Swallowing Exercises for Dysphagia Therapy Following Stroke
NeuroRehab Team
Tuesday, March 14th, 2017
Neurological conditions can cause trouble with swallowing as a result of damage to the brain, spinal cord and nerves. This type of swallowing problem is called dysphagia. The most common conditions associated with dysphagia include stroke, head trauma, multiple sclerosis, cerebral palsy and motor neuron disease, but any neurological disease can cause dysphagia.
Key Facts
- 23% to 50% of acute stroke patients are dysphasic. Daniels SK. Arch Phys Med Rehabil 2008.
- The presence of dysphagia has been associated with an increased risk for pulmonary complications and even mortality. Marik PE. Chest. 2003.
- Upon admission, there is an association between dysphagia and poor overall outcomes for 6 months following stroke. Smithard DG. Stroke 1996.
Swallowing difficulties can result in drooling, choking, and even an infection of the lungs called aspiration pneumonia. To avoid these complications, recovery and rehabilitation from neurological illness often involves a formal swallowing evaluation. And exercises designed to improve swallowing can help strengthen and coordinate the nerves and muscles involved in swallowing. Exercising your swallowing muscles is the best way to improve your ability to swallow.
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In addition to exercises you may do with your therapist, you can also improve your swallowing function with at-home exercises as well. Here are some different exercises developed by dysphagia rehabilitation experts.
Shaker Exercise
Lie flat on your back and raise your head as though you were trying to fixate your gaze on your toes. While you do this, make sure not to raise your shoulders. This simple exercise can strengthen muscles to improve swallowing ability. It is best to do the exercise three to six times per day for at least six weeks. If you are able to successfully carry out the exercises, increase the duration of each head lift and the number of repetitions.
Hyoid Lift Maneuver
This is a rather simple exercise. Place a few small pieces of paper (about 1 inch in diameter) over a blanket or a towel. Then place a straw in your mouth and suck one of the pieces of paper to its tip. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar container and stop sucking.This will release the paper into the container. Your goal is to place about 5 to 10 pieces of paper into the container to build your muscles and muscular control.
Mendelssohn Maneuver
This simple exercise is very effective at improving the swallowing reflex. It involves swallowing your own saliva. Normally, as the saliva enters the area just behind your mouth during swallowing, your “Adam’s apple” (the hard area about halfway down the front of your neck) moves up and then back down. To do this exercise, keep the Adam’s apple elevated for about 2 to 5 seconds each time. You can help it stay there with your fingers at first, in order to better understand the movement you are about to do. Repeat this exercise several times per day until you are able to control your swallowing muscles without assistance from your hands.
Effortful Swallow
The purpose of this exercise is to improve the contact and coordination between the different muscles used during the act of swallowing. In essence, the exercise consists of swallowing. But as you do it, you must try to squeeze all of the muscles of swallowing as hard as you can. You do not need to swallow food during the exercise. Just a dry swallow will do. Perform this exercise 5 to 10 times, 3 times per day to strengthen your muscles.
Supraglottic Swallow
You should try this exercise without food first. As you become better at the exercise, you can try it with actual food in your mouth. This exercise consists of 3 simple steps. First, take a deep breath. Hold it as you swallow, then cough to clear any residues of saliva or food which might have gone down past your vocal cords.
Super Supraglottic Swallow Maneuver
This exercise is just like the supraglottic maneuver described above, but with an extra twist. After you take that deep breath, bear down while swallowing. The pressure generated helps with swallowing and increases the strength of your swallowing muscles.
Reference: Verywell.com
