Thursday, June 12, 2014

Let's Talk Dysphagia - Top Ten List: Swallowing Exercises

Lately, I have been treating a large variety of patients whom have dysphagia.  Dysphagia, which is pronounced (dis-FAY-ja) is a swallowing problem that is often caused by weakness; or a loss of feeling in your tongue, lips, palate and/or throat.

The causes of dysphagia are wide in range and can result from such things as: a stroke, disorders like Parkinson's or Multiple Sclerosis, a head injury, and even a recent intubation that was needed for help with breathing for a surgery (the tubes that have been put in place for the surgery can hurt surrounding throat muscles).

As a speech-language pathologist who works in an outpatient hospital clinic, I often see patients who have previously undergone a swallow evaluation at the hospital.  The swallow evaluation was probably performed by a speech-language pathologist who either completed a bedside swallow evaluation and diagnosed the dysphagia after watching the client eat food and liquids, or, after they underwent a video swallow study in which an evaluation was completed via X-ray.  The video swallow studies are awesome because they show the swallow happen in real time.  The client is asked to eat or drink food or liquid that has barium mixed in it and this barium is what helps to show where the food and liquid goes during the moving X-ray.  It is a very nice way to see if a person is having trouble getting the food straight down into their stomachs and down into their esophagus safely, or if the food or liquid is going other places, like getting stuck in areas of the throat or accidentally going down the windpipe.When a person has food or liquid that goes down their windpipe (trachea), that is when they have had the occurrence of aspiration.  Aspiration is dangerous because it can often cause pneumonia. It is this dangerous occurrence of aspiration that inspires an SLP/dysphagia therapist to help increase their client's awareness of and to help prevent from happening.  The following picture shows aspiration of a liquid during a video swallow study. The liquid in the front of picture has left the esophagus and has gone past the vocal cords and is heading towards the lungs. When the food or liquid enters the lungs, bacteria may form around the substance and aspiration pneumonia could result.

During dysphagia treatment, therapists provide a large amount of safe swallow strategies and food and liquid alternation suggestions to clients.  They also work on strengthening the swallow and that is what leads me up to today's top ten list!  Here are ten swallowing exercises that I like to teach my clients in order to help improve the strength in the back of their tongues.  This back of the tongue area connects to swallowing muscles and it is hoped that by improving the tongue strength in back, that we also improve the swallow timing and accuracy. Please see the following picture to notice how close the back of the tongue is in relation to the swallowing muscles that are in the back of the throat.

Disclaimer: It is advised that these exercises be completed only after a trained therapist who is familiar with dysphagia treatment has explained and modeled them correctly, and only after the therapist has advised them after completing a swallow evaluation. Twin Sisters Speech & Language Therapy LLC is not liable for any problems or medical concerns that may result from the advice presented here. Please do these swallowing exercises at your own risk. 

Top Ten List: 
Swallow Strengthening Exercises

1) Swallow hard.  Swallow and as you do, tighten all of the muscles of the throat.  I tell my clients to "squeeze" as you swallow. Repeat 10 times. 

2) Say, "GA" strongly.  Push out the "g" sound very hard. Repeat 10 times.

3) Gargle.  This should NOT be done with liquids!  I tell my clients to pull back their tongues and to hold "gaaaaa". Repeat 10 times.

4) Tongue back. Pull the tongue straight back and hold it there for five seconds. Repeat 10 times.

5) Yawn. Pretend to yawn by opening the mouth wide.  Yawns helps to pull the tongue back and the back of the tongue connects to the swallowing muscles. Repeat 10 times.

6) Say "ball" and exaggerate the "l" sound for five seconds. Repeat 10 times.

7) Tongue out.  Stick your tongue out forward until you feel a slight pull.  Hold for five seconds. Repeat 10 times.

8) Say, "KA" strongly.  Push out the "k" sound very hard. Repeat 10 times.

9) Tongue out & swallow. Stick out the tip of your tongue between your front teeth, VERY GENTLY bite down on the tongue to keep it from slipping away, then swallow.  This one is tricky, but can be achieved with practice! Repeat 10 times. 

10) Cough. Take a big breath and try to cough hard. This is a nice thing to practice as a strong cough can protect your airway from liquids and solids remaining in there once they have been aspirated. 

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