Effortful Swallow

SKILL: Swallowing

BRIEF RATIONALE: This exercise improves swallowing safety and efficiency.

Before beginning the Effortful Swallow treatment, you will read precautions and agree to continue. The speech therapist will provide guidance on any suggested materials (e.g. ice, water, food items). You will learn how to perform the exercise via written instructions and a simple video demonstration. .

You will rate your effort after every swallow:

1. Normal- it feels like the same amount of effort as your "norma'l" swallow
2. Moderate- it feels more effortful than your normal swallow, but it's not the hardest you can do
3. Maximum- this is the most effort you can produce during the swallow

After completing a set of repetitions, you will rate your fatigue and take a rest break based on your rating. You can always extend the break if needed.

REPLAY VIDEO: A replay button is available in the lower-left corner of the screen to review the video demonstration.

FOR THE CLINICIAN:

According to a systematic review by Bahia & Lowell (2020), physiological improvements related to the effortful swallow can include:

• Increased tongue-to-palate pressure and duration
• Increased base of tongue pressure and duration
• Increased hyolaryngeal movement
• Prolonged laryngeal closure
• Increased pharyngeal contraction with a positive impact on epiglottic inversion and duration of inversion
• Increased UES pressure and duration of opening
• Increased esophageal pressure, especially in the mid and distal regions

It is beneficial to view the effortful swallow on a videofluoroscopic swallow study to confirm positive physiological change, as there's some mixed evidence on the impact of this exercise. It's recommended to use sEMG for biofeedback if it's available to you.

Consider incorporating motor learning principles into this treatment for best results. For example:

• Practice amount- choose high intensity for more repetitions
• Practice variability- do the exercise using different types of boluses (if safe & appropriate)
• Practice schedule- start with blocked practice (one type of bolus) and then randomize it
• *Feedback control- the treatment relies on self-evaluation (or self-ratings)
• *Feedback frequency- intermittent written feedback is automatically provided based on the patient's ratings

Selected References:

1. Bahia, M. M., & Lowell, S. Y. (2020). A systematic review of the physiological effects of the effortful swallow maneuver in adults with normal and disordered swallowing. American Journal of Speech-Language Pathology, 29(3), 1655–1673. https://doi.org/10.1044/2020_ajslp-19-00132
2. Zimmerman, E., Carnaby, G., Lazarus, C. L., & Malandraki, G. A. (2020). Motor learning, neuroplasticity, and strength and skill training: Moving from compensation to retraining in behavioral management of Dysphagia. American Journal of Speech-Language Pathology, 29(2S), 1065–1077. https://doi.org/10.1044/2019_ajslp-19-00088