Swallowing Exercises

Swallowing Exercises

This leaflet has been provided as part of your swallow therapy, as recommended by your Speech and Language Therapist (SLT). These exercises may help improve or maintain your swallow function. Please do not use without seeking guidance and agreement from your SLT first. The exercises will be tailored to your needs and you will be shown the most appropriate exercises and how to do them.

Effortful Swallow

Why?

• If there is food, drink, saliva residue in a ‘well’ at the base of your tongue.
• If the strength of the base of your tongue against the wall of your throat is reduced.

How?

• Gather some saliva in your mouth and imagine there is a golf ball mixed in with it that you must swallow.
• Tuck your chin in tightly.
• Swallow ‘hard’ using all the muscles in your throat to push the golf ball through.

You might find it useful to push your tongue against the roof of your mouth while you swallow. as you can by really squeezing all muscles tightly as you swallow 

https://www.medbridgeeducation.com/patient-ed-library/condition/2667-Effortful-Swallow

• Practice this technique                times per day
• Stop if you are getting tired or finding it difficult

Masako

Why?

• If there is a muscle weakness in your throat which leads to difficulty clearing food, drinks or saliva in the ‘well’ at the base of your tongue.
• To strengthen the base of your tongue to the wall of your throat when swallowing.

How?

• Stick out your tongue and hold it between your lips/teeth.
• Swallow your saliva whilst holding this position.

Tip: If you don’t have enough saliva, moisten your mouth in between repetitions.

• If this is too difficult to begin with, you can keep your tongue against the inside of your teeth.

https://www.youtube.com/watch?v=7nW-4TuW1GM

• Practice this technique 3 times per day. 3-5 repetitions per set.
• Stop if you are getting tired or finding it difficult.

Mendelsohn

Why?

• If your voice box doesn’t rise during swallowing, it may mean that airway protection when eating and drinking is reduced.
• To help open the entrance to your food pipe (oesophagus) so that food, fluid and saliva can clear from your throat.

How?

• Place your middle 3 fingers (index, middle and ring) gently on your Adam’s apple (voice box). Swallow once to practice, you will feel the Adam’s apple move up and down as you swallow.
• When you start to swallow and your Adam’s apple rises, try to hold it up with your throat muscles by squeezing for several seconds before letting it drop back down. You need to hold your breath as you hold your Adam’s apple up and breathe out as your Adam’s apple drops.

https://www.youtube.com/watch?v=NHZ5g8roe_A

• Practice this technique 3 times per day. 5 repetitions per set.
• Stop if you are getting tired or finding it difficult.

Pitch Glides

Why?

• If your voice box doesn’t rise during swallowing, it may mean that airway protection when eating and drinking is reduced.
• It can strengthen the muscle in your throat.

How?

• Say “ee” starting with a low pitch and gliding up your voice range to your highest comfortable pitch. Hold pitch for 10-20 seconds as strongly as possible.

• Practice this technique 3 times per day. 5 repetitions per set.
• Stop if you are getting tired or finding it difficult.

Shaker

Why?

• The strap muscles in the neck move the voice box up and out of the way to keep food and liquid from ‘going the wrong way’. These exercises increase flexibility and strength to help food and drink pass through the food pipe.

How?

Shaker (static) part A:

• Lie down on your back on the bed or floor. Do not use a pillow. Your shoulders need to be flat against the surface.
• Keep your shoulders flat against the bed or floor and lift your head up, bringing your chin down to your chest until you can see your toes.
• Keep your head lifted for up to 60 seconds and then lower your head and rest for 60 seconds.
• Repeat this 2 times

https://www.youtube.com/watch?v=d1ThTZhAncY

Shaker (dynamic) part B:

• Lie down on your back on the bed or floor.  Do not use a pillow. Your shoulders need to be flat against the surface.
• Keep your shoulders flat against the bed or floor and lift your head up, bringing your chin down to your chest until you can see your toes.
• Hold for 1 second then immediately lower your head.
• Repeat this 30 times.

https://www.youtube.com/watch?v=jS-L4Obwik0

• Practice parts A and B 3 times per day.
• Stop if you are getting tired or finding it difficult.

Modified Shaker/ Chin tuck against resistance

Why?

• The strap muscles in the neck move the voice box up and out of the way to keep food and liquid from ‘going the wrong way’. These exercises increase flexibility and strength to help food and drink pass through the food pipe.
• It provides an alternative exercise for those which may not be suitable for the Shaker (parts A and B) exercise.

How?

• Sit upright in a chair
• Use an inflated ball or rolled up towel and place this under the chin for resistance
• With the resistance in place, try to tuck your chin towards the chest
• Hold for 10 seconds, then relax

Video: https://www.youtube.com/watch?v=QmHFCuyKdH4

• Practice 3 times a day
• Stop if you are getting tired or finding it difficult.

Helpful tips (adapted from Queensland Health, Clinical Task Instruction sheet):

Effortful Swallow:

Q. Do you find you have an inability to swallow due to a dry mouth sensation?

A. If your SLT advises, take a sip of fluid between attempts. If it is not recommended to do this, consider steam inhalation or using dry mouth spray or wetting your lips with a mouth care sponge.

Masako Manoeuvre:

Q. I am unable to keep my tongue between my teeth during swallowing?

A. Consider holding your tongue between two fingers using a piece of gauze, or gently bite down to maintain tongue protrusion.

Q. Do you find you have an inability to swallow due to a dry mouth sensation?

A. If your SLT advises, take a sip of fluid between attempts. If it is not recommended to do this, consider steam inhalation or using dry mouth spray or wetting your lips with a mouth care sponge.

Shaker:

Q. I keep moving my chin forward instead of lifting my head off the bed. How do I remedy this?

A. Focus on lifting up your head and try to look at your toes.

Q. I’m struggling to move my head forward with my chin down. How do I achieve this?

A. Lift up your head and try and look at your toes. Keep your chin in whilst you try and lengthen the back of your neck.

Modified Shaker/ Chin tuck against resistance:

Q. I don’t feel I am positioning the towel/ ball correctly and keeps dropping.

A. If possible, try and ask a friend to hold the ball/ towel in place whilst you get used to the correct position. If unsure, ask your SLT to re-demonstrate the exercise and re-review the video link

Mendelsohn Manoeuvre:

Q. I can’t maintain holding my voice box in a high position

A: Ask your SLT to re-demonstrate, so you can aim to hold your voice box for a couple of extra seconds in the exercise.

Pitch glides:

Q. It hurts when I voice and my voice breaks

A: stop the exercise and do not push through pain. Make sure you have good vocal hygiene (ask your SLT if you need advice), and only complete at a pitch that is comfortable for you. If you have a known problem with how your vocal cords are moving, this exercise need to be adapted for you.

If you have any queries do not hesitate to contact your speech and language therapist on the details below.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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