Lingual Exercises for Adult Speech Therapy

When To Use Lingual Exercises

Lingual exercises can be appropriate for patients with tongue weakness after a stroke, brain injury, or surgery of the tongue—but only if exercises focus on regaining strength and movement.

Use lingual exercises if their Oral Motor Examination showed:

• Difficulty moving tongue side-to-side
• Difficulty moving tongue up-and-down
• Difficulty clearing a bolus from oral cavity
• Difficulty manipulating a bolus around their mouth
• Speech intelligibility

The patient must also be able to follow multi-directions. These exercises may not be appropriate for patients with cognitive impairments.

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

More Dysphagia Posts

• Swallowing Exercises & Strategies
• Effortful Swallow
• Dysphagia Diets

Lingual Exercises

Lingual Range of Motion Exercises

Use these stretches with patients who have difficulty fully sticking their tongues out:

1. Protrude your tongue out as far out as you can
   • Hold it for a count of 5 seconds
   • Relax
   • Repeat tongue-out 10 times
2. Next, retract your tongue as far back as you can
   • Like you’re going to say the ‘K’ sound
   • Relax
   • Repeat tongue-in 10 times
3. Next, protrude your tongue out then retract it in
   • Hold each for 5 seconds. Relax.
   • Repeat tongue-out, tongue-in for 5-10 repetitions
4. Next, stick your tongue out as far as you can to the right
   • Hold for 5 seconds. Relax.
5. Stick your tongue out as far as you can to the left
   • Hold for 5 seconds
   • Repeat tongue-left, tongue-right for 5-10 repetitions for each movement
6. Next, lift your tongue up as far as you can
   • Like you’re trying to lick your nose
   • Hold for 5 seconds. Relax.
   • Repeat tongue-up for 10 repetitions
7. Next, stick your tongue down as far as you can
   • Like you’re trying to lick your chin
   • Hold 5 seconds. Relax.
   • Repeat tongue-down for 10 repetitions
8. If not too fatigued, stick out your tongue and lick all around your lip in one direction (clockwise). Relax.
   • Then go around in the other direction (counter-clockwise).
   • Repeat tongue-around (outside the mouth) 5-10 sets, in each direction
9. Finally, move the tongue clockwise inside your mouth. Relax.
   • Move your tongue around in the other direction.
   • Repeat tongue-around (in the mouth) for 5-10 sets, in each direction

Lingual Strengthening Exercises

Use the handle of a spoon or a tongue depressor to add resistance.

1. Press your tongue inside your cheek to the right against resistance
   • Hold for 5 seconds
2. Press your tongue inside your cheek to the left against resistance
   • Hold for 5 seconds
   • Repeat the press on both sides, 5-10 times
3. Stick your tongue out. Resist as the therapist pushes down on your tongue
   • Hold for 5 seconds
4. Stick your tongue out. Resist as the therapist pushes up on your tongue
   • Hold for 5 seconds
   • Repeat resisting down and up, 5-10 times

…But Is It Evidence-Based?

It can be confusing when the dysphagia treatment literature contradicts itself. One study may find that a certain exercise is effective. While another finds the exact opposite!

But just because a certain exercise lacks proof, doesn’t necessarily mean that it shouldn’t be used (Langmore, S.E. & Pisegna, J.M., 2015).

So what’s a clinician to do?

First of all, keep up with the research and current best practices! But also be guided by the principles of motor learning, neuroplasticity, and exercise rehabilitation.

Below is a quick review. To learn more, read How To Make Dysphagia Treatment Exercises More Effective.

• Work at the patient’s level
• Keep exercises salient (the best exercise for swallowing is swallowing!)
• Be specific
• Emphasize correct form
• Repeat, repeat, repeat
• Do different types of movements
• Gradually increase the challenge

References

• _{American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved Feb, 22, 2023, from www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/}
• _{Hwang, N. K., et al. (2019). Tongue stretching exercises improve tongue motility and oromotor function in patients with dysphagia after stroke: A preliminary randomized controlled trial. Archives of oral biology, 108, 104521. https://doi.org/10.1016/j.archoralbio.2019.104521}
• _{Langmore, S.E., & Pisegna, J.M. (2015). Efficacy of exercise to rehabilitate dysphagia: A critique of the literature. International Journal of Speech-Language Pathology, 17(3), 222-229.}
• _{Lazarus, C., et al.(2003). Effects of two types of tongue strengthening exercises in young normals. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP), 55(4), 199–205. https://doi.org/10.1159/000071019}

Dysphagia Patient Handouts

For evidence-based patient handouts, worksheets, templates, and much more, check out The Adult Speech Therapy Starter Pack!