An intensive swallowing exercise protocol for improving swallowing physiology in older adults with radiographically confirmed dysphagia

Figures & data

Table 1 Swallowing exercises completed in each set of exercises

Exercise	Reps per set	Targeted outcome	Instruction
Effortful swallow	20	Increase muscular activation of the pharyngeal constrictors and base of tongue^Citation25	1. Push your tongue up to the roof of your mouth 2. Swallow “hard” with effort 3. Pretend you are swallowing a golf ball
Tongue-hold swallow	20	Increased contraction of the superior pharyngeal constrictor muscle^Citation26	1. Hold your tongue gently between your teeth 2. Swallow your saliva with your tongue in this position
Supraglottic swallow	20	Volitional laryngeal vestibule closure^Citation27	1. Take a breath and hold it 2. Swallow with effort 3. Cough
Shaker exercise	20	Strengthening of hyolaryngeal elevation muscles^Citation28	1. Lie flat on your back 2. Lift only your head and look at your toes (do not lift your shoulders) 3. Hold this position for 1 second and then lower your head
Mendelsohn maneuver	20	Volitional prolonging of hyolaryngeal elevation and upper esophageal sphincter opening^Citation29	1. Begin a regular swallow 2. As you feel your larynx move in an upward direction, squeeze your muscles 3. Maintain this position for up to 5 seconds 4. Relax and finish the swallow
Effortful pitch glide	10	Shortening and constriction of the pharynx^Citation30	1. Take a deep breath 2. Say the sound “eee” with effort moving from a low pitch to a high pitch

Table 2 Comparison of swallowing impairment and physiology from pre-treatment to post-treatment

	PAS score		MBSImP oral total		MBSImP pharyngeal total
	Pre-tx	Post-tx	Pre-tx	Post-tx	Pre-tx	Post-tx
Median	3	1	4	4	10	7
Min	1	1	2	1	7	3
Max	7	8	9	6	14	11
Z	−0.42		−2.132		−2.257
P	0.67		0.033		0.024

Note: Bolded results signify statistical significance.

Abbreviations: Max, maximum; Min, minimum; MBSImP, Modified Barium Swallowing Impairment Profile; PAS, Penetration–Aspiration Scale; Tx, treatment.

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