Free Swallowing Exercises Handout and How To Guide

In this article, you’ll learn how to teach swallowing exercises and safe swallowing strategies to your speech therapy patients with dysphagia.

To make this easier, we include a free, fully illustrated swallowing exercises handout for you to print out.

You’ll learn:

  • How to teach swallowing exercises (with videos!)
  • Safe swallowing strategies
  • The signs of dysphagia and how to treat them
  • Risk factors of aspiration

Let’s dive in!

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Signs of Dysphagia & How to Treat Them

signs of dysphagia

1. Anterior spillage

Treatment: Thickened liquids, small bites, and sips, labial exercises

2. Inadequate mastication

Treatment: Modified diet textures, small bites and sips, lingual exercises

3. Uncoordinated oral phase

Treatment: Bolus hold, lingual exercises, small bites and sips

4. Oral residue

Treatment: Alternating bites and sips, lingual sweep, lingual exercises

5. Pharyngeal pooling

Treatment: Thickened liquids, small bites and sips, bolus hold, chin tuck, lingual exercises

6. Regurgitation

Treatment: Small bites and sips, thinner consistencies, Masako maneuver, Mendelsohn maneuver (or effortful pitch glide), head lift or chin tuck against resistance

7. Reduced epiglottic movement

Treatment: Mendelsohn maneuver (or effortful pitch glide), effortful swallow, head lift or chin tuck against resistance

8. Vallecular residue

Treatment: Dry swallow, alternating bites and sips, effortful swallow, Mendelsohn maneuver (or effortful pitch glide), lingual exercises

9. Reduced UES opening

Treatment: Head turn. Mendelsohn maneuver (or effortful pitch glide), head lift or chin tuck against resistance

10. Pyriform sinus residue

Treatment: Dry swallow, alternating bites and sips, head turn, Mendelsohn maneuver (or effortful pitch glide), head lift or chin tuck against resistance, jaw opening exercise

11. Laryngeal penetration

Treatment: Thickened liquids, small bites and sips, alternating bites and sips, bolus hold, chin tuck, Mendelsohn maneuver (or effortful pitch glide), effortful swallow

When To Recommend an Instrumental Swallow Evaluation

instrumental swallow evaluation

Most patients with dysphagia would benefit from at least one instrumental swallowing evaluation. This may be a Modified Barium Swallowing Study (MBSS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

The results of an instrumental evaluation can help a lot when choosing goals, exercises, and strategies.

Refer the patient for an instrumental evaluation if you suspect laryngeal penetration or aspiration

Also consider ordering an MBSS or FEES when upgrading a patient from thickened liquids to thin liquids.

While waiting on an instrumental evaluation, monitor the patient’s lung sounds, educate on overt signs and symptoms of aspiration, and train in the use of safe swallowing strategies, exercises, and modified diet textures.

Read More About Dysphagia:

Swallowing Exercises

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Visit our shop for print-and-go dysphagia handouts, exercises, and treatment guides

Below is a list of swallowing exercises.

Choose exercises for your patients based on the underlying impairments and signs and symptoms they present with. Modify as needed.

Model the exercise, then have the patient demonstrate it back to you. Encourage daily practice, at least twice a day.

Print out the swallowing exercises handout to help them learn and remember their exercises.

And educate patients and caregivers about the signs and symptoms of aspiration. Read ahead for a checklist of aspiration risk factors.

Pharyngeal Exercises

Alisha Kleindel, MS, CCC-SLP demonstrates the Mendelsohn maneuver

1. 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)
  4. Repeat to fatigue (or in sets of 5-10 swallows, as appropriate)

Watch How To Do An Effortful Swallow

(Bahia, 2020)

2. 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
  3. Hold it for 3 seconds. Relax
  4. Repeat 5-10 times

3. Chin Tuck Against Resistance

  1. Sit up straight
  2. Place a rolled-up hand towel lightly under your chin and against your neck
  3. Push your chin down into the towel and hold for 60 seconds
    • Repeat 3 times
  4. Next, push your chin down hard into the towel and hold for 3 seconds
    • Relax briefly
    • Repeat the 3-second hold then relax up to 30 times

Watch how to do chin tuck against resistance.

4. Jaw Opening Exercise

  1. Lightly place the front of your tongue against the roof of your mouth
  2. Place your fist under your chin, pressing upward
  3. Slowly press your jaw down into your fist. Continue pressing upwards with your fist. Relax
  4. Repeat 5-10 times

5. Effortful Pitch Glide (Monkey EEE)

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

6. 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. Take a breath

(Vose, 2014)

Super supraglottic swallow (illustrated by Chung Hwa Brewer, 2021)
Super-supraglottic swallow (illustrated by Chung Hwa Brewer, 2021)

7. Masako Exercise

  1. Sit up straight
  2. Gather saliva in your mouth
  3. Stick out your tongue and hold it gently between your teeth (Relax your eyes and cheeks)
  4. While holding your tongue between your teeth, swallow
  5. Repeat to fatigue (or in sets of 5-10 swallows, as appropriate)

A patient should not do this exercise with food or liquid; only their saliva.

Watch the Masako Exercise.

Tongue Strengthening Exercises

Tongue-to-palate resistance training may improve tongue muscle strength and swallow function in patients with dysphagia (Kim, 2017).

You can use a tongue-strengthening device such as the IOPI®, or coach your patients to press their tongue against their palate. Here’s how:

1. Tongue Press Forward

Lift the front part of your tongue (more than just the tongue tip). Press it against the ridge that behind your top front teeth. Hold and press 10 seconds. Relax. Repeat 5-10 times.

2. Tongue Press Back

Lift the back of your tongue. Press it against the hard palate, right before it meets the soft palate. Hold and press for 10 seconds. Relax. Repeat 10 times.

Tongue press back (illustrated by Chung Hwa Brewer, 2021)
Tongue press back (illustrated by Chung Hwa Brewer, 2021)

3. Tongue Press Out

  1. Gently bite down on a tongue depressor placed between your upper and lower front teeth
  2. Press your tongue against the tongue depressor. You may hold the tongue depressor in place with your hand if it shifts
  3. Continue pressing for 10 seconds. Remember to gently bite down on the tongue depressor. Relax
  4. Repeat for 5-10 presses

4. Tongue Press Side

  1. Gently bite down a tongue depressor placed between your upper and lower premolars. Press the side of your tongue against the tongue depressor. You may hold the tongue depressor in place with your hand if it shifts
  2. Continue pressing for 10 seconds. Remember to gently bite down on the tongue depressor. Relax
  3. Repeat for 5-10 presses
  4. Switch sides and repeat
Tongue press side (illustrated by Chung Hwa Brewer, 2021)
Tongue press side (illustrated by Chung Hwa Brewer, 2021)

Lingual Range of Motion Exercises

Alisha Kleindel, MS, CCC-SLP demonstrates lingual exercises

Lingual range of motion exercises may improve tongue movement and oral motor function in people with dysphagia (Hwang, 2019).

1. Tongue Out

  • Stick your tongue out as far out as you can
  • Hold it for a count of 5 seconds
  • Relax
  • Repeat tongue-out 10 times

2. Tongue Back

  • 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. Tongue Out-then-Back

  • Protrude your tongue out then retract it in
  • Hold each for 5 seconds. Relax
  • Repeat tongue-out, tongue-in for 5-10 repetitions

4. Tongue Right

  • Stick your tongue out as far as you can to the right
  • Hold for 5 seconds. Relax

5. Tongue Left

  • Stick your tongue out as far as you can to the left
  • Hold for 5 seconds. Relax

6. Tongue Up

  • 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. Tongue Down

  • 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. Tongue Around (Out)

  • 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. Tongue Around (In)

  • 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

Dysphagia Exercises for Head & Neck Cancer

orofacial exercises for head and neck cancer

1. Lip Pucker

Purse your lips then stretch your lips over to the right, and hold for 5 seconds. Now stretch your lips over to the left, and hold for 5 seconds.

2. Pucker side-to-side

Purse your lips like you’re about to whistle and hold for 5 seconds. Press your lips against the back of a spoon to add some resistance.

3. Smile

Showing your upper and lower teeth and gums, clench your teeth gently, avoid squinting your eyes or tensing your neck, and hold for 5 seconds.

4. Pucker/Smile

Purse your lips like you’re about to whistle, and hold for 5 seconds. Now smile wide for 5 seconds. Do not tense your neck muscles.

5. Cheek Puffs

Puff out your cheeks like a blowfish and hold for 5 seconds. Breathe through your nose.

6. Mmm’s

Press your lips together tight, hold for 10 seconds, relax your neck.

Learn more about head and neck cancer swallowing exercises

Safe Swallowing Strategies

compensatory swallowing strategies

Choose safe swallowing strategies for your patients based on the dysphagia signs and symptoms they present with.

Model each, then have the patient demonstrate it back to you.

Encourage daily practice, at least twice a day.

Educate patients and caregivers about the signs and symptoms of aspiration. See the aspiration risk factors below.

Safe Swallowing Strategies:

  1. Take a sip of your drink, look down at your lap, then swallow. 
  2. After each swallow, clear your throat and swallow again. 
  3. Hold each bite/sip in your mouth for 3 seconds, then swallow. 
  4. After each bite of food, take a sip of your drink. 
  5. Take small bites, one at a time. 
  6. After each bite, set your utensil down and eat slowly. 
  7. Swallow each bite/sip twice. 
  8. After each bite/sip, turn your head and then swallow. 
  9. Sit bolt upright whenever you eat or drink. 
  10. Sit upright for at least 30 minutes after eating. 
  11. Use a teaspoon or a small fork. 
  12. Swallow hard like you’re swallowing a whole grape. 
  13. Use your tongue to clear out any leftovers in your mouth. 
  14. Avoid straws and drink straight from the cup. 
  15. Use straws to avoid tilting your head back when you drink. 
  16. Place your medications in apple sauce, yogurt, or pudding. 
  17. Cut your pills in half. 
  18. Crush your pills and place them in apple sauce, yogurt, or pudding. 
  19. Avoid speaking while there’s food in your mouth. 
  20. Eat only when you feel awake and alert. 
  21. Reduce distractions while you eat. Do not watch TV or read. 

Aspiration Risk Factors

supraglottic swallow

Educate EVERY patient with dysphagia and their caregivers about the risk of aspiration.

Below are some of the signs and symptoms that someone is at higher risk of aspiration.

  • Dysphonia (“different” vocal quality)
  • Dysarthria (slurred speech caused by muscle weakness)
  • Abnormal cough
  • Coughing and voice change after swallowing
  • Needing help with feeding
  • Needing help with oral care
  • Resisting feeding
  • Poor dentition
  • History of smoking
  • Feeling full very quickly
  • Weight loss
  • Taking extra effort/time to complete meals
  • Dehydration
  • History of respiratory infections/pneumonia
  • Taking multiple swallows every bite or sip
  • Tongue pumping
  • Impulsive eating behaviors
  • Recurrent sore throat
  • Chest congestion
  • Shortness of breath
  • High-grade temperature

Adapted from UC San Diego School of Medicine, 2006

For more treatment ideas for speech-language pathologists, read How To Treat Dysphagia.

Swallowing Exercises Handout PDF

swallowing exercises handout with pictures

Your Swallowing Exercises Handout comes with 11 illustrations of common swallowing exercises.

Use these images along with the instructions in this article to help your patients learn their swallowing exercises.

More Resources

Check out our shop for more print-and-go dysphagia handouts, illustrations, and treatment guides.

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References

  • 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 pathology29(3), 1655–1673. https://doi.org/10.1044/2020_AJSLP-19-00132
  • 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 biology108, 104521. https://doi.org/10.1016/j.archoralbio.2019.104521
  • Kim, H. D., Choi, J. B., Yoo, S. J., Chang, M. Y., Lee, S. W., & Park, J. S. (2017). Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal of oral rehabilitation44(1), 59–64. https://doi.org/10.1111/joor.12461
  • Masako, F., Logemann, J. A. (1996). Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition. American Journal of Speech-Language Pathology. 5(1), 23-30. https://doi.org/10.1044/1058-0360.0501.23
  • Park, J. S., & Hwang, N. K. (2021). Chin tuck against resistance exercise for dysphagia rehabilitation: A systematic review. Journal of Oral Rehabilitation48(8), 968-977. https://doi.org/10.1111/joor.13181
  • Umay, E., Eyigor, S., Ertekin, C. et al. Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation. Dysphagia 36, 800–820 (2021). https://doi.org/10.1007/s00455-020-10218-8
  • Vose, A., Nonnenmacher, J., Singer, M.L. et al. Dysphagia Management in Acute and Sub-acute Stroke. Curr Phys Med Rehabil Rep 2, 197–206 (2014). https://doi.org/10.1007/s40141-014-0061-2
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