Dysphagia (also known as difficulty swallowing) is dangerous because it can result in food or liquid getting into the lungs causing choking or lung infection known as aspiration pneumonia which can cause death.  There are many causes of dysphagia which can disrupt the normal swallowing mechanism.  

How is dysphagia diagnosed?

Any symptoms of dysphagia must be checked as soon as possible.  Diagnosis starts with a history and evaluation by a speech therapist.  You will be assessed on how you swallow, make certain sounds and have your teeth, lips, jaws, tongue, and cheeks examined.

Instrument assessment may be required to make a diagnosis;

• Modified Barium Swallow test (MBS)
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Safe Feeding Strategies

As a caregiver during feeding, ALWAYS ensure that the patient;

• is alert and awake during meals
• is positioned in an upright position (ideally on a chair)
• has minimal distractions (avoid having conversations during feeding)
• takes another spoonful of food only AFTER swallowing completely
• stays in an upright for around 30 minutes after the meal
• follows the diet modifications as advised by your dietician / speech therapist.  It may mean using thickening liquids in the diet

Some exercises to help improve function of swallowing muscles

Certain exercises can strengthen the swallowing muscles such as the tongue and lips and help improve the swallowing function.  Do consult your Speech Therapist on the type of exercises most suitable for your condition

Strap Muscle Exercises

The strap muscles in the neck moves the voice box and helps prevent the food from getting into your lungs when you swallow. The following exercises help strengthen these muscles :

Shaker Exercise

• Lie down flat on the bed (without a pillow)
• Keep your shoulders flat against the bed and try to lift your head to bring your chin against your chest (as if looking at your toes)
• Keep the head lifted in this position for 60 seconds 
• Repeat as guided by your speech therapist

Stretch Exercise

• Tilt your head back and open your mouth
• Stick your jaw out and push upwards towards your nose
• You should feel your neck muscles feeling stretched
• Hold this position for 5 seconds
• Repeat as guided by your speech therapist

Airway Protection Exercises

These exercises help to keep the voice box closed during swallowing and prevent aspiration into the lungs. 

Supraglottic Swallow

• Hold your breath tightly
• Swallow your saliva twice
• Release your breath with a cough

Pitch Glides

• Sing ‘ee’ or ‘ah’ 
• Start with a low tone and gradually increase the pitch
• Hold this high pitch for 10-20 seconds

Base of Tongue Exercises

The tongue pushes the food into your oesophagus.  These exercises help to strengthen the base of tongue muscle.

Masako Exercise

• Stick out your tongue
• Hold the tongue with your teeth
• Swallow your saliva while holding to the tougue

Effortful Swallow

• Swallow your saliva as hard as you can
• Push as hard as you can with the tongue against the roof of your mouth as you swallow

Jaw Exercises

Reduced jaw opening is called trimus.  It is important to be able to open your mouth widely to eat and these exercises increase the flexibility of the jaw opening.

Jaw Opening

• Open your jaw as wide as possible
• Hold for 5-10 seconds and then close

Jaw Rotation and Imaginary Chewing

• Pretend to chew 
• Rotate your jaw in circular motions in both directions

See your Neurologist, ENT specialist or speech therapist if you have any swallowing issues

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