SWALLOW REFLEX EXERCISES

   (SWALLOW RIGHT)

Myofunktional Exercise  Collect ion

Application:

no illustration

This chapter does not involve one single and special myofunctional exercise. In the following discussion all relevant exercises for the correction of the swallow reflex are reviewed in a synopsis.

The application of the swallow exercises conveniently happens towards the end of the mid-trainingphase after the single detail steps and target muscles have been corrected (see paragraph “Discussion”). Depending on their contents the exercises can be prescribed pointedly for the respective partial problems and special disorders (see the list of exercises with short description at the end of the chapter). In complex impairments with an altered course of reflex they are taken over into the therapy plan in a defined sequence. Before the functional training “swallow” can be started the musculature of tongue, oral diaphragm, velum/pharynx, lips and cheeks should be introduced into their physiological frame regarding their sensitivity, orientation, mobility and tone.

With regard to the anatomy no links are put up. As the SWALLOW MECHANISM is the most vital (partial conscious) neuromotor reflex in our filed of the cranio-mandibular region it is not surprising that almost every muscle is linked into the process.

Contents:

Unspecific, see list below.

Materials:

Procedure:

- Previous exercises: As mentioned above the arrangement of pre-exercises will comply with the degree and complexity of the problem. It is substantial that the musculature is capable of satiating its physiological frame. (In this context also see TONGUE-TIP-ORIENTATION and TONGUE EXERCISES.

-Starting position: Will chiefly be exercise specific; generally the BASIC-POSITION will be required.

- Step-by-step-description:

In the arrangement of the SWALLOW EXERCISES in the overall planning, too, a certain stepwise procedure is indicated. The restitution, here, will run equally from a primarily emphasized installation to a consequently more accentuated habituation, at first during daytime, later on at night as well.

-1 Assembling the reflex chain with the learned and/or unconsciously existing (not affected) detail steps (see SWALLOW-MECHANISM).

-2 Habituation of the routine, the reproducibility.

-3 Habituation of recurrence and frequency.

-4 Accentuated habiltuation.

-Timing: The methodical guidelines have been discussed in the text above.

Characteristics:

Whole scale, predominantly reflex, Function Kinetics. Function-kinetic reflex training is not practicable with an incompetent texture. In case of physical deficiencies the construction of a substitution reflex should be considered.

Remarks:

See the particular exercise, the training should proceed in the logical follow-up of a swallow reflex; not each member of the reflex chain will necessarily need an intensive training; a subtle diagnosis should point out which members of the reflex chain might be defective and which non-functional (see DIAGNOSTIC EXERCISES).

Discussion:

Occasionally there is criticism about the swallow exercises being prescribed too early. The decision about this should be left to the therapist as it should be assumed that the patient will continue swallowing during therapy even without the appropriate muscle function therapeutic prior knowledge. Swallow exercises do require in a great measure the schooling of the neural side of the neuro-motor action -  the motor skill would have been considered in the pre-exercises. It follows from the above that pointedly mental components will be employed as are described in:

(the following list with mental components)

REMINDER

Items for a mental involvement

MNEMONIC

preparative exercise

FEED-BACK-EXERCISE

exercise with an aimed involvement  of sensory skills

HABITUATION EXERCISES

exercise to  accustom a muscular action

LIPS OPEN

conscious reflex control through a reflex atypical posture

MANIPULATION EXERCISE

exercise with measure interfering in the neuromotor process with manipulation.

MEMOS

memory aid

MENTAL TRAINING

remembrance and concentration aid

NIGHT SCHEDULE

daybook (night-) with self self-evaluation PLUSMINUS

daybook with self self-evaluation

REFLEX EXERCISES

coordinated unconscious process of functionally joined actions

SWALLOWPICTURE

self-made painting for memory aid

TIMETABLES

timing prescription for the at home training procedure

It is equally left to the discretion of the therapist in which follow-up he will install the swallowing of different food qualities into the total training course

Frequently the view is held that the swallowing of crumbly food is to be put at first place. What is sure is that preceding the training  of the linked swallow reflex every single chain link must be trained completely, so the chopping up of solid stuff as well, as the accumulating of it or of mushy material.

If the dimple formation had been practiced at an early stage it would not be conclusive why LIQUID SWALLOW should not be carried out from the beginning as it, indeed, matches the development of a human being. Subsequently would, then, be worked out MASH SWALLOW followed by CRUMB SWALLOW.

LIST OF EXERCISES

for the swallow reflex

(in an alphabetical order with short description)

(Pt.-Refl.) = Partial reflex)

OPEN AND CLOSE    

(Pt.-Refl.) occluding the molars

MASH SWALLOW

Training with a defined bolus quality (mushy)

,1-2-3'-EXERCISE (with variations)       

linking together of prescribed detail steps

EAT-(AND DRINK-)EXERCISE

prescribed exercise timing foe the meals

 LIQUID SWALLOW

Training with a defined bolus quality (liquid)

ELASTIC EXERCISES  

Manipulated exercise with elastic as feed-back control of the correct posture

CONTINUOUS SWALLOW

Training of the stringing together of several reflex phases.

CRUMB SWALLOW

Training with a defined bolus quality (crumbly-sold)

LICK

Kinetic exercises to orientate the tongue tip towards the palate

EASY SWALLOW

Exercise to uncouple unconscious nonphysiological concomitants.

SUCKER   

Stimulation and training of saliva swallowing

MOUSE-SQUEAK

(Pt.-Refl.) Pre-exercise for the sucking empty of the Vestibulum volume

DIMPLE

Forming of the dimple shaped indentation

PIPELINE                    

Practicing the continuous repetition of the reflex process

SWALLOW RIGHT

Patient conform description of the swallowing process for instruction

RAPID SWALLOW

Training of the frequently succeeding continuous repetition of the reflex course

WATER-RETAINER

Maintaining the dimple formation in  POINTposition

WATER CARRIER

Maintaining the dimple formation under tongue movements

WORDEXERCISES

Practicing oral motor skill  and muscle coordination (speech)

,ZIP’-EXERCISE

(Pt.-Refl.) exercise for sucking empty of the Vestibulum volume.

Subsequently the exercises are listed up in a prospective chronological follow-up in the course of the swallow training. The arrangement is not obligatory. The schematization here again imposes a simplification leading to inconsistencies. It is advisable to know an exercise from its contents and to prescribe it according to the therapeutic requirements.

EXERCISES ARRANGED IN THE CHRONOLOGY OF THE REFLEX-CHAIN

LICK

OPEN AND CLOSE    

ELASTIC EXERCISES  

SWALLOW RIGHT

,1-2-3'-EXERCISE

MOUSE-SQUEAK

,ZIP’-EXERCISE

DIMPLE

WATER CARRIER

WATER-RETAINER

LIQUID SWALLOW

MASH SWALLOW

CRUMB SWALLOW

EAT-(AND DRINK-)EXERCISE

PIPELINE

CONTINUOUS SWALLOW

RAPID SWALLOW

LICK

EASY SWALLOW

Instructions:

,SWALLOW RIGHT’(instruction to the SWALLOW REFLEX EXERCISE).

Of course swallowing till now always happened somehow. Without swallowing you would perhaps starve which was obviously not the case. But: You can swallow this way and that way and only one is right. With all other variations there will arise difficulties later on. If the tongue does not work on the very precise spot when swallowing it will in the long run cause damage in your mouth.

For example, if it goes forward and hits against the teeth or if it lies in between touching the lips it will twist the incisor teeth in their position. Then they will not be able to bite something off correctly and instead you will have to use your side teeth for that. 

And how do bent teeth look!

Smiling will not be as you would wish. Besides the food does not get correctly down to the stomach. Air gets swallowed and people might be surprised about the burping if it tries to get out again.

Besides you mostly will need to drink with eating to flush down the meal.

And that, too, is not good for your stomach and digestion.

There is also the fact that speaking does go normal with the wrong tongue movements.  People will hear this but they will as well feel it – in their faces! In your mouth the tongue is always dunking into the saliva and lets drops splash out. Who really wants to put up an umbrella when talking with somebody?

So: Eating, speaking, smiling and appearance get affected by an improperly working tongue.

All that is not really necessary when swallowing runs as we have talked about.

At first the food needs to be chewed well. If it is ready to be swallowed, you do a ,ZIP’. The lips, then, will have gone shut the room between lips and teeth emptied and the stuff with one short suck heaved to the tongue tip. Here the tongue has already formed a small dimple in which the food accumulates. Next the tongue rises to the POINT with its tip and presses the release BUTTON for the swallow.

The lips are closed the chin is in (The ‘Drawer is in’).

The teeth are put upon each other and with the well known cat’s hump the tongue makes its filled up DIMPLE wander backwards while it is clinging to the SPOT with its tip.

By this means the meal will get safely down the gullet and into the stomach.

To smooth away these existing difficulties we have thought out muscle exercises. With the aid of theses the tongue will be able to work out to get right strong and nifty.