Exercises to optimise speech and swallowing during and after radiotherapy to the head and/or neck | Hull University Teaching Hospitals NHS Trust

Reference Number: HEY1487/2024
Departments: Speech and Language
Last Updated: 31 May 2024

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Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your Speech and Language Therapist (SLT) but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with your SLT.

Why do I need speech and swallowing exercises?

The following exercises have been advised by your SLT. The exercises aim to strengthen muscles and increase movement in your jaw, tongue, throat and larynx (voice-box). These exercises will therefore help with speech, chewing and swallowing. You may find a mirror helpful to guide you whilst doing the exercises.

All exercises that are appropriate for you will be demonstrated to you by your SLT.

How often do I need to do the exercises?

It is recommended that you do these exercises before, during and following radiotherapy treatment to the head and/or neck. It is advised to practice these ‘little and often’. Aim for several short exercise sessions throughout the day. Your SLT will monitor your progress and advise you how long you need to continue with these exercises following your treatment.

Jaw exercises

Jaw opening

Open your mouth as wide as possible. Hold for 2 seconds and then close.

Jaw rotation

Slowly move your jaw from right to left.
Slowly move your jaw from left to right.
Imagine chewing gum. Whilst your lips are closed, move your jaw one way and then the other.

Jaw opening with resistance

Place a wooden spatula between your upper and lower front teeth.
Gradually increase the number of spatulas you are able to place until resistance is felt.
Hold for 5 seconds and then remove.

Base of tongue exercises

Effortful Swallow

Imagine trying to swallow a large lump of food. Swallow as hard as you can. Feel the muscles squeezing in your tongue, throat and neck.

Gargle

Lift your chin slightly.
Pretend to gargle for 5 seconds (do not use fluid).
You will feel the back of your tongue making contact with the back of your throat.

Protrusion (pushing tongue out)

Push your tongue out as far as you can. Hold for 5 seconds.
Feel the stretch at the back of your tongue.
Relax your tongue.

Retraction (pulling tongue in)

Keep your tongue flat and pull it as far back into your mouth as you can.
Ensure that you do not curl the tip of your tongue.
For added assurance that you are doing this correctly, gently rest your fingers on your neck while you do this. Feel the larynx move up and down.

Tongue exercises

Push your tongue out as far as you can. Hold for 5 seconds and then relax.
Lick all the way around your lips.
Touch the corner of your mouth with the tip of your tongue. Then touch the other corner.
Lift the tip of your tongue and curl it upwards to touch your top lip. Now curl it downwards to touch your bottom lip.
Put your fingers flat on your cheek. Push your tongue into your cheek and try to push your fingers away. Repeat on the other side.
Hold a spoon in front of your mouth. Try and push it away with your tongue and then relax.
Hold a spoon above your top lip. Try to push the spoon upwards with your tongue and then relax.

Laryngeal elevation

When you swallow the larynx moves upwards and lowers on completion of the swallow. This elevation is important for two reasons:

It protects your airway when you swallow.
It opens the top of your oesophagus (food pipe).

The following named exercises aim to assist in this movement.

Mendelsohn

Start your swallow and when you feel your larynx rise, hold it up for as long as you can, and then relax.
For added assurance that you are doing this correctly, gently rest your fingers on your neck while you do this. Feel the larynx move up and down.

Pitch glide

Start from the lowest possible note, glide up the scale to the highest possible note, hold and then relax.
Now repeat starting from the highest note and gliding down to the lowest note. Hold for a few seconds and then relax.
For added assurance that you are doing this correctly, gently rest your fingers on your neck while you do this. Feel the larynx move up and down.

Airway protection

When you breathe in and out, your vocal cords (within your larynx) are open. When you swallow, your vocal cords close. It is important for your vocal cords to close when you swallow to prevent any food or drink entering your airway.

The following exercise is to practice opening and closing your vocal cords:

Breathe in.
Breathe out, letting only a little air out. Hold your breath; let a little more air out, hold and then release.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Speech and Language Therapy Department.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

you must be able to give your consent

you must be given enough information to enable you to make a decision

you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.