speech and swALLOWing exercises

Patients with head and neck cancer may be treated with surgery, radiotherapy, chemotherapy or a combination of these modalities. Each treatment type may have a negative impact on post-treatment swallowing function.

How often should you complete the exercises?

Aim to complete each exercise x4 per day, x10 repetitions each time, unless advised otherwise.

instructions for swallowing exercises

Strap muscle exercises

The strap muscles in the neck move the larynx (voice box) up and out when you swallow to protect your airway and help food and fluids pass through to your oesophagus (gullet). These exercises work on strength and flexibility.

Shaker exercise:

Lie flat on your back (on the floor or bed). Keep your shoulders on the floor or bed.

Part 1:

Raise your head to look at your toes.
Hold this position for 1 minute (you may need to gradually build up to this time), then relax for 1 minute.
Repeat 2 more times.

Part 2:

Raise your head to look at your toes, and then relax your head back down.
Repeat 30 times in a row.

Mendelsohn manoeuvre:

Place your fingers on your larynx (voice box).
Swallow your saliva.
You will be able to feel your larynx lift and lower as you swallow.
Now swallow again. When you feel your larynx lift, don’t let it drop. Hold your larynx up in that position with your throat muscles for several seconds.
Relax and breathe normally.

Falsetto:

Take a deep breath and let it out on an ‘ee’
Slide up the scale as high as you possibly can until you reach a high squeaky voice
Hold that high voice for as long as you can
Rest

Base of tongue exercises

The base of your tongue creates pressure to initiate your swallow and help push food toward your oesophagus. These exercises are designed to strengthen the base of your tongue and improve the pressure which helps to push your food and drink down.

Masako/Tongue hold exercise:

Hold your tongue firmly between your teeth.
Swallow your saliva (you may feel tension in the throat and difficulty starting the swallow).
This exercise can be modified by your SLT if you are unable to complete it.

Effortful swallow:

As you swallow, squeeze hard with all of your throat muscles.
Feel as though you are putting extra effort into your swallow.

Tongue retraction:

Pull your tongue back in your mouth as far as possible.
Hold for one second then relax.

Gargle:

Pull your tongue back in your mouth.
Pretend to gargle as hard as possible.
Hold for five seconds then relax.

Voice exercise

To help maintain laryngeal flexibility.

Pitch glides:

Gentle humming up and down a scale

Benefits

While further research in this area is needed, completing exercises during and/or after radiotherapy treatment may support:

Improved swallowing/voice function.
Shorter duration of non-oral feeding.
Improved weight maintenance/gain.
Reduced restrictions on oral diet.
Improved swallowing-related quality of life.
Reduced or delayed impact of radiation-induced fibrosis (thickening and scarring of tissue causing stiffness/reduced flexibility).

In addition to completing swallowing rehabilitation exercises (or if you are unable to carry these out) it is important to continue swallowing food, fluids, and saliva as much as possible as swallowing itself is an effective exercise.