All slps were educated to provide both types of therapy with equal competence. These sustained head raising exercises were followed by 30 consecutive repetitions of head raisings in the same supine position. Research has shown that the use of this maneuver decreases the anterior movement of the hyoid and would suggest that someone with decreased anterior hyoid movement may not benefit from this exercise unless this is performed in conjunction with the head lift exercise shaker maneuver in order to compensate for decreased anterior hyoid movement. Keep your adams apple in the high position for 12 seconds. You will need a wand to do this exercise try a broom handle, stick or cane. The study follows a crosssectional study design, where 50 healthy individuals 23 males and 27 females performed modified shaker exercise and noneffortful swallow during 10 ml water swallowing. Isometric exercises are performed by raising the head up for 60 seconds followed by a minute rest for a repetition of three.
The shaker exercise is a series of sustained and repetitive head lifting exercises to enhance the strength of infrahyoid and suprahyoid muscular activity 1, 2. Dysphagia rehabilitation exercises queensland health. The shaker exercise video from clinical management of. Keep your shoulders down and only lift your head and neck. How to do your swallowing exercises you can do these exercises when it is best for you for example, before meals, in the waiting room, after you brush your teeth. The shaker technique, also called the head lift, is indicated for patients who exhibit reduced superior and anterior movement of the hyolaryngeal complex.
This will involve practicing your swallowing, moving your head or moving your tongue in. American speechlanguagehearing association 9,684 views. Keep your shoulders flat against the bed or floor 4. The progression of the shaker exercise regimen should be tailored to the individual abilities of each patient, that is, a gradual stepwise progression toward the isometric and isotonic exercise goals. Ensure you do not tip the head and ensure the neck remains straight throughout the. The difference is, with ctar, the patient is holding a 12 cm inflatable rubber ball and performing a chin tuck against it while seated. The isometric portion of the shaker is holding the head up for 1 minute with a minute rest x 3 repetitions. Swallowing exercises national foundation of swallowing. Do this 3 times lift your head and look at your toes and let your head go back down as if doing situps for your neck. The shaker technique, also called the head lift, is indicated for. Do not hold your breath and remember to breathe out as you do the work part of each exercise.
Make sure your head, shoulders, or feet are not elevated. Lift your head upward to the head neutral position, being sure to retract your head. How to carry out shaker head lifting exercise youtube. First, lie flat on your back and raise your head slightly off the ground. If you feel any unusual pain in your joints or muscles while you exercise, do not continue the exercise. Herein lies the empirical foundation of evidencebased pracintroduction exercise rehabilitation has long been a treatment for patients with dysphagia. Oct 26, 2009 the shaker technique, also called the head lift, is indicated for patients who exhibit reduced superior and anterior movement of the hyolaryngeal complex. Radiotherapy to the head and neck can lead to longterm swallowing problems called dysphagia. Shaker exercise part 1 lie down on your back on the bed.
When the exercise does not impede respiration and is easier to complete, we do see greater compliance. What you need to know about swallowing this information describes swallowing problems that can be caused by radiation. Hold it in this position for up to 60 seconds or for as long as you can. Dec 04, 2014 shaker exercises, named after the original author of the approach and also referred to as head lift exercises, utilize a protocol consisting of isometric and isotonic headlifting movements while lying supine. Normal swallowing many muscles and nerves work together to help you swallow see figure 1. Lie on the floor, lift your head off the ground and turn your head to one side.
Before you lift, check the weight and make sure you can lift it safely. The shaker exercise consisted of three 1min head lifts in the supine position with a 1min rest between lifts. Raise your head far enough to be able to see your toes and hold for 1 minute and then rest. If you are able to successfully carry out the exercises, increase the duration of each head lift and the number of repetitions.
Lifting your head from the surface, look toward your toes and then put your head back down. That is, the hyoid and larynx are not lifting and moving forward to the extent needed in order to open the upper esophageal sphincter. Apr 27, 2017 the shaker technique, also called the head lift. Jul 22, 20 there was significant difference for isometric tasks with ctar and no significant difference between ctar and shaker for isokinetic exercise in relation to suprahyoid muscle activity. Video from companion website to the book clinical management of swallowing disorders, 4th. Sit at the table with your elbows and forearms resting on the table, your elbows bent and your hands out in front of you. Do not use a pillow because your shoulders must be flat against the surface. Hold this position for a few seconds and then place your head back down. Dec 15, 20 for patients with dysphagia resulting from upper esophageal sphincter dysfunction, strengthening the suprahyoid muscles through therapeutic exercise has proved effective in restoring oral feeding.
Research has shown that the use of this maneuver decreases the anterior movement of the hyoid and would suggest that someone with decreased anterior hyoid movement may not benefit from this exercise unless this is performed in conjunction with the head lift exercise shaker. The masako maneuver national foundation of swallowing disorders. Shaker exercise, head lifting exercises the patient rests in a supine position and lifts his or her head to look at the toes to facilitate an increased opening of the upper esophageal sphincter through increased hyoid and laryngeal anterior and superior excursion. However, there is no experimental evidence for the same. Voice therapy symptomatic voice therapy is an approach to work directly on single voice components, such as pitch, loudness, resonance, or respiration physiologic and holistic voice therapy is an approach to balance the three subsystems of voice production at once. Your therapist may change the exercises to fit you. Effect of modified shaker exercise on the amplitude and. Arm range of motion exercises for people with hemiplegia. Place a few small pieces of paper about one inch in diameter over a blanket or a towel. The aim of this investigation was to examine the comparative effectiveness of the new recline exercise re and the traditional head lift exercise shaker exercise on submental muscle activity. Do the shaker exercise parts 1 and 2 3 times each day. Strengthens the muscles in the throat and widens the opening of the esophagus.
Evidencebased practice for laryngeal elevation dysphagia cafe. Ctar chin tuck against resistance dysphagia ramblings. Modified shaker chin tuck against resistance ctar and mendelsohns manoeuvre. May 15, 2014 the jaw opening exercise is able to implement a less straining exercise targeting intended muscle groups i. The masako maneuver national foundation of swallowing. Pdf shaker exercise rehabilitation in head and neck cancer. The exercises shown in this pamphlet help to stretch and strengthen the muscles in your mouth and throat. You will need a firm chair and hand held weights or wrist weights for these exercises. With your arms extended over your head, slowly bend your elbows and lower the canetowel behind your head. Lift head up and lower head quickly 30 times head only, do not raise shoulders.
Therapeutic procedure steps sustained head lifting exercise 1. Is the shaker exercise effective in rehabilitating. Press against your forehead while also trying to move your head forward. Raise your head far enough to be able to see your toes. Lift your head to look at your toes, while keeping your shoulders. The following exercises and associated videos are only to be used under the explicit guidance of your physician or speechlanguage pathologist slp. Oct 15, 2019 i think we can all agree, ctar is by far much easier on our patients than the shaker. Effect of modified shaker exercise on the amplitude and duration of. For patients with dysphagia resulting from upper esophageal sphincter dysfunction, strengthening the suprahyoid muscles through therapeutic exercise has proved effective in restoring oral feeding. Lying face down on a firm surface, raise your chest, shoulders and head up by resting on your elbows. This is a variation of the more wellresearched shaker s hyolaryngeal excursion exercise. Let your head hang fully downward so your chin is on or near your chest. Many struggle when lying flat on their backs and struggle to lift their head and maintain the hold. An exercise to help strengthen the small muscles in the front and back of the neck.
Jul 25, 2012 the exercise does result in mild muscular discomfort which dissipates over the first week of the 6week treatment course. This simple exercise can strengthen muscles to improve swallowing ability. Clinical trials are now needed, but the ctar exercises appear effective in exercising the suprahyoid muscles and could achieve therapeutic effects comparable to those of shaker exercises. Then place a straw in your mouth and suck one of the pieces of paper to its tip. When these muscles are innervated, they act together to move the hyoid in an upward and forward fashion. Effects of the head lift exercise on the swallow function. The effects of the head lift exercise on the swallow function. To work your neck, raise your head up and hold while you have your lip up. Lie flat on your back with no pillow under your head. Lower lip lift lift your lower lip up as high as it will go as if you were pouting. Client exercise handout and any required fluids and equipment. Upper body exercises do all these exercises slowly.
If you feel pain or experience unusual symptoms while performing any of these exercises, stop the exercise. Measurement of hyolaryngeal muscle activation using surface. Keep your shoulders flat against the bed, and lift up your head, bringing your chin down to your chest until you can see your toes. New method for enhancing suprahyoid muscle activity using a shaker type exercise, authorwai lam yoon and jason kai peng khoo and susan j. This results in residue in the pyriform sinuses, placing.
The aim of this study was to compare the maximum and mean surface electromyography semg activity of the suprahyoid muscles during the chin tuck against resistance ctar exercise and the shaker. Lie on your back, keeping your shoulders flat on the ground. Rehabilitative swallowing exercises south tees hospitals nhs. Keeping your shoulders flat, lift only your head and neck to look down at your toes. Keep your shoulders flat against the bed or floor, and lift up your head, bringing your chin down to your chest. Ctar works well with elderly clients and for those with neck difficulties who are unable to do the sustained head lift. It is best to do the exercise three to six times per day for at least six weeks. Repeat it three times a day repetitive headlifting exercise 1. Shaker exercise this simple exercise can strengthen muscles to improve your swallowing ability. Thus, the present study examined the effect of modified shaker exercise on the amplitude and duration of pharyngeal muscle contraction using cervical auscultation. Mendelsohn maneuver swallow your saliva, but stop mid swallow. The number of repetitions defined by your clinician is considered a set. Make sure that neither the chair nor table has wheels.
Modified shakers hyolaryngeal excursion exercise shee. Dysphagia treatment studies purdue ieat research lab. To perform this exercise, lie flat on your back and raise your head as though you were trying to fixate your gaze on your toes. To strengthen muscles and improve your ability to swallow. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar. You should perform the set twice resting briefly between each set. A beginning list of dysphagia exercises that have evidence base i collected and typed these exercises up from the handouts. Ignore the number of repetitions and sets as directed in the video. Lift your head and look at your toes lift head only, do not raise shoulders.
Use of the shaker technique for dysphagia treatment nancy. Shaker exercise includes isometric and isotonic exercises. Video from companion website to the book clinical management of swallowing disorders, 4th edition by murry, carrau and chan 2017. Lift the wand over your head as far as you can until you feel a stretch. Scope and objectives of clinical task this cti will enable the allied health assistant aha to. The study follows a crosssectional study design, where 50 healthy individuals 23 males and 27 females performed modified shaker exercise and noneffortful swallow during 10. A commonly prescribed exercise to improve muscle contraction and esophageal opening in patients with swallowing disorders is known as the head raise or the shaker exercise. Keep sucking on the straw to keep the paper attached, bring it over a cup or a similar container and stop sucking.
Please read the disclaimer before reading any of the exercises below. Swallowing exercises for dysphagia therapy following stroke. Swallowing exercises for dysphagia verywell health. Hold your tongue between your teeth while you swallow hard. O exercise start with your jaw wide open and hide your teeth under your lips. You should then rest for two minutes and then repeat this exercise as many times as directed by your clinician. Repeat 3 times and rest 1 minute between repetitions. Turn your head slowly from shoulder to shoulder, turning as far as possible without causing pain.
Increased hyolaryngeal excursion and opening of the upper esophageal sphincter ues medical contraindications populations to avoid this exercise. A randomized study comparing the shaker exercise with. Dysphagia is a common sequela post chemo radiotherapy crt for head and neck cancer hnc and after stroke. Have your head raised high enough so that your eyes are fixated on your toes. One particular exercise, the shaker exercise, is a head lift exercise program designed to strengthen neck muscles and improve laryngeal excursion and ues opening for swallowing shaker et al. Hold for 1015 seconds, then push back against your head for about 5 seconds. What you need to know about swallowing this information describes swallowing problems that can be caused by radiation therapy to the head and neck. Exercises to strengthen the tongue and throat pharynx. Lift your head will keeping your shoulders flat on the bed and look at your toes. Try to work up to the hold times and repeats listed above.
The shaker maneuver is a promising rehabilitative exercise for. Measurement of hyolaryngeal muscle activation using. Measures of peak microvolts during contraction were signi. Please work directly with a licensed medical professional before implementing any of the following therapy exercises. Anecdotal evidence shows that the shaker exercise and its modifications improve pharyngeal muscle contraction. Sep 01, 2016 can exercise improve swallowing for als patients. Shaker exercise, headlifting exercises the patient rests in a supine position and lifts his or her head to look at the toes to facilitate an increased opening of the upper esophageal sphincter through increased hyoid and laryngeal anterior and superior excursion. Lift and lower same starting position as sustained hold 1. Benefit was seen that ctar may be less strenuous than shaker and compliance and achievement of the exercise may be greater. You must consult your physician or medical specialist before using these exercises. Raise your head far enough to be able to see your toes and hold for 1. Speech and swallowing exercises university of utah. The shaker also yielded considerable greater effort to lower the head to the mat.
Bend your head forward to bring your chin to your chest, then lift your head back to an upright position. Therapeutic procedure steps sustained headlifting exercise 1. Do not use a pillow your shoulders must be flat against the surface. These sustained head raising exercises were followed by 30 consecutive repetitions of head raisings in. The head raise exercise has been shown to be effective in improving airway protection and clearance of the food through the throat, but is completed while lying down, and. Alimed supraball chin tuck against resistance ctar is a method for enhancing suprahyoid muscle activity using a sustained head lift shakertype exercise.
Use the hand opposite the turn, to gently push your head to as close to 90 degrees as possible. The exercise does result in mild muscular discomfort which dissipates over the first week of the 6week treatment course. Other types of osmt introduce sensory input to the oropharynx, including mechanical, thermal. To perform the exercise, as described in the studies, the patient lies flat and. With the low back erect, the forces are distributed safely. Your palms should be facing down, and your hands should be as wide apart as your shoulders.