This topic might seem a little off the dysphagia path—but trust me, it’s not. I’ve been thinking a lot lately about NSOMEs (Non-Speech Oral Motor Exercises)—or, as I like to call them, Non-SWALLOWING Oral Motor Exercises.

Recent discussion of NSOMES got me reflecting on how these exercises are still widely used in swallowing rehab—and whether they should be.

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What Are NSOMEs?

NSOMEs are oral motor movements that are not tied to speech or swallowing. Think: “stick out your tongue ten times,” “move your tongue side to side,” or “open and close your jaw.” These exercises are often used with the goal of strengthening the oral mechanism—but here’s the question: are they actually effective for improving swallowing?

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The Problem with Non-Swallowing Exercises

If you’ve ever observed SLPs in a facility, you’ve probably seen these types of exercises prescribed as the core of dysphagia therapy. Often it’s a list: stick out your tongue, touch your nose with your tongue, move your tongue corner to corner—all repeated 10 times, 3 times a day. But how many patients truly improve their swallow function from these drills alone?

In my experience—very few.

Why? Because the swallowing system doesn’t just need to be exercised—it needs to be exercised specifically and functionally.

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Neuroplasticity and Functional Swallowing

Robbins et al. (2008) laid the groundwork for understanding how neural plasticity impacts dysphagia rehabilitation. One of the key principles is specificity—neural changes occur only when the task being practiced is directly related to the desired function. In simpler terms: if you want to improve swallowing, the patient needs to actually swallow.

Swallowing is a complex, coordinated action. You can’t isolate it by working the tongue or jaw in a vacuum and expect results. The best exercise for swallowing is—swallowing.

Read more about Neuroplasticity.

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Exercise Principles in Dysphagia Therapy

Dysphagia rehabilitation is evolving into an exercise-based, evidence-driven field. As therapists, we need to understand and apply the principles of exercise science:

• Specificity: Train the movement you want to improve (i.e., swallowing).
• Repetition: High frequency of task practice is needed to drive change.
• Intensity: Exercises must be challenging enough to push adaptation.
• Progression: Exercises should get harder as the patient improves.
• Use it or lose it: Neural function and motor ability decline without ongoing use.

These are not just physical therapy principles—they apply to us, too.

You can read more about exercise Principles here.

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Evidence-Based Swallowing Exercises That Actually Work

Here are some of the swallowing-specific, evidence-supported exercises I use in my practice:

1. Tongue Resistance Exercises

Robbins et al. (2005) used the Iowa Oral Performance Instrument (IOPI) to strengthen tongue muscles and improve swallowing. Lazarus et al. (2003) compared tongue depressor resistance to IOPI and found similar benefits. I often use tongue depressors for resistance-based tongue movements (protrusion, elevation, depression, lateralization)—10 reps each, 5x/day, 5 days/week.

2. Mendelsohn Maneuver

This maneuver incorporates both resistance and functional swallowing. If you have access to sEMG biofeedback, you can enhance resistance and monitor muscle engagement. (Robbins et al., 2008; Frymark et al., 2009)

3. Masako Maneuver (with Caution)

While the Masako involves swallowing with the tongue held between the teeth (to improve tongue base retraction), it’s not a natural motion and should not be the sole exercise used. I pair it with the Mendelsohn for improved outcomes. (Robbins et al., 2008)

4. Shaker Exercise / Chin Tuck Against Resistance (CTAR)

The Shaker exercise adds resistance using the head’s weight. It improves UES opening and hyolaryngeal elevation. But caution is advised, especially in cardiac patients. An alternative I’ve heard of—though not yet supported by research—is using the Neckline Slimmer with the strongest spring. Use clinical judgment here.

5. Effortful Swallow

This exercise involves the patient swallowing hard while forcefully pushing the tongue against the palate. It increases intraoral pressure and recruits more muscle groups. (Bulow et al., 1999; Robbins et al., 2008; Frymark et al., 2009)

6. Bolus Manipulation

I also use real food and liquid modifications as exercise tools—changing the bolus texture, consistency, and weight to increase challenge. One favorite: pudding through a straw—then progressing to smaller straws. This targets both strength and coordination in a functional way.

For patients who aren’t ready for real food, try mesh feeders or gauze with resistance chewing.

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When NSOMEs May Be Useful

I’ll admit—I do occasionally use NSOMEs, especially for patients recovering from radiation therapy. In these cases, soft tissue and muscular restriction require oral stretching, massage, and myofascial release before functional swallowing tasks can be initiated. In this context, NSOMEs are a tool, not the entire therapy.

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Bottom Line: Function Over Form

Tongue wagging alone won’t fix dysphagia. Neither will jaw stretches done in isolation. If you want to improve function, train the function.

You wouldn’t expect a patient to walk better by only doing leg lifts in a chair. Physical therapists train strength and task—so should we. Our therapy should involve actual swallowing and should get progressively harder as the patient improves.

If your exercises aren’t working—track the data, adjust your plan, and don’t be afraid to ask for help. We’re trained clinicians, not robots on a worksheet.

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Final Thoughts

When planning your next dysphagia session, ask yourself:

• Does this exercise involve actual swallowing?
• Am I using repetition, resistance, and progression?
• Does this challenge the system in a meaningful way?

If not—it’s time to rethink your strategy.

Let’s move past outdated NSOMEs and into a future of evidence-based, function-driven dysphagia therapy. Your patients—and their brains—deserve it.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

References:

Bulow, M., Olsson, R., Ekberg, O., & Hindfelt, B. (1999). Effects of the effortful swallow and the supraglottic swallow maneuver on pharyngeal swallow function in patients with dysphagia. Dysphagia, 14(2), 67–72. https://doi.org/10.1007/PL00009599

Frymark, T., Schooling, T., Maher, A., & Hill, V. (2009). Evidence-based systematic review: Effects of oral motor exercises on swallowing in individuals with dysphagia. American Journal of Speech-Language Pathology, 18(4), 361–375. https://doi.org/10.1044/1058-0360(2009/08-0071)

Lazarus, C. L., Logemann, J. A., Song, C. W., Rademaker, A. W., Kahrilas, P. J., & Pajak, T. (2003). Effects of voluntary maneuvers on tongue base function for swallowing in healthy normal individuals. Folia Phoniatrica et Logopaedica, 55(4), 199–205. https://doi.org/10.1159/000071456

Robbins, J., Butler, S. G., Daniels, S. K., Diez Gross, R., Langmore, S., Lazarus, C. L., … & Smith Hammond, C. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51(1), S276–S300. https://doi.org/10.1044/1092-4388(2008/021)

Robbins, J., Kays, S. A., Gangnon, R. E., Hind, J. A., Hewitt, A. L., & Gentry, L. R. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53(9), 1483–1489. https://doi.org/10.1111/j.1532-5415.2005.53467.x