Dysphagia Rehab Exercises/Gadgets

IOPE (Iowa oral pressure instrument)

Builds up tongue strength at maximum effort.

Improves physiology of swallow and outcomes.

Gives biofeedback on device so that patient can see how weak/strong muscles are working (= improved self awareness)

Masako Maneuver

Patient sticks out their tongue, gently bites lip, and swallow

Increases anterior PPW movement; improves BOT to PPW movement

Mendelsohn maneuver

Hold highest laryngeal position for three seconds Strengthens suprahyoid muscles

Surface Electromyography for feedback

Effortful swallow with sEMG feedback

One study showed increased HL excursion, but questionable effect on the swallow.

Possible that sEMG is motivational for HEP compliance

EMST-150 device (Expiratory Muscle Strength Training)

Inhale and exhale into the device to work on muscle strength

Improve expiratory and submental muscle strength.

For dysphagia, voice, dysarthria

Head lift exercise

Isokinetic: Lay down, 30 head up reps as if looking at toes.

Isometric: head up staring at toes- hold for 1 minute Multiple studies show increase strength of suprayhoids, PES opening, and overall pharyngeal strength

Chin Tuck Against Resistance (CTAR)

Squeeze ball under chin while tucking

Strengthens suprahyoids similar to shaker, but easier and safer

McNeil Dysphagia Therapy Program (MDTP)

Effortful swallow with gradual increase in bolus volume and consistency/viscosity (called resistance)

Improves swallow with function with progressive load/resistance.

Includes oral and pharyngeal components

Gargling Exercise

Sustained gargle to engage tongue base

Increases tongue base retraction/movement

Neuromuscular Electrical Stimulation

Surface electrodes deliver current to contract muscles for strength training

Provides actual resistance to HL excursion; improved after exercise

Sensory stimulation

Apply sensory input to faucial pillars or use sour/cold/carbonated boluses to enhance swallow initiation

Temporarily reduces pharyngeal delay and increases swallow onset via sensory facilitation

LSVT

Loud phonation and pitch glides

Improves laryngeal adduction and airway protection