There are many things that can be causes of difficulty swallowing, called dysphagia, such as: Alzheimer's disease, head and neck cancer, Muscular Dystrophy, traumatic brain injury (TBI), stroke, Parkinson's disease, Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Guillain-Barre syndrome, and Huntington's disease. Difficulty swallowing symptoms may include any of the following: coughing or choking while eating or drinking or after meals, trouble swallowing food, a feeling that foods or pills are getting stuck in the throat or going down "the wrong way", tears or nasal drip during meals, facial reddening during meals, pain or burning during or after swallowing, or a wet or gurgly vocal quality after swallowing.
There are a few different swallow tests which can determine if a person has a swallowing problem (dysphagia) or not, how severe the dysphagia may be, and what diet modifications and/or swallowing exercises may be needed. A speech language pathologist can do a Bedside Swallow Evaluation which does not have to be done in bed. The speech language pathologist will check your mouth, lips, and tongue and observe you eating and drinking. Many times that is enough for an SLP to determine that you have difficulty swallowing symptoms (dysphagia) and she can begin dysphagia treatment to improve your swallow function and manage your swallowing difficulty symptoms and risks of aspiration.
If the Bedside Swallow Eval is inconclusive, she may refer you to an outpatient hospital speech language pathologist to have either a Fiber-optic Endoscopic Evaluation of Swallow test (FEES) or a Modified Barium Swallow Study (MBSS) done. The MBSS is often referred to by many different names, such as: swallow test, swallowing test, barium swallow test, swallow study, and Video Fluoroscopy Swallow Study (VFSS). Both, the swallow study and the FEES are quick and easy tests, but the equipment used for the tests is very expensive, so it is usually only available at hospitals. Anyone who is having difficulty swallowing symptoms should immediately consult with a physician about having a swallow test by a speech-language pathologist for dysphagia and receiving dysphagia treatment if needed. Or, if the swallowing difficulty is more urgent, your physician may want you to have a MBSS (Modified Barium Swallow Study) done immediately.
If it is determined that you have dysphagia, your speech-language pathologist may recommend that you practice the following exercises during therapy and at home, as well as compensatory strategies, to improve your swallow function and safety.
1. The Shaker Exercise
Lie on your back on a bed or sofa without a pillow. Slowly raise your head up so that you can look at your feet, then slowly lower it back down. Repeat until the muscles in your neck feel fatigued.
2. The Shaker Exercise - Extended Hold
Lie on your back on a bed or sofa without a pillow. Slowly raise your head up so that you can look at your feet and hold it there for 30 seconds. Slowly lower it back down. Repeat until the muscles in your neck feel fatigued.
3. Showa's Maneuver
Press your tongue flat against the roof of your mouth and hold it there while you swallow hard, squeezing the muscles in your face and neck tightly. Repeat this exercise after each of the other exercises.
4. Masako's Technique
Protrude the tongue out of the mouth and hold in that position, between the teeth, as you swallow . Repeat this exercise after each of the other exercises.
5. Chin Tuck Against Resistance
Use a rubber ball, your hand, or an ISO-SED to provide resistance under your chin as you press your chin downwards towards your chest, into a chin tuck position. Repeat until the muscles in your throat feel fatigued. This exercise is contraindicated for people with neck injuries.
6. Jaw Opening Against Resistance
Use a rubber ball, your hand, or an ISO-SED to provide resistance under your chin and while holding your head still, slowly open your mouth as widely as possible. Then, slowly close your mouth. Repeat until the muscles in your neck/throat feel fatigued. This exercise may be contraindicated for people with TMJ.
7. Supraglottic Swallow
Take a deep breath and hold while you swallow. Exhale and clear your throat and then swallow again. Repeat after each of the other exercises.
8. Lateralizing Tongue Press Against Resistance
Press your tongue into your right cheek. Gently press against it with your hand to provide resistance and hold for 30 seconds. Then do the same thing on the left side. Alternate back and forth until your tongue muscles become fatigued.
Jolie Parker, MS CCC-SLP is a speech-language pathologist with over 19 years experience who specializes in dysphagia rehabilitation. She is co-owner of Alternative Speech and Swallowing Solutions, co-inventor of the ISO Swallowing Exercise Device. She is author of the ASHA approved CEU course for speech language pathologists: Using the ISO Swallowing Exercise Device in Dysphagia Therapy (ceualliedhealth.com). She is a current ASHA member.