Recent—and not-so-recent—dysphagia literature has made one thing very clear: exercise physiology belongs in swallowing rehab. Researchers like Lazarus, Robbins, Burkhead, and Clark have emphasized that understanding the muscles involved in swallowing—and how they actually function—is key to designing exercises that work.
Spoiler alert: just having someone swallow applesauce with a side of hope isn’t enough.
Swallowing Isn’t Passive. So Why Is Our Therapy?
A lot of traditional dysphagia therapy focused on observation, compensation, and crossing our fingers. But more and more approaches are embracing an exercise-based model—many using actual swallowing as the exercise.
Think: using food for resistance and tweaking the swallow technique to challenge and strengthen the system. You’re not just chewing and praying here—you’re training.
Neuroplasticity: Why What You Do Matters
When you’re designing a dysphagia therapy plan, don’t forget to check in with your old friend neuroplasticity. The brain loves to rewire itself—but only if you give it a good reason.
Here are the principles you need to keep in mind:
- Use it or lose it
- Use it and improve it
- Experience-specific
- Repetition matters
- Intensity counts
- Time (it takes time!)
- Salience (make it meaningful)
- Age (yes, it plays a role)
- Transference
- Interference
👉 Not totally confident in these? Grab your free Neuroplasticity Cheat Sheet.
Not Every Patient Needs Strength Training
Let’s be honest—not every patient needs to “strengthen their swallow.” Timing, coordination, and compensatory strategies are sometimes the real MVPs—especially in populations like head and neck cancer survivors.
Let’s Talk About the EBP Elephant in the Room
How many times have you seen patients doing exercises that have zero evidence behind them? It happens. A lot. We don’t need to shame the SLPs—many were taught that way—but we do need to gently show them the light (and maybe toss those unsupported handouts).
Evidence-based practice isn’t just a buzzword. It’s how we make sure what we’re doing actually helps.
The Exercise Principles That Should Guide You
If you’re going to use exercise, let’s do it right. These are the core principles of exercise science—yes, even for the swallow:
- Individuality
- Trainability
- Specificity
- Progression
- Overload
- Variety
- Rest
- Adaptation
- Recovery
- Reversibility
- Maintenance
- Ceiling (you will eventually plateau)
👉 Want these on hand? Download your Exercise Principles Cheat Sheet.
What Should a Swallowing Exercise Include?
Effective dysphagia therapy exercises should incorporate:
- Resistance
- Speed
- Repetition
- Intensity
- Load
- Pacing
- Fatigue
- Targeted improvements in strength, timing, and coordination
Basically, the swallow needs a workout plan.
Swallowing to Improve Swallowing? Revolutionary.
The best way to improve the swallow is… to swallow. But don’t just go through the motions. Push the swallow beyond its normal comfort zone. Overload the system (safely) and make the muscles work.
Here are some tried-and-true exercises backed by evidence:
- Effortful Swallow – increase force and drive
- Masako Maneuver – target posterior tongue and pharyngeal wall contact
- Mendelsohn Maneuver – improve hyolaryngeal elevation and UES opening
- Shaker Exercise – strengthen suprahyoids to increase UES opening
There are protocols that have been created to help clinicians use clinical reasoning to utilize neuroplasticity and exercise principles to treat dysphagia. Protocols such as:
Dr. Logemann herself credited the research on the Shaker and lingual resistance training from Robbins as foundational for improving lingual strength and overall swallowing function.
Take-away…
Using clinical reasoning and understanding exercise principles and the rules of neuroplasticity can lead an SLP to develop an effective dysphagia treatment plan and determine effective treatments. Our patients deserve the best treatments we can provide.
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:
Burkhead, L.M., Sapienza, C.M., Rosenbek, J.C. (2007). Strength-training exercise in dysphagia rehabilitation: Principles, procedures and directions for future research. Dysphagia, 22:251-265.
Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12: 400-415.
Clark, H.M. (2005). Therapeutic exercise in dysphagic manamgent: Philosophies, practices and challenges. Perspectives in Swallowing and Swallowing Disorders, 24-27.
Lazarus, C., Logemann, J.A., Huang, C.F., and Rademaker, A.W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrice et Logopaedica, 55, 199-205.
Logemann, J.A. (2005). The Role of Exercise Programs for Dysphagia Patients. Dysphagia. 20: 139-140.
Robbins, J.A, Butler, S.G, Daniels S.K., Diez Gross, R., Langmore, S., Lazarus C.L., et al (2008). Swallowing adn dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language and Hearing Research, 51: S276-S300.
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