carnaby-Mann, G., Crary, M. A., Schmalfuss, I., & Amdur, R. (2012). "Pharyngocise": Randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. International Journal of Radiation Oncology Biology Physics, 83 (1) , 210–219.
• Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12 (4), 400–415.
• Clark, H. M. (2005). Therapeutic exercise in dysphagia management: Philosophies, practices, and challenges. Perspectives in Swallowing and Swallowing Disorders, 14 (2), 24–27.
• Crary, M. A., Carnaby, G. D., LaGorio, L. A., & Carvajal, P. J. (2012). Functional and physiological outcomes from an exercise-based dysphagia therapy: A pilot investigation of the McNeill Dysphagia Therapy Program. Archives of Physical Medicine and Rehabilitation , 93 (7), 1173–1178.
• Lazarus, C., Logemann, J. A., Huang, C. F., and Rademaker, A. W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrice et Logopaedica, 55 (4), 199–205.
• Logemann, J. A. (2005). The role of exercise programs for dysphagia patients. Dysphagia. 20 (2), 139–140.
• McCoy, Y., & Wallace, T. (2018). The Adult Dysphagia Pocket Guide: Neuroanatomy to Clinical Practice . Plural Publishing: San Diego, CA.
• Pitts, T., Bolser, D., Rosenbek, J., Troche, M., Okun, M. S., & Sapienza, C. (2009). Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest, 135 (5), 1301–1308.
• Robbins, J. A., Butler, S. G., Daniels, S. K., Diez Gross, R., Langmore, S., Lazarus C. L., & Martin-Harris, B., et al. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. J ournal of Speech, Language and Hearing Research, 51 (1), S276–S300.
• Robbins, J. A., Gangnon, R. E., Theis, S. M., Kays, S. A., Hewitt, A. L. and Hind, J. A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatric Society, 53 (9), 1483–1489.
• Sapienza, C. M. (2008). Respiratory muscle strength training applications. Current Opinion in Otolaryngology & Head and Neck Surgery, 16 (3), 216–220.
• Sapienza, C. M., Davenport, P. W., & Martin, A. D. (2002). Expiratory muscle training increases pressure support in high school band students. Journal of Voice, 16 (4), 495–501.
• Wheeler-Hegland K. M., Rosenbek J. C., & Sapienza, C. M. (2008). Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. Journal of Speech, Language, and Hearing Research, 51 (5), 1072–1087.

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Current and emerging evidence-based strategies for targeting the laryngeal elevators

Introduction.

During the pharyngeal stage of swallowing contraction of the geniohyoid, mylohyoid, thyrohyoid and anterior digastric muscles (laryngeal elevators) facilitates hyolaryngeal excursion and assists upper esophageal sphincter (UES) dilation. 1–3 When decreased hyolaryngeal excursion results in dysphagia, clinicians might choose to increase function in laryngeal elevators by incorporating rehabilitative exercises that promote neuromuscular adaptation. Adaptation occurs when the structural and functional properties of muscles change secondary to some form of stimulation. 4 As an example, clinical goals for a patient with dysphagia related to reduced hyolaryngeal excursion might include increasing the strength, range, or timing of submandibular muscle function during swallowing. When implementing clinical exercises targeting neuromuscular adaptation it is important for the clinician to choose those tasks which employ principles of strength training and motor learning, including resistance (overload), repetition, and specificity. 5

Mendelsohn Maneuver

A widely known exercise is the Mendelsohn maneuver (MM), which requires the patient to volitionally maintain contraction of the submandibular and other muscles during the pharyngeal stage of swallowing, with the aim of holding the larynx as high as possible for as long as possible. 2,6 Even though the MM can be applied as a direct (with food) or indirect (without food) exercise, in both contexts it adheres to the principle of specificity as the exercise is conducted during the act of swallowing. There may be some doubt as to whether this muscular contraction is made against a resistive load (to provide an overload to contraction). However, if one considers the ligaments and muscles originating below the hyoid as a band of elastic tissues providing a degree of resistance to contraction, anterior and vertical excursion of the hyoid must pull and maintain contraction against this resistive band. When an individual is sitting or standing, hyolaryngeal excursion must also act against another form of resistance – gravity. Although progressive loads cannot be applied in this context, the duration of contraction against the resistance can be increased progressively throughout an exercise protocol. Clinical outcome studies investigating the MM have demonstrated improvement in laryngeal excursion (extent of movement and duration of movement) in addition to swallow timing and bolus flow. 6,7

Effortful Swallow

The Effortful Swallow (ES) requires a patient to produce maximum effort when initiating a pharyngeal swallow. To achieve this they are typically prompted to “bear down” or “swallow hard”. It has been suggested that the mechanism for overload during production of ES is this increased volitional effort. 8 Accordingly, this exercise promotes an overload in the laryngeal elevators through amplified neurological drive (theoretically, increased motor unit recruitment) compared to normal swallowing. Although this exercise has been found to influence tongue-base retraction, measures of surface electromyography (sEMG) have found activity in the laryngeal elevators to be significantly greater during ES compared to normal swallows. 2,9 When combined with electrical stimulation, ES has also been found to significantly increase the degree of laryngeal excursion during swallowing in normal and dysphagic populations. 10,11 As with MM, ES adheres to the specificity principle as it is employed during the act of swallowing.

Shaker exercises, named after the original author of the approach and also referred to as head-lift exercises, utilize a protocol consisting of isometric and isotonic head-lifting movements while lying supine. 12 The activation of the hyolaryngeal elevators using this exercise has been confirmed using sEMG. 13 Published research has demonstrated a positive clinical effect of this exercise on hyolaryngeal excursion, UES dilation, and diet level of dysphagic individuals. 12,14 Head lift exercises do not adhere to the principle of specificity, although it is likely that overload is applied to the laryngeal elevators through effort applied to lifting the head towards the toes while lying supine. This is supported by sEMG data which has confirmed a significant increase in laryngeal elevator activity during the head-lift compared to resting baseline measurements. 15

Chin-to-Chest (CtC)

In the last few years clinical scientists have attempted to develop additional resistance-based exercises which target function of the laryngeal elevators, with the aim that these might be further developed as a potential rehabilitative exercises for patients with dysphagia related to decreased hyolaryngeal excursion. Our lab recently published a study which investigated the effect of a resistance-based exercise requiring an individual to open their jaw while pressing their chin into a semi-rigid brace fixed against their chest. 15 We coined this exercise “Chin-to-Chest” (CtC) to reflect the trajectory of movement. Because laryngeal elevators can also serve as depressors of the mandible, our theory was this exercise would require significant activation in the laryngeal elevators compared to rest, and that resistance to the contraction would apply a sufficient degree of overload so that motor unit recruitment was maximized. We also compared activation of the laryngeal elevators during CtC to activation during the head-lift exercise. We found significant increases in laryngeal elevator activity during CtC compared to rest, and significantly greater activation compared to the head-lift exercise. These results supported the incorporation of resistance against contraction to maximize the individual’s recruitment of motor units when performing the task. CtC does not adhere to the principle of specificity, although it does allow the clinician to incorporate the principle of progressive overload by asking the individual to modify the degree of contraction force when performing the exercise.

Chin Tuck Against Resistance (CTAR)

Yoon and colleagues recently published a study which also incorporated resistance against contraction, referred to as the Chin Tuck Against Resistance (CTAR). 16 These authors used a rubber ball placed between the chin and sternum as the resistive load. As with CtC, the authors’ implied that the rubber ball adds sufficient resistance to overload the laryngeal elevators during contraction. Participants were asked to squeeze the ball by tucking their chin as hard as possible so that it was compressed underneath their chin. Data from sEMG revealed significantly greater activation of the laryngeal elevators during CTAR compared to the head-lift exercise. These findings were consistent for both isometric and isotonic movements, and suggested that CTAR has the potential for serving as an alternative or supplementary exercise to the head-lift.

Transcutaneous Neuromuscular Stimulation

Although there are divergent opinions and equivocal evidence for the effect of transcutaneous neuromuscular stimulation (NMES) on laryngeal muscle activity, enough evidence exists (at least in this author’s opinion) to support the clinical theory that NMES applied transcutaneously to the submandibular muscles can facilitate contraction of the laryngeal elevators and influence hyolaryngeal excursion. Kim & Han demonstrated that NMES applied to the suprahyoid muscles resulted in vertical and anterior excursion of 9.6mm and 1.9mm, respectively, during electrical stimulation. 17 Toyama et al. recently compared submandibular NMES along with traditional therapy (Mendelsohn, thermal-tactile stimulation, and tongue exercises) to traditional therapy alone in groups of patients with dysphagia related to reduced hyolaryngeal excursion. The NMES + traditional therapy group exhibited greater post-treatment excursion of the hyoid along greater improvement in ratings of swallow function from videoflouroscopic studies. 18 NMES applied to the submandibular muscles during the act of swallowing is specific to the trajectory of the muscles but is facilitative rather than resistive, and thus does not provide an overload. However, Park et al. suggested that stimulation to the infrahyoid muscles during swallowing can act as a resistive load to the laryngeal elevators. In a randomized controlled trial they found that NMES applied transcutaneously to the infrahyoid muscles at a level that elicited a motor response resulted in significantly greater laryngeal elevation than a control group where NMES was only applied at a sensory level. 10

Newer exercises such as CtC and CTAR show promise but are in need of further research in clinical populations before they can be considered evidence-based strategies for clinical application. Small sample clinical trials and larger controlled trials will be needed, and evidence for the physiological effect of these exercises needs to be further clarified (e.g., via structural imaging during exercise performance). The good news for clinicians is that existing and emerging options do exist for targeting reduced hyolaryngeal excursion. Evidence for MM, ES, Shaker exercises, and NMES has been reported from clinical populations. Studies applying CtC and CTAR to clinical populations are on the horizon. As the research evidence for strategies targeting the laryngeal elevators becomes more robust, clinicians will have additional tools for tailoring plans of treatment to the needs and abilities of the individual patient.

• Thexton a J, Crompton a W, German RZ. Electromyographic activity during the reflex pharyngeal swallow in the pig: Doty and Bosma (1956) revisited. J Appl Physiol . 2007;102(2):587–600. doi:10.1152/japplphysiol.00456.2006.
• Logemann JA. Evaluation and Treatment of Swallowing Disorders . 2nd ed. Austin: Pro Ed; 1998.
• Palmer PM, Luschei ES, Jaffe D, McCulloch TM. Contributions of individual muscles to the submental surface electromyogram during swallowing. J Speech, Lang Hear Res . 1999;42:1378–1391.
• Steele CM. Exercise-Based Approaches to Dysphagia Rehabilitation. Nestle Nutr Inst Work Ser . 2012;72:109–117.
• Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia . 2007;22(3):251–65. doi:10.1007/s00455-006-9074-z.
• McCullough GH, Kim Y. Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke. Dysphagia . 2013;28(4):511–9. doi:10.1007/s00455-013-9461-1.
• McCullough G, Kamarunas E, Mann G, Schmidley J, Robbins J, Crary M. Effects of mendelsohn maneuver on measures of swallowing duration post-stroke. Top Stroke Rehabil . 2012;19(March 2009):234–243. doi:10.1310/tsr1903-234.Effects.
• Clark HM, Shelton N. Training effects of the effortful swallow under three exercise conditions. Dysphagia . 2014;29(5):553–63. doi:10.1007/s00455-014-9544-7.
• Wheeler-Hegland KM, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hear Res . 2008;51(5):1072–87. doi:10.1044/1092-4388(2008/07-0016).
• Park J-W, Kim Y, Oh J-C, Lee H-J. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia . 2012;27(4):521–7. doi:10.1007/s00455-012-9403-3.
• Park J-W, Oh J-C, Lee HJ, Park S-J, Yoon T-S, Kwon BS. Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dysphagia . 2009;24(3):296–301. doi:10.1007/s00455-008-9205-9.
• Shaker R, Easterling C, Kern M, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology . 2002;122(5):1314–1321. doi:10.1053/gast.2002.32999.
• Yoshida M, Groher ME, Crary MA, Mann GC, Akagawa Y. Comparison of surface electromyographic ( sEMG ) activity of submental muscles between the head lift and tongue press exercises as a therapeutic exercise for pharyngeal dysphagia. Gerodontology . 2007;24(2):111–116.
• Logemann JA, Rademaker A, Pauloski B, et al. A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study. Dysphagia . 2009;24(4):403–411. doi:10.1007/s00455-009-9217-0.A.
• Watts CR. Measurement of hyolaryngeal muscle activation using surface electromyography for comparison of two rehabilitative dysphagia exercises. Arch Phys Med Rehabil . 2013;94(12):2542–8. doi:10.1016/j.apmr.2013.04.013.
• Yoon WL, Khoo JKP, Rickard Liow SJ. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia . 2014;29(2):243–8. doi:10.1007/s00455-013-9502-9.
• Kim SJ, Han TR. Effect of surface electrical stimulation of suprahyoid muscles on hyolaryngeal movement. Neuromodulation . 2009;12(2):134–40. doi:10.1111/j.1525-1403.2009.00200.x.
• Toyama K, Matsumoto S, Kurasawa M, et al. Novel Neuromuscular Electrical Stimulation System for Treatment of Dysphagia after Brain Injury. Neurol Med Chir (Tokyo) . 2014:1–8. doi:10.2176/nmc.oa.2013-0341.

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Swallowing Exercises: Closure of the Larynx Exercises

What are closure of the larynx exercises.

Larynx-closure exercises can help you swallow better. With practice, they may help strengthen the muscles of your larynx. Your larynx is the part of your throat that is also known as your voice box.

Before you swallow, you chew your food to an appropriate size, shape, and consistency. When you swallow, this material passes through your mouth and a part of your throat called the pharynx. From there, the chewed food goes through a long tube called the esophagus. It then enters your stomach and your gastrointestinal tract.

During breathing, air travels from your mouth and pharynx into the larynx (toward your lungs). When you swallow, a flap called the epiglottis moves to block the entrance of food particles into your larynx and lungs. The muscles of the larynx pull upward to assist with this movement. They also tightly close during swallowing. That prevents food from entering your lungs.

Swallowing needs a series of coordinated actions from your muscles in these regions. But sometimes they may not work right. That can lead to problems swallowing. Muscle weakness in these areas can make swallowing hard to do. For example, food particles might be more likely to end up in your lungs if the muscles that close your larynx are weak. Swallowing exercises can improve the strength, mobility, and control of these muscles. Over time, they may help you to swallow normally again.

Your healthcare provider or a speech-language pathologist (SLP) may prescribe swallowing exercises to improve your swallowing. The exact exercises will depend on why you are having trouble swallowing. For example, you may have a problem when the food is in your pharynx. If so, you may benefit from working the muscles in that region. Specifically, larynx-closing exercises may help you keep food moving normally down through the pharynx and into the esophagus.

You can do these exercises in your hospital room or at home. Often you can do these exercises on your own. But you may also work with a health professional to practice them.

Why might I need closure of the larynx exercises?

You might need to do larynx-closing exercises if you have trouble swallowing. Not being able to swallow properly is called dysphagia.

Dysphagia may lead to aspiration. That’s when foods you eat, your saliva, or material that comes up from your stomach and intestines enters into your respiratory tract. This serious situation can lead to pneumonia and other problems. As a result, dysphagia should be diagnosed and treated promptly.

As part of your treatment plan, your healthcare provider and SLP may prescribe swallowing exercises. (They are usually in addition to other treatments, such as dietary changes, medicines, or surgery.) Over time, practicing these exercises can strengthen your swallowing muscles. You will be able to swallow better. That, in turn, can prevent aspiration.

Different conditions can lead to swallowing problems. Some examples are:

• Significant dental problems
• Conditions that reduce saliva such as Sjögren syndrome
• Mouth lesions
• Parkinson disease or other nervous system conditions
• Muscular dystrophies
• Blockage in the esophagus such as from a tumor or a narrowing of the esophagus
• History of radiation, chemotherapy, or both to the neck or throat for cancer

What are the risks of closure of the larynx exercises?

Swallowing exercises, such as those for the larynx, are very safe. If you feel pain or discomfort while doing them, temporarily stop. Tell your healthcare provider or therapist right away. Don’t practice these exercises unless they have been prescribed for you.

How do I get ready for closure of the larynx exercises?

Before you start these exercises, determine if you need to change your positioning. Your SLP will show you how to do so, if needed. (For example, it may be better if you do these exercises while out of bed.)

It's best to remove distractions from your environment. Turn off the television. Do the exercises at a time when you won’t have visitors. You will be able to fully concentrate and get the most benefit from them. You can do these exercises at any time that is convenient for you.

Your SLP can tell you if there is anything else you need to do before starting.

What happens during closure of the larynx exercises?

Your SLP can show you the specific exercises you should do and explain how often to do them. As an example, you may be asked to do the following exercises:

• Take a deep breath and hold it. Keep holding your breath while you swallow. Immediately after swallowing, cough. (This is called the supraglottic swallow.) Repeat a few times.
• Inhale and hold your breath very tightly. Bear down (like you are having a bowel movement). Keep holding your breath and bearing down as you swallow. (This is called a super-supraglottic swallow.) Repeat a few times. There is no need to use food or liquid with either of these exercises. This exercise should be done with caution. People with uncontrolled blood pressure should not do this exercise as bearing down can increase blood pressure. 
• Take a breath. Keep holding your breath as you bear down. Hold for a few seconds and then relax. Repeat a few times.
• Hold your breath tightly. Place both hands under your chair. Pull as if you are trying to lift up your chair with you in it. Let go of your breath and say “ah” while you continue to pull. Relax. Repeat a few times.
• Hold your breath tightly. Turn your head to the left or to the right. Let go of your breath and say “ah” while your head is still turned. Relax. Repeat a few times.

All these exercises help close the larynx. This may improve your swallowing.

In most cases, you’ll be practicing the larynx-closing exercises along with other types of swallowing exercises. If so, do these in the same order each time. Don’t leave any exercises out. Your healthcare team will plan a series of exercises that specifically targets the source of your swallowing problem.

Your SLP can give very specific instructions about how to do each exercise and how often you should practice it. In many cases, you’ll need to practice your exercises several times a day for the most benefit.

What happens after closure of the larynx exercises?

You can resume your normal activities right after doing your swallowing exercises.

Keep a record of the times you do your swallowing exercises. It will remind you to do your exercises as prescribed. It will also provide helpful feedback on your progress to your SLP. Make a note of what exercises you do and when you do them. Also note any problems. Discuss them with your SLP.

Your SLP and medical team will monitor your progress. They may make changes to your exercise therapy, if needed. (This monitoring may include bedside swallowing exams or imaging tests.) It may take a few weeks to notice an improvement in your swallowing.

As your ability to swallow improves, your risk of aspiration may drop. Your SLP may be able to modify your diet. You may also be able to eat certain types of food again. This can improve your nutritional intake, your overall health, and your quality of life.

Continue to practice all your swallowing exercises as prescribed by your SLP or healthcare provider. You will benefit most from following the prescribed therapy. If you miss practice sessions, your progress will slow. To maximize your chance of a good outcome, work closely with all the members of your healthcare team to properly treat your condition.

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
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Swallowing Exercises

The following exercises and associated videos are only to be used under the explicit guidance of your physician or speech-language pathologist (SLP). You must consult your physician or medical specialist before using these exercises. If you feel pain or experience unusual symptoms while performing any of these exercises, stop the exercise immediately and consult your medical team before any further use. Read and understand all instructions carefully before using.

Your physician or speech-language pathologist will select which exercises are useful to improving your swallowing function. If an exercise is not selected, do not attempt it without consulting your medical team. They will develop a program customized and unique to the needs of each patient. This includes the number of repetitions, the number of seconds each exercise should be performed, and the rest period between exercises.

A two page PDF available in both English and Spanish are available by clicking the link below. These can be printed by your clinician to allow them to customize your swallowing exercise routine.

 [rescue_button colorhex=”#60b6d1″ url=”https://swallowingdisorderfoundation.com/free-swallow-exercises-pdf/” title=”Visit Site” target=”blank” class=”left” border_radius=”3px”]Free PDF of Exercises [/rescue_button]

This information (instruction and videos), unless otherwise noted, have been provided to the NFOSD by the UC Davis Health System, Department of Otolaryngology and Nancy Swigert, CCC-SLP, BCS-S, F-ASHA and colleagues. The material is copyrighted. All rights associated with this copyrighted material will be enforced. It is being made available free of charge to all physicians and speech language pathologists to be used by their patients.

1. Effortful Swallow: Collect all the saliva in your mouth onto the center of your tongue. Keep your lips closed and tight together. Pretend you are swallowing a grape whole in one big, hard swallow. The number of repetitions is patient specific. Click here for Video.

2.   Isokinetic (dynamic) Shaker: The number of repetitions defined by your clinician is considered a set. You should perform the set twice (resting briefly between each set). You should then rest for two minutes and then repeat this exercise as many times as directed by your clinician. Ignore the number of repetitions and sets as directed in the video. Click here for Video. The number of repetitions and sets are patient specific.

3. Isometric (static) Shaker: Click here for Video. The length of each repetition and the number of repetitions is set by your clinician. Rest for one minute between repetitions.

4.  Jaw Thrust: Move your lower jaw as far forward as you can. Your lower teeth should be in front of your upper teeth. Click here for Video. Note, patients with jaw replacement should use extra caution before performing this exercise so as not to stress the jaw bone. The length of time for each repetition and number of repetitions is patient specific.

5.  Lollipop Swallowing: Click here for Video. Place a sugarless lollipop in your mouth and lick. Lick three times and then do an effortful swallow with your lips firmly pressed together. Swallow as hard as you can. The number of repetitions is patient specific.

6.  Masako Maneuver: Stick your tongue out of your mouth between your front teeth and gently bite down to hold it in place. Swallow while keeping your tongue gently between your teeth. You can let go of your tongue between swallows and repeat. Click here for Video. The number of repetitions is patient specific.

7.  Mendelsohn Maneuver: Place your middle three fingers (index, middle, ring) on your Adam’s Apple (the skin in front of your neck beneath your chin). Swallow once to practice. Feel your Adams Apple slide upward as you swallow. Now, swallow again and when your Adam’s Apple gets to its highest position in the throat, squeeze your throat muscles and hold it as high as you can for as long as your clinician has directed for this exercise (or as long as you can if you can’t hold it for this length of time). Click here for Video. The length of time for each repetition and number of repetitions is patient specific.

8.   Yawn : The goal of this exercise is to increase the strength of the back of the tongue and throat muscles. Yawn and when you get into a big stretch, hold that position for as long as indicated. Click here for Video.

9.  Supraglottic Maneuver: Perform this exercise if and only if directed by your clinician. Your clinician should also provide direction as to the position of your head (tucked, right, left, straight). Collect a small bit of saliva in mouth. Take a deep breath and hold your breath (if the vocal folds are not closed then try to inhale and say ah, turn off your voice and hold your breath). Keep holding your breath while you swallow. Immediately after you swallow, cough. Practice with saliva prior to food or liquid. Click here for Video. The number of repetitions is patient specific.

10.  Tongue Strength Exercise: Using a tongue depressor, press the tip of your tongue out against the tongue depressor. Put the tongue depressor on the tip of your tongue and push up. To exercise the middle part of your tongue, put the tongue depressor towards the middle of your tongue and push up against the roof of your mouth. To exercise the back of the tongue, say the “k” sound, then put the tongue depressor on the spot of the tongue that made contact with the roof of your mouth and push up. Next, sweep the tip of your tongue from the very front of your mouth to the back along the roof of your mouth. Lastly, lateralize your tongue from one corner of your mouth to the other. The number of repetitions is patient specific. Click here for Video.

11. Tongue Range of Motion: First, stick your tongue out as far as possible and hold as instructed. Then pull the tongue back into the mouth as far as you can. Then, lateralize the tongue tip to one corner of your mouth and hold. Then switch to the opposite side and hold.  Lastly, open your mouth put your tongue tip behind your top teeth and hold the stretch. The number of sets is patient specific. Click here for Video.

12. Tongue Retraction Exercise : Don’t use the tip of your tongue. Instead, pull the back of your tongue as far into the mouth as you can and hold. Click here for Video.

13. Effortful   Pitch Glide: Say “eee” in as low a pitch as possible and then gradually raise the pitch of your voice until the highest tone possible. Hold this tone for the length of time directed by your clinician. Click here for Video.

14. Lip Range of Motion : Pull your lips into a smile and hold the stretch. Next, open your jaw wide and then stretch your lips into a smile and hold. Click here for Video.

In addition to the swallowing exercises above, there are also devices on the market designed to help improve the swallow function.  The link below will direct you to information on devices that can be used in conjunction with the exercises above. We provide this information to empower the patient.   Please consult with your medical professional as this type of treatment may not be right for you:

[rescue_button colorhex=”#60b6d1″ url=”https://swallowingdisorderfoundation.com/tongue-strengthening-devices-dysphagia-rehabilitation/” title=”Visit Site” target=”blank” class=”left” border_radius=”3px”]Swallowing Devices [/rescue_button].

6 Comments On “ Swallowing Exercises ”

• Trackback: What it’s like to wake up and find yourself unable to swallow - Quartz […] pathologists and other dysphagia experts have developed a repertoire of a dozen or so swallowing exe... qz.com/639247/what-its-like-to-wake-up-and-find-yourself-unable-to-swallow
• Trackback: What it’s like having dysphagia — the disease that makes it feel like you’re being ‘constantly waterboarded’ | Vus Times […] pathologists and other dysphagia experts have developed a repertoire of a dozen or so swallowin... vustimes.com/what-its-like-having-dysphagia-the-disease-that-makes-it-feel-like-youre-being-constantly-waterboarded
• Trackback: What it's like having dysphagia — the disease that makes it feel like you're being 'constantly waterboarded' | newusatoday […] pathologists and other dysphagia experts have developed a repertoire of a dozen or so swallowing ex... newusatoday.ga/?p=9718
• Trackback: What it’s like having dysphagia, the disease that makes it feel like you’re being ‘constantly waterboarded’ – Izon Inc […] pathologists and other dysphagia experts have developed a repertoire of a dozen or so swallowing ex... izoninc.com/blog/what-its-like-having-dysphagia-the-disease-that-makes-it-feel-like-youre-being-constantly-waterboarded
• Trackback: What it is like having dysphagia — the illness that makes it really feel such as you’re being ‘continually waterboarded’ – GloboTimes.com | Global Breaking News, Stories, Multimedia, Events, Trends, Launches, Researches, Reviews, […] pathologists and other dysphagia experts have developed a repertoire of a dozen or so swallowing ex... globotimes.com/news-story/what-it-is-like-having-dysphagia-the-illness-that-makes-it-really-feel-such-as-youre-being-continually-waterboarded
• Trackback: Problemet e gëlltitjes – Disfagia – OLT Retorika […] Të tjera ushtrime me video mund të gjeni edhe në https://ndso.website-development.info/oral-swall... retorika-ks.com/2017/09/problemet-e-gelltitjes-disfagia

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Tests & Procedures

Swallowing exercises: how to do larynx-lifting exercises, what are larynx-lifting exercises.

Larynx-lifting exercises are done to help improve swallowing. They are a type of treatment when you have trouble swallowing (dysphagia). The exercises may help you increase the strength and mobility of the muscles of your larynx (voice box) over time. This may help the ability to swallow. These exercises are sometimes used with other types of swallowing exercises.

Before you swallow, you chew your food to a size, shape, and texture that can be swallowed. When you swallow this material, it passes through your mouth and down through parts of your throat called the pharynx and larynx. From here, the food or liquid passes through a long tube (esophagus) before entering your stomach. This movement requires a series of actions from the muscles in these areas.

When you breathe, air passes through your pharynx and larynx, too. It then travels down through a long tube (trachea) before it reaches your lungs. There is a small piece of tissue called the epiglottis that acts like a flap and covers your trachea when you swallow food or drink. This is so food and fluids don't go into your trachea and lungs.

Muscle weakness in these areas can make proper swallowing difficult. A speech-language pathologist (SLP) may prescribe specific swallowing exercises to improve your swallowing. Swallowing exercises can give increased strength, mobility, and control to these muscles. Over time, this may help you to swallow normally again.

Why might I need larynx-lifting exercises?

You might need to use larynx-lifting exercises if you have dysphagia. Dysphagia can lead to food or fluid going into the airways or lungs (aspiration). This can lead to pneumonia and other problems. Because of this, it’s important to promptly identify and treat your dysphagia if you have it.

Medical conditions can lead to dysphagia. Some examples are:

Severe dental problems

Mouth lesions

Conditions that reduce saliva such as Sjögren syndrome

Parkinson disease or other nervous system conditions

Muscular dystrophies

Blockage in the esophagus, such as from a tumor

History of radiation, chemotherapy, or both to the neck or throat for cancer

An SLP may be more likely to prescribe larynx-lifting exercises if they think you are having reduced laryngeal motion that is causing you trouble with the pharyngeal phase of swallowing. For example, this might happen from neck cancer or after a stroke.

What are the risks of larynx-lifting exercises?

Larynx-lifting exercises are safe. If you have any discomfort during the exercises, you can stop doing them. Let your healthcare provider or therapist know right away. Don’t practice these exercises unless someone from your medical team prescribes them to you.

How do I get ready for larynx-lifting exercises?

Before you start your larynx-lifting exercises, you may need to change your body position. Ask your healthcare provider or SLP on the best position for this exercise. Your SLP will give you instructions on how to do this, if needed. For example, it may be better to do these exercises while out of bed.

It's also helpful to remove distractions from your environment. Turn off the TV and do the exercises at a time when you won’t have visitors. This will let you focus on your exercises and get the most benefit from them. You can do these exercises at any time that is convenient for you. Your SLP will let you know if there is anything else you need to do before getting started.

What happens during larynx-lifting exercises?

The exercises will depend on the exact nature of your swallowing problem. For example, you may have a problem with the second phase of swallowing. This is when the food material is in your pharynx. If so, you may benefit from working the muscles in your larynx. Larynx-lifting exercises may help you keep your food moving normally down through the pharynx and into the esophagus. If you have a problem with other stages of swallowing, your SLP might give you different swallowing exercises.

You can do these exercises in your hospital room or at home. Often you can do them on your own, but you may also work with a health provider to practice these exercises.

Your SLP can show you the exercises you should do and explain how often to do them. For example, you may be asked to try these:

Mendelsohn maneuver. Start to swallow. Use your throat muscles to stop your Adam’s apple, also known as the larynx or voice box, at its highest point for a couple of seconds. At first, it may help you to use fingers to help keep it up, until you understand the movement that is involved. Then finish the swallow by letting your Adam’s apple to return to a resting position.

Falsetto exercise. Use your voice to slide up the pitch scale as high as you can, to a high, squeaky voice. Hold the high note for several seconds with as much strength as possible. While you do this, you can gently pull up on your Adam’s apple.

Both of these exercises help lift the larynx, which may improve your swallowing.

Your SLP can tell you how to do each exercise and how often you should practice it. In many cases, you’ll need to practice your exercises several times a day for the most benefit.

You will likely be doing larynx-lifting exercises along with other types of swallowing exercises. If so, do these in the same order each time. This will help make sure you don’t forget any exercises.

What happens after larynx-lifting exercises?

You can go back to your normal activities right after you finish practicing your larynx-lifting and other exercises.

As part of your treatment plan, your healthcare provider and SLP may prescribe other treatments. These may include changes to your diet, changes in eating position, medicines, or surgery.

It’s a good idea to keep a record every time you do your swallowing exercises. This serves as a reminder to you to do your exercises as prescribed. It also provides helpful feedback on your progress to your SLP. Make a note of what exercises you did and when you did them. Also note any problems, so you can discuss them with your SLP.

Your SLP and medical team may modify your exercises as they watch your progress over time. You may have bedside swallowing exams. And you may have other tests, such as a fiberoptic evaluation of swallowing (FEES) test. This is when a very thin, flexible scope is inserted through your nose to look at your throat as you swallow.

It may take a few weeks to notice an improvement in your swallowing. As your ability to swallow improves, your risk for aspiration will decrease. Your SLP may be able to change your diet and allow you to eat certain types of food again. This can improve your nutrition, your overall health, and your quality of life. You may still have problems with swallowing even after practicing these exercises regularly. Your SLP will tell you what kind of progress to expect.

Continue to practice all your swallowing exercises as prescribed by your SLP. You will benefit most from following the therapy exactly as prescribed. Your progress may be less if you skip practice sessions. Work closely with all the members of your healthcare team. This will improve your chance of having a good outcome.

Before you agree to the test or the procedure, make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how you will get the results

Who to call after the test or procedure if you have questions or problems

How much you will have to pay for the test or procedure

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Health Encyclopedia

Swallowing exercises: closure of the larynx exercises, what are closure of the larynx exercises.

Larynx-closure exercises can help you swallow better. With practice, they may help strengthen the muscles of your larynx. Your larynx is the part of your throat that is also known as your voice box.

Before you swallow, you chew your food to an appropriate size, shape, and consistency. When you swallow, this material passes through your mouth and a part of your throat called the pharynx. From there, the chewed food goes through a long tube called the esophagus. It then enters your stomach and your gastrointestinal tract.

During breathing, air travels from your mouth and pharynx into the larynx (toward your lungs). When you swallow, a flap called the epiglottis moves to block the entrance of food particles into your larynx and lungs. The muscles of the larynx pull upward to assist with this movement. They also tightly close during swallowing. That prevents food from entering your lungs.

Swallowing needs a series of coordinated actions from your muscles in these regions. But sometimes they may not work right. That can lead to problems swallowing. Muscle weakness in these areas can make swallowing hard to do. For example, food particles might be more likely to end up in your lungs if the muscles that close your larynx are weak. Swallowing exercises can improve the strength, mobility, and control of these muscles. Over time, they may help you to swallow normally again.

Your healthcare provider or a speech-language pathologist (SLP) may prescribe swallowing exercises to improve your swallowing. The exact exercises will depend on why you are having trouble swallowing. For example, you may have a problem when the food is in your pharynx. If so, you may benefit from working the muscles in that region. Specifically, larynx-closing exercises may help you keep food moving normally down through the pharynx and into the esophagus.

You can do these exercises in your hospital room or at home. Often you can do these exercises on your own. But you may also work with a health professional to practice them.

Why might I need closure of the larynx exercises?

You might need to do larynx-closing exercises if you have trouble swallowing. Not being able to swallow properly is called dysphagia.

Dysphagia may lead to aspiration. That’s when foods you eat, your saliva, or material that comes up from your stomach and intestines enters into your respiratory tract. This serious situation can lead to pneumonia and other problems. As a result, dysphagia should be diagnosed and treated promptly.

As part of your treatment plan, your healthcare provider and SLP may prescribe swallowing exercises. (They are usually in addition to other treatments, such as dietary changes, medicines, or surgery.) Over time, practicing these exercises can strengthen your swallowing muscles. You will be able to swallow better. That, in turn, can prevent aspiration.

Different conditions can lead to swallowing problems. Some examples are:

Significant dental problems

Conditions that reduce saliva such as Sjögren syndrome

Mouth lesions

Parkinson disease or other nervous system conditions

Muscular dystrophies

Blockage in the esophagus such as from a tumor or a narrowing of the esophagus

History of radiation, chemotherapy, or both to the neck or throat for cancer

What are the risks of closure of the larynx exercises?

Swallowing exercises, such as those for the larynx, are very safe. If you feel pain or discomfort while doing them, temporarily stop. Tell your healthcare provider or therapist right away. Don’t practice these exercises unless they have been prescribed for you.

How do I get ready for closure of the larynx exercises?

Before you start these exercises, determine if you need to change your positioning. Your SLP will show you how to do so, if needed. (For example, it may be better if you do these exercises while out of bed.)

It's best to remove distractions from your environment. Turn off the television. Do the exercises at a time when you won’t have visitors. You will be able to fully concentrate and get the most benefit from them. You can do these exercises at any time that is convenient for you.

Your SLP can tell you if there is anything else you need to do before starting.

What happens during closure of the larynx exercises?

Your SLP can show you the specific exercises you should do and explain how often to do them. As an example, you may be asked to do the following exercises:

Take a deep breath and hold it. Keep holding your breath while you swallow. Immediately after swallowing, cough. (This is called the supraglottic swallow.) Repeat a few times.

Inhale and hold your breath very tightly. Bear down (like you are having a bowel movement). Keep holding your breath and bearing down as you swallow. (This is called a super-supraglottic swallow.) Repeat a few times. There is no need to use food or liquid with either of these exercises. This exercise should be done with caution. People with uncontrolled blood pressure should not do this exercise as bearing down can increase blood pressure. 

Take a breath. Keep holding your breath as you bear down. Hold for a few seconds and then relax. Repeat a few times.

Hold your breath tightly. Place both hands under your chair. Pull as if you are trying to lift up your chair with you in it. Let go of your breath and say “ah” while you continue to pull. Relax. Repeat a few times.

Hold your breath tightly. Turn your head to the left or to the right. Let go of your breath and say “ah” while your head is still turned. Relax. Repeat a few times.

All these exercises help close the larynx. This may improve your swallowing.

In most cases, you’ll be practicing the larynx-closing exercises along with other types of swallowing exercises. If so, do these in the same order each time. Don’t leave any exercises out. Your healthcare team will plan a series of exercises that specifically targets the source of your swallowing problem.

Your SLP can give very specific instructions about how to do each exercise and how often you should practice it. In many cases, you’ll need to practice your exercises several times a day for the most benefit.

What happens after closure of the larynx exercises?

You can resume your normal activities right after doing your swallowing exercises.

Keep a record of the times you do your swallowing exercises. It will remind you to do your exercises as prescribed. It will also provide helpful feedback on your progress to your SLP. Make a note of what exercises you do and when you do them. Also note any problems. Discuss them with your SLP.

Your SLP and medical team will monitor your progress. They may make changes to your exercise therapy, if needed. (This monitoring may include bedside swallowing exams or imaging tests.) It may take a few weeks to notice an improvement in your swallowing.

As your ability to swallow improves, your risk of aspiration may drop. Your SLP may be able to modify your diet. You may also be able to eat certain types of food again. This can improve your nutritional intake, your overall health, and your quality of life.

Continue to practice all your swallowing exercises as prescribed by your SLP or healthcare provider. You will benefit most from following the prescribed therapy. If you miss practice sessions, your progress will slow. To maximize your chance of a good outcome, work closely with all the members of your healthcare team to properly treat your condition.

Before you agree to the test or the procedure, make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how you will get the results

Who to call after the test or procedure if you have questions or problems

How much you will have to pay for the test or procedure

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Swallowing Exercises: Closure of the Larynx Exercises

What are closure of the larynx exercises.

Larynx-closure exercises can help you swallow better. With practice, they may help strengthen the muscles of your larynx. Your larynx is the part of your throat that is also known as your voice box.

Before you swallow, you chew your food to an appropriate size, shape, and consistency. When you swallow, this material passes through your mouth and a part of your throat called the pharynx. From there, the chewed food goes through a long tube called the esophagus. It then enters your stomach and your gastrointestinal tract.

During breathing, air travels from your mouth and pharynx into the larynx (toward your lungs). When you swallow, a flap called the epiglottis moves to block the entrance of food particles into your larynx and lungs. The muscles of the larynx pull upward to assist with this movement. They also tightly close during swallowing. That prevents food from entering your lungs.

Swallowing needs a series of coordinated actions from your muscles in these regions. But sometimes they may not work right. That can lead to problems swallowing. Muscle weakness in these areas can make swallowing hard to do. For example, food particles might be more likely to end up in your lungs if the muscles that close your larynx are weak. Swallowing exercises can improve the strength, mobility, and control of these muscles. Over time, they may help you to swallow normally again.

Your healthcare provider or a speech-language pathologist (SLP) may prescribe swallowing exercises to improve your swallowing. The exact exercises will depend on why you are having trouble swallowing. For example, you may have a problem when the food is in your pharynx. If so, you may benefit from working the muscles in that region. Specifically, larynx-closing exercises may help you keep food moving normally down through the pharynx and into the esophagus.

You can do these exercises in your hospital room or at home. Often you can do these exercises on your own. But you may also work with a health professional to practice them.

Why might I need closure of the larynx exercises?

You might need to do larynx-closing exercises if you have trouble swallowing. Not being able to swallow properly is called dysphagia.

Dysphagia may lead to aspiration. That’s when material from your stomach and intestines enters into your respiratory tract. This serious situation can lead to pneumonia and other problems. As a result, dysphagia should be diagnosed and treated promptly.

As part of your treatment plan, your healthcare provider and SLP may prescribe swallowing exercises. (They are usually in addition to other treatments, such as dietary changes, medicines, or surgery.) Over time, practicing these exercises can strengthen your swallowing muscles. You will be able to swallow better. That, in turn, can prevent aspiration.

Different conditions can lead to swallowing problems. Some examples are:

• Significant dental problems
• Conditions that reduce saliva such as Sjögren syndrome
• Mouth lesions
• Parkinson disease or other nervous system conditions
• Muscular dystrophies
• Blockage in the esophagus such as from a tumor
• History of radiation and/or chemotherapy to the neck or throat for cancer

What are the risks of closure of the larynx exercises?

Swallowing exercises, such as those for the larynx, are very safe. If you feel pain or discomfort while doing them, temporarily stop. Tell your healthcare provider or therapist right away. Don’t practice these exercises unless they have been prescribed for you.

How do I get ready for closure of the larynx exercises?

Before you start these exercises, determine if you need to change your positioning. Your SLP will show you how to do so, if needed. (For example, it may be better if you do these exercises while out of bed.)

It's best to remove distractions from your environment. Turn off the television. Do the exercises at a time when you won’t have visitors. You will be able to fully concentrate and get the most benefit from them. You can do these exercises at any time that is convenient for you.

Your SLP can tell you if there is anything else you need to do before starting.

What happens during closure of the larynx exercises?

Your SLP can show you the specific exercises you should do and explain how often to do them. As an example, you may be asked to do the following exercises:

• Take a deep breath and hold it. Keep holding your breath while you swallow. Immediately after swallowing, cough. (This is called the supraglottic swallow.) Repeat a few times.
• Inhale and hold your breath very tightly. Bear down (like you are having a bowel movement). Keep holding your breath and bearing down as you swallow. (This is called a super-supraglottic swallow.) Repeat a few times. There is no need to use food or liquid with either of these exercises. This exercise should be done with caution and people with uncontrolled blood pressure should not do this exercise as bearing down can increase blood pressure. 
• Take a breath. Keep holding your breath as you bear down. Hold for a few seconds and then relax. Repeat a few times.
• Hold your breath tightly. Place both hands under your chair. Pull as if you are trying to lift up your chair with you in it. Let go of your breath and say “ah” while you continue to pull. Relax. Repeat a few times.
• Hold your breath tightly. Turn your head to the left or to the right. Let go of your breath and say “ah” while your head is still turned. Relax. Repeat a few times.

All these exercises help close the larynx. This may improve your swallowing.

In most cases, you’ll be practicing the larynx-closing exercises along with other types of swallowing exercises. If so, do these in the same order each time. Don’t leave any exercises out. Your healthcare team will plan a series of exercises that specifically targets the source of your swallowing problem.

Your SLP can give very specific instructions about how to do each exercise and how often you should practice it. In many cases, you’ll need to practice your exercises several times a day for the most benefit.

What happens after closure of the larynx exercises?

You can resume your normal activities right after doing your swallowing exercises.

Keep a record of the times you do your swallowing exercises. It will remind you to do your exercises as prescribed. It will also provide helpful feedback on your progress to your SLP. Make a note of what exercises you do and when you do them. Also, note any problems. Discuss them with your SLP.

Your SLP and medical team will monitor your process. They may make changes to your exercise therapy, if needed. (This monitoring may include bedside swallowing exams or imaging tests.) It may take a few weeks to notice an improvement in your swallowing.

As your ability to swallow improves, your risk of aspiration may drop. Your SLP may be able to modify your diet. You may also be able to eat certain types of food again. This can improve your nutritional intake, your overall health, and your quality of life.

Continue to practice all your swallowing exercises as prescribed by your SLP or healthcare provider. You will benefit most from following the prescribed therapy. If you miss practice sessions, your progress will slow. To maximize your chance of a good outcome, work closely with all the members of your healthcare team to properly treat your condition.

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how you will get the results
• Who to call after the test or procedure if you have questions or problems
• How much you will have to pay for the test or procedure

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