![]() Lingual exercises with resistance using the IOPI, the Tongue-O-Meter, or tongue depressors. ![]() Straw drinking, decreasing the size of the straw to make the task more difficult.Labial press, by holding a tongue depressor between the lips during swallowing exercises.Increased bolus size may also help to drive the UES opening. Changes in the size of the bolus, which may increase load of the bolus, thereby increasing the sensory component of the swallow, which many elderly patients need.External pressure to the cheek or to the tongue, for example by using a spoon.Changes in flavor, which may increase sensory input of the swallow, driving the motor output.Carbonated beverages, which may increase speed of the swallow through sensation.Try these exercise plans for the following swallowing issues, featuring exercises available in MedBridge’s HEP library. Often, exercise programs or pages of exercises are passed down in a facility and used for years with no adaptation to current evidence or changes to individualize the exercises to suit the patient’s needs. Simple range-of-motion exercises such as sticking out your tongue with no resistance do not lead to increased swallow strength. But when you are working to strengthen swallowing muscles, you should incorporate the following in your exercise plan:Įxercises need to progress and require resistance and intensity to increase strength. Not every patient will require exercises for strengthening since not every patient with dysphagia has a strength issue. When we prescribe exercises for our patients, are we using exercise science? Exercise science principles include: Think about the principle of “use it or lose it” and how it relates to those patients who are strict NPO. We also need to make sure that we are increasing the repetition and intensity of the prescribed exercise. Exercises such as repeating words that begin with /k/ or /g/ or tongue movements are not swallow-driven. This means including exercises that are swallow-driven. We also need to be mindful that when we are rehabilitating the swallow, we need to have the patient practice swallowing. ![]() The principles of neuroplasticity should drive our therapy plan. When we are creating a dysphagia treatment plan, we need to be mindful not only of the swallowing physiology and dysfunction-whether it be sensory or motor driven-but we also need to remember the principles of neuroplasticity and exercise physiology. We can then make the appropriate recommendation for an instrumental exam, whether it be FEES or VFSS to determine the pharyngeal physiology. This includes a complete clinical swallow evaluation with a complete history and chart/records review, brief cognitive exam, oral motor exam, and a thorough cranial nerve exam. First, we need an accurate assessment to determine the physiology and dysfunction of the swallow. ![]() When choosing the most appropriate exercise routine or plan of care for each patient, we have to keep several things in mind. Helping to rehabilitate someone with dysphagia so the person can eat and drink safely and in the most effective means can be quite a rewarding experience. ![]()
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