Exercise Protocols

Evidence-based swallowing exercises targeted to specific physiological impairments. Select exercises based on MBSImP findings for individualized treatment planning.

Shaker Exercise (Head Lift)

Strengthening exercise for the muscles that open the upper esophageal sphincter and elevate the larynx

Suprahyoid muscles, UES opening
Frequency: 3 times daily
Duration: 6 weeks minimum

Chin Tuck Against Resistance (CTAR)

Strengthening exercise using resistance to improve hyolaryngeal excursion

Suprahyoid muscles
Frequency: 3 times daily
Duration: 4-6 weeks

Jaw Opening Exercise (JOCE)

Active exercise to strengthen muscles that open the jaw and assist with hyoid elevation

Suprahyoid muscles, anterior belly of digastric
Frequency: 3 times daily
Duration: 4-6 weeks

Effortful Pitch Glide

Vocal exercise to improve laryngeal elevation through pitch manipulation

Laryngeal elevation
Frequency: 3 times daily
Duration: 4-6 weeks

Masako Maneuver (Tongue Hold)

Exercise to strengthen the pharyngeal wall by increasing effort during the swallow

Pharyngeal constrictors, tongue base
Frequency: 3 times daily
Duration: 4-6 weeks

Tongue Strengthening Exercises

Progressive resistance exercises to increase tongue strength and control

Tongue muscles (intrinsic and extrinsic)
Frequency: 3 times daily
Duration: 8 weeks

Tongue Range of Motion Exercises

Exercises to improve tongue mobility and coordination for oral phase functions

Tongue mobility
Frequency: 3 times daily
Duration: Ongoing as needed

Lip Strengthening and ROM

Exercises to improve lip closure and control for bolus containment

Orbicularis oris, lip muscles
Frequency: 3 times daily
Duration: 4-6 weeks

Expiratory Muscle Strength Training (EMST)

Respiratory exercise using a threshold device to improve cough strength and airway protection

Expiratory muscles, submental muscles, vocal fold closure
Frequency: 5 days per week
Duration: 4-8 weeks

Vocal Fold Adduction Exercises

Exercises to improve vocal fold closure for airway protection

Vocal folds, laryngeal musculature
Frequency: 3 times daily
Duration: 4-6 weeks

McNeill Dysphagia Therapy Program (MDTP)

Systematic exercise program using real food swallows with progressive challenge

Swallowing system globally
Frequency: 3-5 times per week with clinician
Duration: Variable based on progress

Mendelsohn Maneuver (Exercise Version)

Exercise to improve and prolong laryngeal elevation and UES opening duration

Laryngeal elevation, PES opening
Frequency: 3 times daily
Duration: 4-6 weeks

Effortful Swallow (Exercise Version)

Strengthening exercise to increase pressure generation during the swallow

Tongue base, pharyngeal muscles
Frequency: 3 times daily
Duration: 4-6 weeks

Supraglottic Swallow (Exercise Version)

Exercise to improve voluntary airway closure before and during the swallow

Vocal fold closure, airway protection
Frequency: 3 times daily
Duration: 4-6 weeks

LSVT LOUD / SPEAK OUT!

Intensive voice treatment that can have carryover benefits to swallowing

Voice, respiratory support, swallowing
Frequency: 4 times per week
Duration: 4 weeks intensive

Exercise Prescription Guidelines

  • - Select exercises based on identified physiological impairments
  • - Consider patient fatigue and overall tolerance
  • - Progress exercises gradually as strength/coordination improves
  • - Provide written home exercise program when appropriate
  • - Schedule follow-up to monitor progress and adjust program

Important Notice

Exercise protocols should be individualized based on patient presentation, medical status, and cognitive ability. Some exercises require physician clearance (especially those involving breath-holding or increased intrathoracic pressure). Always consider contraindications and monitor for adverse effects.