Updated Swallowing Exercises

This last week I saw a Ear, Nose and Throat specialist. He scoped my throat and saw significant atrophy in the sphincter muscles and voice box. Below are a few updated Swallowing Exercises provided by a speech therapist.

Perform each of these exercises 10-20 times in a row.

1. Oral Control Exercises

    a. Using lips and tongue, move straw from left cheek to right cheek.

    b. Place straw at center of lips. Using lips and tongue, move in and out.

2. Pharyngeal Stripping Exercises

    a. Swallow hard, squeezing all your muscles. Pretend you are swallowing an egg.

3. Tongue Base Exercises

    a. Stick tongue out, bite tip with teeth or hold tip with a gauze pad. While doing this, swallow, keeping your tongue anchored.

    b. Pull the tongue into the back of the mouth, keeping tongue tip down. Hold for a slow count of 5.

4. Laryngeal Elevation Exercises

    a. Start to swallow normally. Hold your Adam’s apple up with your neck muscles when it gets to the top. Hold for a slow count of 5.

Here is a link to a video on throat exercises:  https://www.youtube.com/watch?v=ZS_4fO6MxyA&feature=share

Laryngospasm, Additional Info on

Thanks to one of my regular readers with Kennedy’s Disease, I have some additional information on my recent post about Laryngospasm. Hearing the sound of the person gasping for air on the videos always brings me back to those initial few times when it jerked my awake at night.

Bastian Medical Media has a website on the subject with a couple of good videos as well as an audio description of the process. In the second video, Dr. Bastian introduces the straw technique that can be practiced ahead of time to help minimize the impact of the spasm when it occurs. Below is an introduction to the spasm. You can read the entire article and watch the video by clicking on this Bastian Medical Media link.

Laryngospasm

“A sudden reflexive closure of the larynx occurring when an individual is trying to breathe. Laryngopasm occurs more frequently in persons who have vocal cord paralysis or in those experiencing sensory neuropathic cough; it is also seen as an aftermath of an upper respiratory infection.A typical laryngospasm episode begins abruptly and lasts approximately one minute. The individual often makes loud inspiratory noises, the loudness of which abates gradually over the first minute or two. The voice may be choked off during the same time, making it difficult to speak. Laryngospasm is terrifying not only to the person experiencing it but also to family, friends, or strangers observing the episode. An attack may awaken its victim from sound sleep. Rarely, an individual will experience a series of laryngospasms, making it appear that they are having one much longer spasm…” 

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There is also a web page in Anesthesiology website on the subject. I was unaware this spasm can be an issue when a person is coming out of surgery. Below is an introduction to the topic. You can read the entire article by clicking on this Anesthesiology website link.

Laryngospasm-The Best Treatment

“Almost 40 years ago, Dr. N. P. Guadagni showed me a technique for prompt termination of laryngospasm, which I have used countless times with complete success. Because I have used the techniques so often myself and have taught it to hundreds of residents and nurses. However, a thorough literature search has not revealed any mention of it. The technique involves placing the middle finger of each hand in what I term the laryngospasm notch. This notch is behind the lobule of the pinna of each ear. It is bounded anteriorly by the ascending ramus of the mandible adjacent to the condyle, posteriorly by the mastoid process of the temporal bone, and cephalad by the base of the skull (Figure 1). The therapist presses very firmly inward toward the base of the skull with both fingers, while at the same time lifting the mandible at a right angle to the plane of the body (i.e., forward displacement of the mandible or “jaw thrust”). Properly performed, it will convert laryngospasm within one or two breaths to laryngeal stridor and in another few breaths to unobstructed respirations…”

I thought I was going to die

The first time it happened to me, I believed I would die. My wife did not understand what was happening. Fear gripped both of us. Neither of us could go back to sleep afterward. The second time it happened, it was no better and yet, in some ways, worse. We realized the first time was not an isolated incident. This was another symptom of Kennedy’s Disease.

Laryngospasm, often referred to as "dry drowning,” is a spasm of the vocal cords in the throat that temporarily blocks the flow of air to the lungs. There is a good YouTube video that explains the process well.

The spasm can be triggered by a nasal drip hitting the trigger point in the larynx, acid reflux, a particle of food, or just from the vocal cords being weak and sagging a bit. It can happen anytime, but the worst time is at night when you are jerked from your sleep unable to breathe. A person wakes up gasping for air and is not able to talk. The feeling is as if you have phlegm going down the wrong pipe and you are not able to clear it. Learning to deal with dry drowning and to minimize its impact is important.

The most frequent question asked about these spasms is what can I do to help the person?
First, it is important to understand that not everyone with Kennedy's Disease experiences this symptom. Yet, it can be a symptom and that is why it is important to understand what it is, and what can be done to help.

When it happens: This will sound counter-intuitive, but the best way to ease the recovery process is to remember that the more you fight it by gasping for air, the worse the situation becomes. Since the Larynx is a muscle, it works like the other muscles in the body. If a muscle becomes starved for oxygen it will release (relax) thus, in theory, it should open back up. We have never heard of a case where the person lost consciousness, but if that does happen, you might need medical attention.

Remember, this is a spasm and is different from choking on an object that needs to be dislodged from the throat.

If it happens in bed: Throw the feet over the edge of the bed and sit upright. Often when we wake up with this gagging, we are prone and then only partially sit up. By doing this, we are compressing the diaphragm making it more difficult to get a full breath of air to clear the blockage.

Try to relax and breathe slowly. Yes, I know that it is easy to recommend that you just sit there and relax, but it really does minimize the trauma. Panicking or tightening up only makes the situation worse. Tilt your head back and turn your head to one side. Breathe in very slowly through the nose with the mouth closed. As the windpipe starts to open you might begin coughing up phlegm.

Talk about it before it happens. As mentioned above, the situation frightens the wife (significant other) and children as much as the person experiencing the problem. All an observer can do is be there in case assistance is needed. It is helpful to develop a hand signal so you can communicate with others in the room when this occurs (e.g., a thumbs up if you feel that it is opening back up or a closed fist if it is not opening and you might need some help).

What else will help?

1. Consider elevating the shoulders and head by using a foam wedge (about 12" high). You can normally pick up one at any medical supplier. 
2. Practice coughing every day. What I mean by this is to try to bring something up several times a day by coughing hard. Our lungs weaken over time and we find it more difficult to clear the throat when anything blocks it (including water and food). 
3. Practice sniffing every day. With the mouth closed, take a deep sniff (filling up the lungs) and exhale normally. Practice sniffing several times a day. 
4. Practice swallowing exercises every day. Stick out your tongue as far as comfortable. Bite lightly on it to hold it in place. While holding the tongue swallow ten times. Repeat several times a day. This exercise will also make it easier to swallow food. 
5. Keep a glass of water next to the bed. If you become dry, take a drink. Water cleanses and clears the throat and loses phlegm. 

Since adding the wedge and practicing the exercises above, I went from experiencing the gagging/choking sensation once a week to having one every 4 -6 months. Over the last ten years, I have not had one gagging or choking experience in bed.

FYI: There is additional information on this subject in the next post. Click here to read it now.

If anyone else has any tips to help minimize the impact or eliminate the problem, please let me know.

Problems with chewing and swallowing?

Benjamin Franklin wrote, “An ounce of prevention is worth a pound of cure.” Much of my life living with Kennedy’s Disease is focused on preventing or slowing the inevitable.

One area of the body that becomes particularly troublesome for those of us with Kennedy's Disease is often the most neglected. As the disease progresses, the face and throat muscles also weaken. Many of us begin to experience problems with swallowing, choking, dry-drowning (Laryngospasm), facial muscle wasting, jaw weakness, etc.

Some exercises will help maintain the throat, tongue and facial muscles and possibly delay or moderate several of the issues mentioned above. I practice many of these exercises several times a week (shown with an asterisk). They do help — especially with the chewing and choking issues. Try these exercises for a month and see if they help.

Stick Out Your Tongue: * Bite down lightly on your tongue to hold it in position. Swallow ten times (or more) while holding the tongue between the teeth. Perform this exercise every day. At first, you might find this exercise extremely difficult. Over time, it will become easier. [Strengthens throat muscles]

Large Smile:* Make the sound "EEEEEEEEEEEEEEEEEEEEEE" as you stretch your mouth muscles into a large smile. You should be able to feel throat muscles vibrate (stretch). Perform this routine ten times. [Strengthens throat and facial muscles]

Pucker your Lips:* Make the sound "OOOOOOOOOOOOOOOOOOO" as you pucker you lips. You should once again be able to feel your throat muscles vibrate (stretch). Perform this routine ten times. [Strengthens throat and facial muscles]

Stretch the Tongue: Open your mouth and stick out your tongue as far as possible. Be sure your tongue comes straight out of your mouth and does not go off the side. Hold, relax and repeat several times. Work toward sticking your tongue out farther each day, but still pointing straight ahead. Perform this routine ten times. [Strengthens tongue muscles]

Tongue Darts:* Stick your tongue out as far as you can and pull it back fast. Repeat ten times as quickly as you can. [Strengthens tongue muscles]

Circle the Mouth: Swab all your teeth and gums with your tongue. First, the inside of your teeth and then the outside. Perform this routine ten times. [Strengthens tongue muscles]

Vibrate the throat:* Say Mah-Mah-Mah-Mah as quickly as you can. Be sure there is an M and an AH each time. Then say Lah-Lah-Lah-Lah as quickly and accurately as you can. Perform this routine five times alternating between the sounds. [Strengthens throat muscles]

Hard Coughs:* Cough hard several times each day. [Strengthens the lungs and throat muscles]

Clear the Throat:* Clear the throat (um-hum) several times a day. [Strengthens throat muscles]

Big Yawn:* Take a deep breath and open the mouth wide as if you were yawning. With the mouth open wide, move the jaw from side to side. Perform this routine ten times. [Strengthens facial muscles]

Jaw Pushes:* Place the palm of your hand against the bottom of your jaw. While pressing up with your palm, open your jaw as far as possible. Relax the jaw. Perform this routine ten times. [Strengthens jaw muscles]

If you have other face, tongue, jaw and throat exercises that work for you, please let me know.

Swallowing Difficulties?

Many of us living with a progressive neurological disorder notice the throat muscles weakening over time. There are several good exercises available to help improve or maintain your current capabilities. A physical therapist can be of  help.

I perform the following exercises every day, often twice a day, and it seems to help.

1. Stick Out Your Tongue: Bite down lightly on your tongue to hold it in position. Swallow ten times (or more) while holding the tongue between the teeth. Perform this exercise every day

2. Large Smile: Make the sound “EEEEEEEEEEEEEEEEEEEEEE” as you stretch your mouth muscles into a large smile. You should be able to feel throat muscles vibrate (stretch).

3. Pucker your Lips: Make the sound “OOOOOOOOOOOOOOOOOOO” as you pucker you lips. You should once again be able to feel your throat muscles vibrate (stretch).

Please note the study below. Only six patients were tested, but the information might be helpful.

Head Lift Exercise Improves Swallowing Dysfunction in Spinal and Bulbar Muscular Atrophy.

Abstract

BACKGROUND:

Dysphagia due to bulbar involvement is a major symptom of patients with spinal and bulbar muscular atrophy (SBMA). The aim of this pilot study was to test the efficacy and safety of the head lift exercise for swallowing dysfunction in SBMA.

METHODS:

We enrolled 6 subjects with genetically confirmed SBMA and instructed them to perform the head lift exercise for 6 weeks. The efficacy outcome measures were the changes from baseline in tongue pressure, the scores of swallowing functional questionnaires, and the motor functional scales and parameters of videofluorography (VF).

RESULTS:

All subjects completed the study and no major adverse effects were recorded. Tongue pressure significantly increased by 19.2 ± 0.15% (p < 0.05) after the 6-week head lift exercise. The scores for oral dysphagia also improved, although there was no significant change in VF parameters or other variables examined pre- and post-exercise.

CONCLUSION:

Our findings suggested that the head lift exercise may improve swallowing dysfunction, particularly tongue pressure, in SBMA.

The Head Lifting Exercise is shown below. You can download it from Dr. Shaker’s website also.