Parkinson’s Swallowing Treatments: A Helpful Guide For Speech-Language Pathologists

Given the high prevalence of swallowing disorders in Parkinson’s disease, managing dysphagia is an important skill set for speech-language pathology professionals to have.

This article reviews evidence-based Parkinson’s swallowing treatment strategies and techniques, with how-to guides and videos.

Parkinson’s Swallowing Treatments

Depending on how dysphagia is defined and measured, anywhere from 18.5% to 100% of people with Parkinson’s disease will develop dysphagia (Kwon & Lee, 2019).

Before making a dysphagia treatment plan, complete a clinical swallow evaluation and, as needed, an instrumental assessment.

Some dysphagia treatments restore normal swallow function. These rehabilitation strategies include swallowing exercises and modalities.

Other dysphagia treatments compensate for swallowing impairments by changing the patient’s diet or behavior (American Speech-Language-Hearing Association, n.d.) These compensatory strategies aim to change the swallow, not restore swallowing function—although sometimes they do (Suiter & Gosa, 2019)! More on that below.

Evidence-based dysphagia compensations for Parkinson’s disease include postural techniques, swallow maneuvers, and diet modifications. Let’s start with these.

Postural Techniques for Parkinson’s Disease

A postural technique is a way that a patient holds their head when they swallow to direct the movement of a bolus.

Chin-down Posture

The chin-down posture aims to delay swallow initiation and is an evidence-based postural technique for some patients with Parkinson’s disease (Ayres et al, 2017).

Before recommending the chin-down posture, it’s best to complete an instrumental assessment to determine if it is, in fact, doing what you hope it is.

How to do chin-down posture:

1. Bring down your chin and look at your toes. Try not to move your neck forward (Young et al., 2015)
2. Hold this posture as you swallow

Swallowing Maneuvers For Parkinson’s Disease

A swallowing maneuver is a specific way of swallowing that changes the timing and/or strength of the swallow. With swallowing maneuvers, it’s best to complete an instrumental assessment to confirm that the maneuver is having the effect you intend it to.

While these maneuvers compensate for swallowing impairments, with the right patients, they can also be swallowing exercises.

Here are swallowing maneuvers that may help some patients with Parkinson’s disease. Again, which ones you recommend will depend on each individual’s dysphagia assessment results.

Effortful Swallow

The effortful swallow aims to improve tongue base retraction and reduce pharyngeal residue. It’s both a compensatory strategy and an exercise.

How to do the effortful swallow:

1. Sit up straight
2. Gather saliva in your mouth or take a sip of water
3. Swallow while squeezing your throat as hard as you can (pretend that you’re swallowing a whole grape)

(Bahia & Lowell, 2020)

Super-Supraglottic Swallow or Supraglottic Swallow

The super-supraglottic swallow and supraglottic swallow maneuvers aim to improve airway protection and airway clearance to decrease the risk of laryngeal penetration and aspiration. They’re both compensatory strategies and exercises.

Use with caution if the patient has cognitive impairments, as this maneuver requires a fair amount of sequencing.

How to do the super-supraglottic swallow:

1. Take a deep breath and hold it tightly while ‘bearing down’
2. Continue to hold your breath and bear down as you swallow
3. Cough immediately after swallowing (but before taking a breath)
4. Then immediately swallow hard again (before taking a breath)
5. Now take a breath

(Vose et al., 2014)

Mendelsohn Maneuver

The Mendelsohn maneuver aims to improve airway protection and airway clearance to decrease the risk of laryngeal penetration and aspiration. It’s both a compensatory strategy and an exercise.

Again, use with caution if the patient has cognitive impairments.

How to do the Mendelsohn maneuver:

1. Place your fingers gently on your throat. Swallow your saliva and feel your Adam’s apple move up and down.
2. Swallow your saliva again, but halfway through the swallow, hold your Adam’s apple up using the muscles under your chin.

Learn more about swallowing maneuvers and exercises by reading our Swallowing Exercises How-To Guide.

Diet Modifications For Parkinson’s Disease

Some patients with Parkinson’s disease may benefit from diet modifications to increase swallowing safety and/or increase caloric intake.

To maximize hydration and nutrition, you may recommend an altered diet based on your patient’s swallowing strengths and deficits. It’s best to first complete a VFSS or FEES to determine the safest and least restrictive diet. Use the IDDSI terminology when modifying textures and liquid levels.

To increase caloric intake, encourage smaller, more frequent meals plus snacks. Work with a registered dietitian to help support your patient.

Swallowing Exercises For Parkinson’s Disease

The goal of swallowing exercises is to improve the physiology of the swallow (Groher & Crary, 2010). This means increasing muscle strength, speed, range of motion, and/or swallow coordination (Brewer, 2025).

Choose swallowing exercises based on your patient’s swallowing deficits, cognitive abilities, goals, and motivation. Again, it’s best practice to use the results of an instrumental assessment to determine the most effective exercises based on your patient’s oral and/or pharyngeal deficits.

The following swallowing exercises are effective for some patients with Parkinson’s disease. You’ll recognize them because they’re also compensatory strategies for this population!

• Effortful Swallow to increase tongue base retraction and reduce pharyngeal residue
• Super-Supraglottic/Supraglottic Swallow to enhance airway protection. Use with caution if the patient has cognitive deficits.
• Mendelsohn maneuver to enhance airway protection. Use with caution if the patient has cognitive deficits.

In general, you’ll recommend 8-12 repetitions per set, 3 sets per day, 3-5 times per week. See The Adult Speech Therapy Protocols Pack for more guidance.

If your patient has trouble managing their saliva, read How To Assess And Treat Drooling In Parkinson’s Disease for how to help.

Swallowing Modalities For Parkinson’s Disease

Swallowing modalities are another way to restore normal swallow function. They aim to improve hyolaryngeal elevation, cough, and the strength of the laryngeal muscles.

These swallowing treatments focus on the ‘use it or lose it’ principle of neuroplasticity.

• LSVT LOUD®-inspired voice and swallow therapy. LSVT LOUD aims for vocal loudness, but it can also improve swallowing function.
• Expiratory Muscle Strength Training (EMST): EMST strengthens submental and respiratory muscles involved in airway protection.

Environmental & Behavioral Modifications To Improve Swallowing

Here are ways to adjust mealtime and routines to improve swallowing safety in patients with Parkinson’s disease.

• Keep an upright posture during and after meals
• Have small, more frequent meals to reduce fatigue
• Minimize distractions to improve focus on swallowing
• Take small sips and bites
• Clear your throat/cough and re-swallow as needed when eating/drinking
• Swallow twice to decrease oral and pharyngeal residue 
• Time meals with Parkinson’s disease medications to improve swallowing safety
• Adaptive equipment, such as weighted utensils, can help decrease tremors. Work with an occupational therapist for help
• Educate caregivers and multidisciplinary teams on safe feeding practices

Are you a new clinician? We created the Adult Speech Therapy Roadmap Course for you! This self-paced online course will teach you the ropes of how to assess, treat, and document. Learn more about The Roadmap

References

• American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved May, 2025, from www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/.
• Ayres, A., Jotz, G. P., Rieder, C. R., & Olchik, M. R. (2017). Benefit from the Chin-Down Maneuver in the Swallowing Performance and Self-Perception of Parkinson’s Disease Patients. Parkinson’s disease, 2017, 7460343. https://doi.org/10.1155/2017/7460343
• Bahia, M. M., & Lowell, S. Y. (2020). A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing. American journal of speech-language pathology, 29(3), 1655–1673. https://doi.org/10.1044/2020_AJSLP-19-00132
• Brewer, C. (2025). The Adult Speech Therapy Protocols Pack. Harmony Road Design Publishing.
• Brewer, C., Aparo, M. (2021). The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Brooks, M., McLaughlin, E., & Shields, N. (2019). Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review. International journal of speech-language pathology, 21(1), 89–100. https://doi.org/10.1080/17549507.2017.1387285
• Groher, E.M., Crary, M.A. (2010). Dysphagia: Clinical Management in Adults and Children. Mosby Elsevier.
• Kwon, M., & Lee, J. H. (2019). Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders. Journal of movement disorders, 12(3), 152–160. https://doi.org/10.14802/jmd.19048
• Mahler, L., & Ramig, L. O. (2012). Intensive treatment of dysarthria secondary to stroke. Clinical Linguistics and Phonetics, 26(8), 681–694. https://doi.org/10.3109/02699206.2012.696173
• Rosenbek J, John H. Dysphagia in Movement Disorders. Vol 1. San Diego, CA: Plural Publishing; 2008
• Vose, A., Nonnenmacher, J., Singer, M. L., & González-Fernández, M. (2014). Dysphagia Management in Acute and Sub-acute Stroke. Current physical medicine and rehabilitation reports, 2(4), 197–206. https://doi.org/10.1007/s40141-014-0061-2
• Young, J. L., Macrae, P., Anderson, C., Taylor-Kamara, I., & Humbert, I. A. (2015). The Sequence of Swallowing Events During the Chin-Down Posture. American journal of speech-language pathology, 24(4), 659–670. https://doi.org/10.1044/2015_AJSLP-15-0004