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Swallowing is a complex activity, controlled partly by voluntary action and partly by reflex activity (Kendall and McCreary 1993). Exercise can improve the action of the muscles involved in the reflex portion as well as in the voluntary portion of swallowing. Sitting, the functional eating position, is a practical position for exercising the muscles involved. Another good treatment position is prone on elbows.

Chewing is necessary to mix the food with saliva and shape it for swallowing. The tongue moves the food around within the mouth and then pushes the chewed food back to the pharynx with humping motions. To keep the food inside the mouth, patients must be able to hold their lips closed. Exercise of these facial and tongue motions is covered 7 Sects. 13.2 and 13.3.

A hyperactive gag reflex will hinder swallowing. To help moderate this conditioned reflex, use prolonged gentle pressure on the tongue, preferably with a cold object. Start the pressure at the front of the tongue and work back toward the root. Simultaneous controlled breathing exercises will make the treatment more effective.

When the food reaches the back of the mouth and contacts the wall of the pharynx it triggers the reflex that controls the next part of the swallowing action. At the start of this phase the soft palate must elevate to close off the nasal portion of the pharynx. Facilitate this motion by stimulating the soft palate or uvula with a dampened swab. You can do this on both sides, or concentrate just on the weaker side.

As the swallowing activity continues, the hy-oid bone and the larynx move upward. To stimulate the muscles that elevate the larynx use quick ice, ice sticks and stretch reflex. Give the stretch reflex diagonally down to the right and then to the left. Treat hyperactivity in these muscles with prolonged icing, relaxation techniques, and controlled breathing.

Fig. 13.19. Stimulation or relaxation of the throat

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