Swallowing Exercises for Dysphagia from Neurological Causes

Swallowing can be a challenge after a stroke
Getty Images/ Jose Luis Pelaez

While swallowing is considered an effortless, reflexive action, it's actually quite a complicated and coordinated maneuver among many muscles and nerves.

This is why neurological conditions, which are characterized by damage to the brain, spinal cord or nerves, can result in difficulties swallowing (called dysphagia).

Neurological Causes Of Dysphagia

The most common neurological conditions associated with dysphagia include:

  • Stroke
  • Head trauma
  • Multiple sclerosis
  • Cerebral palsy
  • Dementia
  • Tumors of the brain or spinal cord
  • Cervical spine injury
  • Motor neuron disease 
  • Myopathy

Depending on the specific neurological condition, a person may experience dysphagia for unique reasons. For example, with a stroke, a person may have difficulties swallowing because there may be an absent or delayed swallowing reflex, weakened throat muscles, and difficulty controlling tongue movements.

In Parkinson disease, dysphagia may occur from a delayed swallow response, as well as a symptom called tongue pumping, in which a person's tongue moves back and forth repetitively preventing food from leaving the mouth.

Symptoms and Complications Of Dysphagia

Swallowing difficulties can result in an excess production of saliva, drooling, coughing or choking during eating, and even difficulty speaking or a hoarse voice. An infection of the lungs called aspiration pneumonia may also occur, as can malnutrition and dehydration.

To avoid these complications of dysphagia, the evaluation of neurological illness often involves a formal swallowing assessment. This can help identify dysphagia before complications occur.

Exercises for Dysphagia

Therapies designed to improve swallowing are focused on strengthening muscles and building coordination of the nerves and muscles involved in swallowing.

In fact, exercising your swallowing muscles is the best way to improve your ability to swallow.

In addition to the exercises you may do with your speech and swallow therapist, you can also improve your swallowing function with at-home swallowing exercises.

Here are some swallowing exercises developed by dysphagia rehabilitation experts:

Shaker Exercise

This simple exercise can strengthen muscles to improve your swallowing ability.

To perform this exercise, lie flat on your back and raise your head as though you were trying to fixate your gaze on your toes. While you do this, make sure not to raise your shoulders.

It is best to do this exercise three to six times per day for at least six weeks. If you are able to successfully carry it out, then you can prolong the duration of each head lift and increase the number of repetitions.

Hyoid Lift Maneuver

This exercise will help you build swallowing muscle strength and control.

Place a few small pieces of paper (about one inch in diameter) over a blanket or a towel. Then place a straw in your mouth and suck one of the pieces of paper to its tip. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar container and stop sucking.

This will release the paper into the container.

Your goal for each session is to place about five to 10 pieces of paper into the container.

Mendelsohn Maneuver

This simple exercise is very effective at improving the swallowing reflex. It involves swallowing your own saliva. Normally, as the saliva enters the area just behind your mouth while swallowing, your Adam's apple (the hard area about halfway down the front of your neck) moves up and then back down.

To do this exercise, keep your Adam's apple elevated for about two to five seconds each time. In order to better understand the movement, you can keep your Adam's apple elevated with your fingers at first.

Repeat this exercise several times per day until you are able to control your swallowing muscles without assistance from your hands.

Effortful Swallow

The purpose of this exercise is to improve the contact and coordination between the different muscles used during the act of swallowing.

In essence, the exercise consists of swallowing. But as you do it, you must try to squeeze all of the muscles of swallowing as hard as you can. You do not need to swallow food during the exercise. Just a dry swallow will do.

Perform this exercise five to 10 times, three times per day to strengthen your muscles.

Supraglottic Swallow

You should try this exercise without food first. As you become better at the exercise, you can try it with actual food in your mouth.

This exercise consists of three simple steps:

  • First, take a deep breath
  • Hold your breath, as you swallow
  • Cough to clear any residues of saliva or food which might have gone down past your vocal cords

Super Supraglottic Swallow Maneuver

This exercise is just like the supraglottic maneuver described above, but with an extra twist.

After you take that deep breath, bear down while swallowing. The pressure generated helps with swallowing and increases the strength of your swallowing muscles.

A Word From Verywell

If you or a loved one has dysphagia from a neurological cause, these exercises can improve swallowing and help prevent aspiration and malnutrition.

During swallow rehabilitation, your therapist may also recommend dietary changes to improve swallowing like using a straw or spoon, taking smaller bites of foods, or using a thickener to bulk up thin liquids.

Sources:

Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of swallowing and cough functions following stroke: An expiratory muscle strength training trial. Arch Phys Med Rehabil. 2016 Aug;97(8):1345-51.

Lembo AJ. (2017). Oropharyngeal dysphagia. Talley NJ, ed. UpToDate. Waltham, MA: UpToDate Inc.

Rofes L, Arreola V, Mukherjee R, Swanson J, Clavé P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment Pharmacol Ther. 2014 May;39(10):1169-79.

Tjaden K. Speech and swallowing in Parkinson's disease. Top Geriatr Rehabil. 2008;24(2):115-26.

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