Swallowing exercises for patients with head and neck cancer who are starting radiation therapy.
How radiation treatment can cause swallowing problems? Radiation treatment to the head
and neck area can cause many side effects. Some of the side effects can result in short
and long term swallowing problems. Short term swallowing problems are due to changes in saliva,
thick mucus, pain and swelling in the mouth and throat which can make it difficult to swallow.
Long term swallowing problems can set in months or years after treatment has finished. Muscles
in the mouth and throat can become stiff, making it difficult to safely and easily swallow food
liquid or even your spit. How swallowing problems can affect your health. Swallowing
problems can make eating and drinking difficult if left untreated swallowing problems can cause
weight loss and dehydration. In some cases it can result in an aspiration pneumonia this is a lung
infection caused by bacteria from the mouth and throat getting into the lungs when food or drink
goes down the wrong way into the windpipe when swallowing. What can you do to prevent
swallowing problems. We use thirty muscles when we swallow. It is important to keep these muscles
working well you can keep your swallowing muscles working by continuing to eat during treatment
if itis safe to do so and by doing swallowing exercises during and after treatment has finished.
There are five exercises shown in this video. These exercises help to strengthen and stretch the
muscles in your mouth and throat. These are: One - The effortful swallow, Two – The Masako Technique,
Three – Jaw Range of Motion Exercise, Four – Tongue Range of Motion Exercise
and Five – The Supraglottic Swallow. Exercise one and two help to strengthen your throat muscles,
exercises three and four help to stretch the jaw and tongue muscles.
Exercise five helps to protect your airway when swallowing.
It is best to begin these exercises two weeks before treatment three times a day during
treatment. If you cannot start these exercises before treatment start them as soon as you can.
Do these exercises once daily after treatment is done as part of a maintenance program.
Before you begin this exercise make sure you have the following items:
mouth rinse solution this may be a baking soda rinse salt water or flat club soda,
your mouth rinse will help you get rid of mucus buildup in your mouth
and will keep your mouth moist between exercises, water to sip and swallow if your mouth feels dry.
If someone on your healthcare team told you it is not safe to eat or drink by mouth
do not swallow any water only rinse your mouth with your mouth rinse if your mouth becomes dry,
a small bowl to spit out your mouth rinse you can also spit your mouth rinse in a sink
tissues to wipe your mouth and a small mirror to help you see
how well you are doing each exercise. Now we will begin with the exercises
the first two exercises help to strengthen the throat muscles.
Exercise one The Effortful Swallow and exercise two The Masako Technique.
When we swallow the back of the tongue and muscles in the throat work together to push food down
towards the food pipe. Strengthening your throat muscles will keep those muscles working well.
This may help prevent food from sticking in the back of your throat when eating and drinking.
To begin sit comfortably with your mouth relaxed,
press your tongue against the roof of your mouth as hard as you can.
With your tongue in this position press your lips together and swallow as hard as you can.
If you are able to eat by mouth you can do this exercise with each mouthful after you
chew your food. To do this exercise with food chew food well and then swallow hard.
It is normal for your mouth to feel dry when you are doing this exercise if your
mouth feels dry take a sip of water or use your mouth rinse solution to keep your mouth moist.
Pause this video and repeat the exercise five to ten times.
Exercise Two – The Masako Technique. To begin sit comfortably with your mouth relaxed.
Stick out your tongue slightly. Hold the tip of your tongue between your teeth.
Keeping your tongue between your teeth try to swallow your spit.
To make this exercise easier to do, lower your head slightly as you swallow. If you
had surgery to your tongue it may be hard to get the tip out between your teeth.
Do your best to stick your tongue out as far as you can.
As a tip for each exercise if you are not sure how well you are doing the exercise,
use your mirror, this will help you see what you are doing.
Pause this video and repeat the exercise five to ten times. The next two exercises help to
stretch the jaw and tongue muscles. Exercise three jaw range of motion and exercise four
tongue range of motion. When we take a bite of food the muscles of the jaw and tongue help
with chewing controlling and moving the food and drink from the front to the back of the throat.
Exercise Three – Jaw Range of Motion. This exercise will help prevent stiffness in your jaw.
Before starting the jaw range of motion exercise, let’s talk about Trismus.
Some patients are at high risk for getting Trismus. Trismus is a condition that affects
the muscles that move your jaw this will make it harder to open your mouth. Talk to
your health care team to find out if you are at high risk of getting Trismus.
To get more information about Trismus, you can review the pamphlet ‘ Are you at
Risk’ found in your new patient package or talk to a member of your health care team
Now let’s get started with the Jaw Range of Motion Exercise.
To begin this exercise sit comfortably with your mouth relaxed. Open your mouth as wide as you can.
You should feel a good stretch but not any pain. Once you are in the position
hold it for five seconds. Relax your jaw for a few seconds to give your mouth a break.
Now move your jaw to the left once you are in the position, hold it for five seconds,
relax your jaw for a few seconds to give your mouth a break.
Now move your jaw to the right, once you are in the position hold it for five seconds,
relax your jaw for a few seconds to give your mouth a break.
Pause this video and repeat the exercise five to ten times. If you are able hold each position for
a full five seconds this will make sure you give your jaw a good stretch and have better results.
It may help to count in your mind slowly to make sure you get a proper stretch.
Exercise Four – Tongue Range of Motion.
To begin sit comfortably with your mouth relaxed stick your tongue out as far as it can go. Do not
hold your tongue between your teeth. This will make sure you give your tongue a good stretch.
If you had surgery to your tongue it will be hard to move your tongue out,
stick your tongue out as far as you can. Once you are in the position hold it for five seconds.
Relax your tongue for a few seconds to give your mouth a break.
Now move your tongue up towards your nose once you are in this position hold it for five seconds.
Relax your tongue for a few seconds to give your mouth a break.
Now move your tongue down towards your chin once you are in this position hold it for five seconds.
Relax your tongue for a few seconds to give your mouth a break. Now move your tongue to
the left side of your mouth once you are in this position hold it for five seconds.
Relax your tongue for a few seconds to give your mouth a break. Now move
your tongue to the right side of your mouth. Hold it for five
seconds. Relax your tongue your tongue for a few seconds to give your mouth a break.
Pause the video and repeat this exercise five to ten times.
If you are able hold each position for a full five seconds,
this will make sure you give your tongue a good stretch and have better results.
It is normal for your mouth to feel dry when you do this exercise if your mouth feels dry
take a sip of water or use your mouth rinse solution to keep your mouth moist.
Exercise Five – The Supraglottic Swallow.
This exercise works on the muscles in your airway good airway protection is important
when swallowing to make sure food and drink doesn't go down the wrong way into the windpipe.
To begin sit comfortably with your mouth relaxed.
Take a breath in and hold your breath very briefly, swallow, and then cough when you exhale.
Do this exercise in a smooth motion, do not pause between steps.
Let’s do this exercise one more time. Take a breath in, swallow and then cough when exhale.
Pause this video and repeat the exercise five to ten times.
Once you feel comfortable you can do these exercises anywhere. For example in your car,
in your living room or in the waiting room before your appointment.
If you have any trouble doing these exercises talk to a member of your health care team.
Remember when you start treatment with these exercises three times each day if possible
continue these exercises once a day after you finish treatment. Watch this video as often
as you need it may take some practice to be able to do these exercise well.
In this video you have learned five exercises to help strengthen
and stretch your swallowing muscles. These are: One – The Effortful Swallow,
Two – The Masako Technique, Three – Jaw Range of Motion Exercises,
Four – Tongue Range of Motion Exercises, Five – The Supraglottic Swallow.