You want to provide the best possible care to your patients with dysphagia. But how do you know if your exercise program will be effective?
In this post, you’ll get practical tips for how to make your dysphagia treatment exercises work better! We’ll draw from exercise science, motor learning, and neuroplasticity.
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Functional Exercise Works Best
If you remember only one thing from this post, let it be this:
The best exercise for swallowing is swallowing.
Research shows that functional exercises are best. They target the right muscles, motor plans, and sensory systems.
And, maybe most importantly, swallowing is meaningful to the patient who wants to eat safely by mouth again. This increases motivation and buy-in, both key to successful rehab.
Choose swallowing and swallow-driven exercises, where the patient is practicing all or parts of the swallow.
Also, as much as possible, try to have a meal-time environment that feels natural to the patient. Can you schedule therapy during mealtimes? Can a caregiver have them ready for you at the dining table?
So how else can you make swallowing exercises more effective? Keep reading!
How Exercise Works
When rehabbing movements post neurological event (stroke, etc.)—whether it’s leg, arm, or swallowing movements—you’re targeting several systems:
- Muscle strength (strength training)
- Motor learning
- Neuroplasticity
Do these systems overlap? Absolutely.
Are there other systems at play? For sure.
But the rehab world has solid evidence for how to target strength training, motor learning, and neuroplasticity. So let’s delve into them!
How To Make Dysphagia Treatment Exercises More Effective
The following tips draw from exercise science, motor learning, and neuroplasticity. Use them to maximize your dysphagia exercise programs.
1. Decide If Your Patient Needs Exercise
Ask yourself these questions:
- Are they alert? Can they follow directions?
- Is there an underlying weakness?
- Will exercise increase strength?
- Will exercise improve functioning?
If the answer is YES to all of these questions, then consider adding exercises to your dysphagia treatment (unless contraindicated for your patient).
2. Always Work At The Patient’s Level
You want to push the patient’s ability, but not too much. Safety first.
When deciding on number of repetitions, it’s ideal that patients to repeat an exercise to the point of fatigue. But, some may need to do sets of 5-10 repetitions, rest, then repeat.
When finding that just right balance, consider safety, form (is the movement getting sloppy?), and how the patient’s feeling (pain, motivation, fatigue, etc.)
3. Make Exercises Salient
Eating is innately salient. But you can maximize neuroplasticity by increasing how meaningful your treatment is!
Work towards a birthday dinner. Or an outing with a beloved grandchild.
Again, try to have a meal-time environment that feels natural to the patient. Try to make your treatment session as fun and comfortable as possible.
4. Be Specific
Teach the movement that you want them to improve. In other words, to improve swallowing, the patient must swallow!
5. Emphasize Correct Form
Practice doesn’t make perfect if they’re doing the movement wrong!
If a patient has poor form when swallowing or during exercises, take the time to teach them the correct form.
If, despite training, their form seems compromised by fatigue or pain, give yourself permission to hold off until they’re feeling better. Strengthening bad form is counterproductive.
Think about your own workouts. If you do a squat but your knees are misaligned, not only will you not get the results you’re looking for—but you could also injure your knees! The same goes for swallowing exercises.
6. Repeat, Repeat, Repeat!
Neural and muscular changes only happen after extensive and prolonged exercises. So have your patient swallow a lot!
Again, work at the patient’s level when it comes to swallowing exercises. Ideally, they’ll repeat the exercises to the point of fatigue. But some may need smaller sets if safety, poor form, pain, or other factors are at play.
7. Do Different Types of Movements
Challenge the muscles by doing different types of movement. We can help maximize muscle strength by facilitating isometric, isotonic, and concentric movements. Here’s how:
For isometric movements, do exercises that hold the swallow or hold a swallowing exercise for a few seconds (e.g., Shaker 3-second head lift exercise, Mendelsohn maneuver).
For isotonic movements, hold the move for a longer time (e.g. Shaker 60-second head hold exercise).
For concentric movements, do exercises that practice the swallow (e.g. Effortful Swallow exercise).
8. Gradually Make The Exercises More Difficult
As the patient improves, gradually make the exercises more difficult. You want to keep your patient challenged! You can do this by progressing towards:
- More repetitions (work to fatigue)
- Faster speeds
- Isometric, isotonic, and concentric movements:
- For isometric: hold the swallow for a few more seconds (Shaker 3-second head lift exercise or Mendelsohn maneuver)
- For isotonic: hold the move longer (Shaker 60-second head lift exercise)
- For concentric: swallow, Effortful Swallow exercise, or a heavier bolus (5 ml of pudding to 10 ml of pudding)
- Heavier ‘weights,’ such as a larger bolus (if the patient is safely able to manage one)
9. Recommend Maintenance Exercises
Throughout therapy, assign your patients a home program made up of the exercises that you’re doing in-session.
And when you discharge, strongly encourage them to keep up their exercises (as needed)!
Remind them of the first principle of neuroplasticity: “Use it or lose it!”
10. Learn More About The Brain
For those who want to nerd out about neuroplasticity and motor learning, here you go!
Read 9 Principles of Motor Learning and Principles of Neuroplasticity.
Which Dysphagia Exercises Should I Choose?
There may not be one right answer to this question. And that’s okay.
Start by reviewing the results of your oral mechanism examination. Which muscle groups were weak, asymmetrical, atrophied, and/or had decreased range of motion?
Did a swallow study show decreased UES opening or reduced hyolaryngeal movement?
Choose your swallowing exercises based on these areas of weakness.
Keep in mind that after a neurological event, sometimes the goal is to get the brain better connected back to that muscle. You do this by using the muscle over and over again. While it may not seem functional at the time, that brain-muscle activation might be the best move until the muscles are back online.
Below, you’ll find links to help you choose swallowing exercises.
If you’re feeling analysis paralysis, remember the 10 tips above. If you pair these principles of how exercise works with the solid recommendations below, you’ll do good by your patients.
Dysphagia Exercise Ideas
- Adult Dysphagia (ASHA practice portal)
- Choosing Exercises for Dysphagia Treatment: An Evidence-Based Approach (Tiffany Wallace)
- Swallowing Exercises & Strategies
- Dysphagia Exercises Videos
Dysphagia Exercise Protocols
- McNeill Dysphagia Therapy Program (swallowing rehab program)
- Effective Swallowing Protocol (electrical stimulation + exercise program)
More Dysphagia Resources
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References
- Adult Speech Therapy. (2022, November 8). 10 Principles of Neuroplasticity for Adult Speech Therapy. Adult Speech Therapy. Retrieved March 2, 2023, from https://theadultspeechtherapyworkbook.com/10-principles-of-neuroplasticity/
- Adult Speech Therapy. (2021, March 27). What is Motor Learning? 9 Principles for Speech Therapy. Adult Speech Therapy. Retrieved March 2, 2023, from https://theadultspeechtherapyworkbook.com/what-is-motor-learning/
- Babu, S., Balasubramaniam, R. K., & Varghese, A. (2017). Effect of Modified Shaker Exercise on the Amplitude and Duration of Swallowing Sounds: Evidence from Cervical Auscultation. Rehabilitation research and practice, 2017, 6526214. https://doi.org/10.1155/2017/6526214
- Burkhead, L.M., Sapienza, C.M., and Rosenbek, J.C. (2007). Strength-Training Exercise in Dysphagia Rehabilitation: Principles, Procedures, and Directions for Future Research. Dysphagia, 22, 251-265.
- Carnaby, G. D., LaGorio, L., Silliman, S., & Crary, M. (2020). Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial. Journal of oral rehabilitation, 47(4), 501–510. https://doi.org/10.1111/joor.12928
- Crary, M.A., & Carnaby-Mann, G.D. (2008). McNeil Dysphagia Therapy Program Manual.
- Wallace, T. L., & Mansolillo, A. (2021, February 3). Choosing Exercises for Dysphagia Treatment: An Evidence-Based Approach. MedBridge. Retrieved March 2, 2023, from https://www.medbridgeeducation.com/blog/2021/02/choosing-exercises-for-dysphagia-treatment-an-evidence-based-approach/
- Zimmerman, E., Carnaby, G., Lazarus, C.L., & Malandraki, G.A. (2020). Motor Learning, Neuroplasticity, and Strength and Skill Training: Moving From Compensation to Retraining in Behavioral Management of Dysphagia. American Journal of Speech-Language Pathology, 29, 1065-1077.