As we know from other behavioral interventions, the best way to improve performance on an activity is practicing task specific components of the behavior. In other words, the best way to rehabilitate the swallow is to swallow! Making this a more effortful task is what can make it exercise. Assessing correct completion and adequate effort put forth by the patient can be difficult by observation or palpation alone, so consider using forms of biofeedback when possible, such as sEMG. This exercise can be completed with or without a bolus, not only to prevent dry mouth (xerostomia) symptoms, but as the natural “weight” the exercises exert force on during the activity (Barikoo et al,. 2001).  Consider incorporating principles using varying bolus consistencies from intervention protocols such as MDTP (McNeill Dysphagia Therapy Program) during sessions and meal times (Carvajal et al., 2014). Also consider the addition of NMES (neuromuscular electrical stimulation) during these exercises to the suprahyoid/submental muscles (Park et al., 2012). This exercise does not impede normal motor patterns for the swallow and can target multiple physiologic movements involved in the swallow: hyolaryngeal elevation and excursion, base of tongue retraction, and pharyngeal constriction, etc,. (Bülow et al., 2001 & Hoffman et al., 2012). This exercise often requires a high volume of repetitions given the muscle fiber types involved in swallowing, their capacities for endurance, and the functional reserve of the patient.

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