Exercise and techniques to promote swallowing ability

Presented by

Thanya Wutthisirawachatikul

Occupational Therapist

Important: These swallowing and voice exercises are not a general home program. They should be selected after an individual swallowing assessment by a qualified speech-language pathologist, occupational therapist, physician, or other trained dysphagia professional. Using the wrong exercise or practising with food or liquid may increase residue, coughing, choking, or aspiration risk.

Vocal-Fold Closure Exercise

Vocal Fold

Adduction Exercise

- Sit comfortably on a chair with the hands clasped in front of the chest.

- Breathe in comfortably without straining.

- Produce a comfortable “ee” sound while gently pressing the hands together. Do not bear down.

- Repeat only the number prescribed by the swallowing or voice specialist; do not automatically perform 10 repetitions.

Precautions

- Use caution and obtain professional clearance if you have uncontrolled high blood pressure, heart or lung disease, dizziness, or symptoms caused by breath-holding or straining.

Vocal Pitch-Glide Exercise

- Sit comfortably with the shoulders relaxed.

- Produce a comfortable “ee” sound.

- Glide gently from a lower to a higher pitch without forcing the voice or holding the sound to exhaustion.

- Repeat only as prescribed and stop if the voice becomes painful, strained, or increasingly hoarse.

Precautions

- Keep breathing normally. Do not hold the breath or push forcefully during practice.

Masako Maneuver (Tongue-Hold Exercise)

- Sit upright with the back supported.

- Place the tip of the tongue gently between the front teeth.

- Perform a dry saliva swallow while keeping the tongue gently forward. Do not practise this exercise with food or liquid.

- Perform only the number of repetitions prescribed by the swallowing specialist.

Clinician-Assisted Tongue-Hold Variation

- Sit upright with professional supervision.

- Position the tongue forward only as instructed.

- Do not bite, pull, or clamp the tongue forcefully.

- Attempt a dry saliva swallow only if the clinician has confirmed that this exercise is appropriate.

- Stop if coughing, choking, pain, bleeding, or breathing difficulty occurs.

Recommendation

- Do not use gauze to pull the tongue or attempt an assisted tongue-hold exercise independently. A clinician-assisted variation should be performed only by a trained swallowing professional because the exercise may be unsuitable for some swallowing problems.

Swallowing Techniques

Mendelsohn Maneuver

- Place the fingers lightly on the front of the neck only to feel laryngeal movement; do not squeeze or manually pull the larynx upward.

- Perform one dry saliva swallow.

- At the highest point of the swallow, try to hold the larynx elevated for the period prescribed by the clinician, then relax.

- Repeat only as prescribed. Stop if the exercise causes pain, coughing, dizziness, or shortness of breath.

Supraglottic Swallow

- Take a comfortable breath and hold it only if a swallowing specialist has confirmed that this manoeuvre is safe for you.

- Do not practise with food or liquid unless the clinician has specified the exact texture, volume, and level of supervision.

- While holding the breath, swallow as instructed, then cough immediately and swallow again if directed by the clinician.

- Perform only the prescribed number of repetitions. This manoeuvre may not be appropriate for people with certain cardiac, respiratory, or cognitive conditions.

Chin Tuck Against Resistance (CTAR)

- Sit comfortably and upright.

- Use the ball or rolled towel specified by the clinician.

- Place it under the chin without obstructing breathing.

- Press the chin downward against the resistance while continuing to breathe normally.

- Hold only for the duration prescribed; do not automatically hold for one minute.

- Perform only the prescribed repetitions; do not automatically complete 30 repetitions.

Shaker Exercise

- Lie on the back with the head resting flat, only if medically safe and instructed.

- Keep the arms relaxed beside the body.

- Lift the head to look toward the toes without lifting the shoulders, for the prescribed duration.

- Lower the head and rest as instructed.

- Perform only the prescribed number of repetitions rather than automatically completing 30.

Precautions

- The Shaker exercise may be unsuitable for people with cervical-spine problems, significant neck pain, heart or respiratory disease, uncontrolled blood pressure, or limited ability to follow instructions. Stop for chest pain, marked shortness of breath, dizziness, or worsening neck symptoms.

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