The mechanism of the safe swallow depends on a combination of voluntary and involuntary control of oral, laryngeal, pharyngeal, respiratory and esophageal muscles working together in harmony. Approximately 1 in 25 adults will experience dysphagia (difficulty with swallowing) every year. Swallowing problems can affect people of all ages, but becomes increasingly prevalent as we age. Conservative estimate are that 22% of adults of 50 have signs or symptoms of dysphagia. With such a high occurrence rate, speech pathologists are critical in the management of swallowing difficulties in all settings, including hospitals, skilled nursing facilities and people’s homes. Here are a few simple home swallowing exercises that are recommended to facilitate the maintenance of function and safety of the developed swallowing skills following dysphagia treatment.
1. Labial Seal Exercises
Without proper labial closure, we are unable to pull food off of a utensil, keep food or liquids in our mouths or create optimal intra oral pressure for swallowing safety. One of the easiest exercises to improve or maintain our labial seal it is simply press your lips together like you’re putting on Chapstick.
You can also increase the effectiveness of this exercise by placing a straw horizontally between your lips like you are holding a rose and keeping it there for 30-60 seconds while watching television or reading a book. We recommend you do at least 20 lip presses per day to maintain optimal strength. The added weight to these metal straws will help to strengthen the lips more than regular plastic straws and are also better for the environment.
2. Tongue Sweep Exercises
Even when we don’t have swallowing difficulty, little particles of food can get lodged between our gums and cheeks leaving residue that can either get stuck for prolonged periods of time to the point that we forget it is there, or it is eventually carried to the back of the mouth via saliva and are so small we do not trigger the swallow reflex which increases the risk of something falling into the lungs. To prevent oral residue, use lingual sweeps around your mouth between the cheeks and teeth starting from back side of right or left side of mouth to the other and complete on both top and bottom teeth.
This lateral movement of the tongue exercises can also be accomplished using these small lollipops placed into the mouth and moving it to each side between the teeth and cheeks using just your tongue to wedge it in the cheek on both sides, without use of your hands to guide the lollipop.
3. Base of Tongue Retraction Exercises
As food and liquids pass through our mouth and into our throats, the base of the tongue moves up and back into our throats. This helps to push down the flap (epiglottis) that protects our airway as we swallow, ensuring that everything we eat and drink bypasses our lungs and goes into the stomach. One way we can target this movement in the tongue is to pretend to make a strong /k/ or /g/ sound. Try pulling your tongue back like you are starting a K or G sound and hold it back there for 5-10 seconds. If this seems too challenging or confusing, try instead to repeat words that contain these sounds like, “cupcake, cuckoo, google, go-go” while emphasizing the k and g sounds in the word approximately 10 times each. Base of tongue exercises can also be accomplished by imitating the gag reflex, which brings the tongue base movement lower in the throat which triggers swallow function and epiglottic closure.
For a deeper stimulation and strengthening, these exercises may be easier to perform with some physical stimulation to the back of the throat. Use of the same small lollipops mentioned above or this ice finger can keep you from having to physically put your finger down your throat to elicit a gag reflex.
4. Effortful Swallow Exercises
Sometimes the best practice for improving or maintaining your swallow is to just do the action itself. The effortful swallow is simply completing a normal swallow, but pushing hard when you swallow. This is much like when you have to GULP down something rather large like a pill or a grape. If you find this exercise difficult to complete, try looking down at your chest and trying to make a hard swallow.
For those who may have weak neck muscles, there is a simple neck machine that can strengthen the accessory muscles around the laryngeal muscles to assist with developing your effortful swallow technique. BONUS: It can also help prevent a double chin!
5. Respiratory Exercises
Development of the strength and coordination of our breathing muscles not only allow the oral cavity to create pressure to help facilitate pushing food through the swallow passages, it can also help to improve cough efficiency for clearing airway should something accidentally fall into the wrong passage. To improve your respiratory strength, try taking as deep a breath in as you can, and without leaking out any air, hold it in for 10-15 seconds, and then control the release of air and blow out for 10-15 seconds. Obviously , the longer you can hold and expire, the better and the stronger the muscles will become.
If you are working with someone who has difficulty with coordination, using bubbles or trying to blow a cotton ball across a table while blowing through a straw without stopping can help to accomplish controlled respiratory breathing. If you really want to strengthen respiratory muscles, use this measured expiration device to gauge your progress and ensure continued progression of function.
Any person who suffers from swallowing difficulties regardless of the different signs and symptoms should immediately be seen by a professional speech language pathologist (SLP) to ensure swallow safety, obtain appropriate diet recommendations and identify the need and effectiveness of compensatory strategies. Following swallowing therapy, these exercises can serve as a guide to help to maintain function and progress for those who do not have access to professional devices or who reside in home or facilities with no therapist onsite. For more information or to talk with a skilled speech pathologist, please contact us here or email us at hcstraightup@gmail.com.
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