Head and Neck Cancer Dysphagia Exercises

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Speech therapy has a lot to offer patients undergoing treatment for head and neck cancer.

Although you may not be a cancer specialist, you are the dysphagia expert and can help patients swallow safely, maintain function, and enjoy a better quality of life—regardless of the etiology.

In this post, you’ll find head and neck cancer dysphagia exercises and stretches to use before, during, and after cancer treatment.

For pre-made dysphagia handouts and treatment guides, check out The Adult Speech Therapy Starter Pack!

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Table Of Contents
  1. When To Start Head and Neck Cancer Exercises?
  2. Head and Neck Cancer Dysphagia Exercises & Stretches
  3. Patient Handouts
  4. References

When To Start Head and Neck Cancer Exercises?

You’ll ideally start preventative dysphagia therapy before the cancer treatment (chemoradiation, surgery).

Then work on maintaining and restoring swallowing during and after cancer treatment.

Dysphagia Exercises Before Cancer Treatment

When possible, start dysphagia treatment at least two weeks before chemoradiation begins.

Teach the pertinent swallowing exercises and stretches and provide a home program and patient education.

The goal of dysphagia exercises before cancer treatment is to maintain muscle strength, range of motion, oral intake, and swallowing function and safety.

Communicate with nursing or oncology to share your plan, learn precautions, and otherwise collaborate.

Dysphagia Exercises During Cancer Treatment

During chemoradiation, the focus will be on continuing swallowing exercises and safely maximizing oral intake.

Common limitations to dysphagia exercises are pain, aspiration risk, xerostomia, and lymphedema (swelling).

Check in with the patient one to two times per week to reassess aspiration risk, swallowing, strength, range of motion, and ability to maintain hydration and nutrition by mouth.

Encourage patients to continue their swallowing exercises every day and to eat by mouth, as appropriate.

Refer out to specialists as needed, and continue to communicate with nursing or oncology about updates, precautions, and your plan of care.

Dysphagia Exercises After Cancer Treatment

After chemoradiation or surgery, the goal of dysphagia exercises is to restore strength, range of motion, and any swallowing skills that were impacted by the cancer treatment.

At this stage, therapists may opt for dysphagia exercise programs, like the McNeill Dysphagia Therapy Program.

As always, refer out and communicate with the care team as needed.

Head and Neck Cancer Dysphagia Exercises & Stretches

head and neck cancer dysphagia exercises

Which Exercises To Choose

Here are dysphagia exercises and stretches recommended by well-respected head and neck cancer hospitals, recent research, and reputable health organization (ASHA, NHS). Each has its own take on which are best, so how do you decide which to choose?

When deciding which of these exercises and stretches to choose, 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?

What is the patient’s radiation plan or surgery precautions?

How is the patient doing? Where are they feeling pain, stiffness, or swelling? How fatigued are they?

Choose swallowing exercises based on these areas of weakness and unique patient factors. Find that just-right challenge so that your patient can maintain their swallow.

Is There A Protocol?

While there is no single best protocol, the University Health Network in Canada developed a swallowing exercises program for patients with head and neck cancer who are starting radiation.

See their PDF handout and video.

1. Effortful Swallow

Read How To Do An Effortful Swallow.

2. Mendelsohn Maneuver

  • Swallow your saliva and use your fingers to feel your Adam’s apple move up and then down
  • Swallow your saliva again, but when you feel your Adam’s apple up as high as it can go, hold it using muscles under your chin
  • Hold for 3 seconds; finish the swallow
  • Repeat 5-10 times

3. Shaker Exercise

  1. Lay flat on your back
    • Keep your shoulders on the ground
  2. Lift your head as if looking at your toes; hold for 60 seconds
  3. Lay your head back down
  4. Repeat 2 times
  5. Next, lift your head; hold for 3 seconds
  6. Lay your head back down
  7. Repeat up to 30 times

4. Supraglottic Swallow

  1. Breathe in and hold your breath
  2. While holding your breath, swallow
  3. Cough out the breath you were holding as strong as possible
  4. Repeat 5-10 times

5. HAWK

  • Say the word “HAWK” in a loud voice, emphasizing the ‘K’ sound
    • It will sound like “haw-KKH”
    • On the “K” push your tongue hard up onto the roof of your mouth
  • Repeat 5-10 times

6. Effortful Pitch Glide

  • Glide on the ‘eee’ sound from a low pitch to a high pitch
    • Squeeze the muscles in your throat
  • Hold the highest pitch possible for 3-5 seconds
  • Repeat 5-10 times

7. Masako Exercise

Read how to do the Masako Exercise.

8. Tongue Range of Motion Exercises

  • Stretch your tongue out as far as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times
  • Stretch your tongue up as far as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times
  • Stretch your tongue down as far as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times
  • Stretch your tongue as far to the left as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times
  • Stretch your tongue as far to the right as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times

9. Jaw Range of Motion Exercises

  • Open your mouth as wide as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times
  • Stretch the lower jaw as far to the left as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times
  • Stretch the lower jaw as far to the right as you can
    • Hold 5 seconds, rest
    • Repeat 5-10 times

Patient Handouts

For evidence-based dysphagia handouts, therapist treatment guides, and much more, check out The Adult Speech Therapy Starter Pack!

References

  • American Speech-Language-Hearing Association. (n.d.). Head and neck cancer [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Head-and-Neck-Cancer/. Retrieved April, 27, 2023.
  • Cambridge University Hospitals, NHS Foundation Trust. (2022). Swallowing Exercises for Patients with Head and Neck Cancer. https://www.cuh.nhs.uk/patient-information/swallowing-exercises-for-patients-with-head-and-neck-cancer/. Retrieved April, 27, 2023.
  • Goyal, N., et al. (2021). Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope investigative otolaryngology, 7(1), 70–92. https://doi.org/10.1002/lio2.702.
  • Hsiang C-C, et al. Early Postoperative Oral Exercise Improves Swallowing Function Among Patients With Oral Cavity Cancer: A Randomized Controlled Trial. Ear, Nose & Throat Journal. 2019;98(6):E73-E80. doi:10.1177/0145561319839822.
  • Memorial Sloan Kettering Cancer Center. (2022). Radiation Therapy to Your Head and Neck: What You Need to Know About Swallowing. https://www.mskcc.org/cancer-care/patient-education/radiation-therapy-head-and-neck-swallowing. Retrieved April, 27, 2023.
  • Royal Burkshire NHA Foundation Trust (2021). Swallowing exercises: A guide for patients with head and neck cancer. https://www.royalberkshire.nhs.uk/media/ponb3b2t/swallowing-exercises-head-and-neck-cancer_jun21.pdf. Retrieved April, 27, 2023.
  • The University of Texas M. D. Anderson Cancer Center, (2008). Preventive Swallowing Exercises Head and Neck Radiation Therapy Patients. https://nmsha.net/wp-content/uploads/2014/10/Preventive-Swallowing-Exercises-Head-and-Neck-Radiation-Ther-Patients.pdf. Retrieved April, 27, 2023.
  • University Health Network. (2022). Swallowing Exercises for patients with head and neck cancer starting radiation treatment. https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Swallowing_Exercises_for_Patients_with_Head_and_Neck_Cancer_Receiving_Radiation_Treatment.pdf. Retrieved April, 27, 2023.
  • Wang, Y.-H., et al. (2022). Exercise for Trismus Prevention in Patients with Head and Neck Cancer: A Network Meta-Analysis of Randomized Controlled Trials. Healthcare, 10(3), 442. MDPI AG. Retrieved from http://dx.doi.org/10.3390/healthcare10030442
  • Zhang, J., Li, Q., Wu, HY. et al. A Systematic Review of Swallowing Training Measures for Postoperative Oral Cancer Patients. Dysphagia 37, 1839–1850 (2022). https://doi.org/10.1007/s00455-022-10445-1
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