Dysphagia Series: Swallowing Exercises & Strategies – FREE Patient Handout

First Things First


The American Speech-Language Hearing Association, better known as ‘ASHA’, defines dysphagia as “problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.” ASHA’s website has a great overview of dysphagia.

Treating dysphagia requires high levels of training and skill.

This article is intended for Speech Language Pathologists or other qualified therapists with the appropriate training and competency to work with adults with dysphagia.


We’ll go over:

1. Common signs of dysphagia and how to treat them
2. Swallowing exercises
3. Compensatory swallowing strategies
4. Signs and symptoms of aspiration (FREE patient handout)

Virtual Speech Therapy Swallowing Evaluation SLP Eval Forms image 0


Signs of Dysphagia & How to Treat Them


1. Anterior spillage

Treatment: Thickened liquids, Labial exercises

2. Inadequate mastication

Treatment: Modified diet textures, Lingual exercises

3. Uncoordinated oral phase

Treatment: Bolus hold, Lingual exercises

4. Oral residue

Treatment: Alternating bites and sips, Lingual exercises

5. Pharyngeal pooling

Treatment: Thickened liquids, Small bites and sips, Bolus hold, Chin tuck, Lingual exercises

6. Nasal regurgitation

Treatment: Small bites and sips, Thinner consistencies, Masako maneuver, Mendelsohn maneuver, Shaker exercise

7. Reduced epiglottic movement

Treatment: Mendelsohn maneuver, Effortful swallow

8. Vallecular residue

Treatment: Dry swallow, Alternating bites and sips, Chin tuck, Effortful swallow, Mendelsohn maneuver, Lingual exercises, Masako maneuver

9. Reduced opening of UES

Treatment: Head turn. Mendelsohn maneuver, Shaker exercise

10. Pyriform sinus residue

Treatment: Dry swallow, Alternating bites and sips, Head turn, Mendelsohn maneuver, Effortful swallow

* 11. Laryngeal penetration

Treatment: Thickened liquids, Small bites and sips, Bolus hold, Chin tuck, Mendelsohn maneuver, Effortful swallow


When to refer for a Swallowing Evaluation?

*If you suspect laryngeal penetration or aspiration, you may need to refer the patient for a Modified Barium Swallowing Study (MBSS) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

Also consider ordering a MBSS or FEES when upgrading a patient from thickened liquids to thin liquids

Until these evaluations are completed, you can monitor the patient’s lung sounds, educate on overt signs and symptoms of aspiration, and train in the use of safe swallowing strategies, exercises, and modified diet textures. Read on for details!


Swallowing Exercises

Below are a list of common swallowing exercises. Pick and choose for your patients based on the signs and symptoms they present. Modify as appropriate.

Provide a list of the exercises you recommend. Model each, then have the patient demonstrate it back to you. Encourage daily practice, at least twice a day.

* Educate patients and caregivers about the signs and symptoms of aspiration. Read ahead for a free patient handout.


Pharyngeal Exercises

Effortful swallow: Swallow your saliva HARD, pretend that you’re swallowing a whole grape, and repeat 10 times.

Mendelsohn maneuver: Swallow your saliva and feel your Adam’s apple move up and down. Swallow your saliva again, but halfway through the swallow, hold your Adam’s apple up using the muscles under your chin. Hold it for 1-3 second.

Monkey EEE: Say “eee” in your normal voice then quickly glide up to say a high pitched “eee,” repeating x3 in a row, pause, then repeat again.

Shaker: Lay flat on your back, do not use a pillow. Raise your head to look at your toes (keep your shoulders on the ground) and hold for up to 60 seconds. Breathe through your nose. Relax back down for 60 seconds. Complete two more times. Then, raise your head and hold up for 3 seconds. Relax down and repeat up to 30 times.

Chin tuck against resistance: (use in place of the Shaker exercise with patients physically unable to lay flat on their backs. Such as people with chronic back pain). While seated, place a rolled-up hand towel under your chin, pressed lightly against your neck. Press your chin down into the towel, keep your spin straight, and hold for up to 60 seconds. Relax for 60 seconds. Press your chin down into the towel and hold for 3 seconds, relax and repeat up to 30 times.

Super spraglottic swallow: Take a deep breath and hold it tight, take a bite or a sip, swallow hard, cough, then breathe.


Lingual Exercises

Masako maneuver: Stick your tongue out and hold it gently between your lips, swallow while sticking your tongue out.

Hawk: (use this with patients who have difficulty completing the Masako). Say the word “hawk,” emphasizing the “k” sound.

Superior lingual press: Tough your tongue tip to the roof of your mouth, where it feels softer, then press and hold for 20 seconds.

Lateral lingual press: Push your tongue inside your cheek and hold for 10 seconds, switch sides and hold for 10 seconds. You can also press your fingers against your cheek to add some resistance.

Anterior lingual press: Stick out your tongue tip as far out as it can go, hold for 10 seconds, relax and repeat. You can also press your tongue tip against the back of a spoon to add some resistance.

Gargle: Pretend to gargle for 10 seconds.


Orofacial Exercises

Lip Pucker: Purse your lips like you’re about to whistle and hold for 5 seconds. Press your lips against the back of a spoon to add some resistance.

Pucker side-to-side: Purse your lips then stretch your lips over to the right, hold for 5 seconds, and then stretch your lips over to the left, hold for 5 seconds.

Smile: Showing your upper and lower teeth and gums, clench your teeth gently, avoid squinting your eyes or tensing your neck, hold for 5 seconds.

Pucker/Smile: Purses your lips like you’re about to whistle, hold for 5 seconds, then smile wide for 5 seconds. Do not tense your neck muscles.

Cheek puffs: Puff out your cheeks like a blow fish and hold for 5 seconds. Breathe through your nose.

Mmm’s: Press your lips together tight, hold for 10 seconds, relax your neck


Compensatory Swallowing Strategies

Below is a list of common compensatory swallowing strategies. Pick and choose for your patients based on the signs and symptoms they present.

Provide a list of the exercises you recommend. Model each, then have the patient demonstrate it back to you. Encourage daily practice, at least twice a day.

* Educate patients and caregivers about the signs and symptoms of aspiration. Read ahead for a free patient handout.

Chin Tuck: Take a sip of your drink, immediately look down at your lap, then swallow.

After each bite of food, take a sip of your drink.

Take small bites, one at a time.

After each bite, set your fork down and eat slowly.

Effortful swallow: Every time you swallow, swallow HARD like you’re trying to swallow a whole grape.

Swallow each bite and sip TWICE before taking another bite or sip.

Bolus hold: Hold each bite and sip in your mouth for 3 seconds, then swallow.

After each bite and sip, turn your head and then swallow.

Super supraglottic: Hold your breath and bear down, take a small sip and swallow, pause and then cough.

Sit bolt upright whenever you eat or drink something.

Sit upright for at least 30 minutes after eating.

After each swallow, clear your throat hard and swallow again.

Use your tongue to clear out any leftovers in your mouth.

Avoid straws and drink straight from the cup.

Use a straw to avoid tilting your head back when you drink from a cup.

Place your medications in a carrier, such as apple sauce, yogurt, or pudding.

Cut your pills in half.

Crush up your pills and place them in a carrier, such as apple sauce, yogurt, or pudding.

Avoiding speaking while there’s food in your mouth.

Eat only when you feel awake and alert.

Reduce distractions while you’re eating, do not watch TV or read a book while eating.

Aspiration Risk Factors (FREE printable patient handout)


* It’s important to educate EVERY dysphagia patient and their caregivers about the risk of aspiration.

Thehomehealthslphandbook.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.