Not being a fan of the traditional lingual exercises, I took hold of an adaptive method, which I love and continue to use with my patients when appropriate.
Now the disclaimer: There are many situations where this exercise would not be appropriate and may even be downright unsafe. For example, if your patient is fresh off of a blunt head trauma and likes to bite SLPs, this would not be recommended. If your patient is not able to understand what you are about to do, it is probably not going to be a welcomed surprise. SLPs are well schooled and intelligent individuals, but better safe than sorry.
Now, if I am going to be an advocate for intensive swallow rehabilitation, patient’s should have the feeling they are getting their money’s worth. Take the traditional lingual exercises for example and humor me on the following fictitious exchange:
SLP: We are going to work on tongue base retraction. Patient: What does my tongue have to do with my throat problem? SLP: We need to propel the bolus Patient: What’s a bolus? SLP: Don’t worry, just trust me. Stick out your tongue and hold for three seconds. One.Two.Three. Now rest. Do it again. Rest. Do it 1000 times by tomorrow, okay?
Now, no one has ever come across a ridiculous example like that before. Several things about that example can be addressed. First, the patient probably will not comply with the recommendations because buy-in at the patient level has not been achieved. Yes, there are some patients who like to know all the anatomical details, but giving a simple explanation that the patient can connect with would probably be more ideal. Additionally, compliance is not likely to be achieved due to poorly thought out frequency and duration. Of course, 1000 times is ridiculous, but what kind of buy-in should we expect if a patient can’t expect significant results from unwarranted repetition. Lastly, perhaps, in this scenario, the patient was assigned five other exercises that were isolated exercises and did not include the actual activity of swallowing (I know, lots of assumptions here, but this is my blog). Compliance for swallowing exercise must be challenging when we are doing more talking about swallowing then actually doing it.
The way I have learned to adapt the simple lingual protrusion and retraction exercise is to make it like an exercise circuit which ends in the act of swallowing. Again, I give my patients a pep talk before we begin, like a trainer would to an athlete, who was about to initiate a rapid drill sequence. Once informed that slight discomfort is expected, I explain the circuit.
- Moisten your mouth with this swab to create some saliva
- Gently protrude your tongue. I am going to hold your tongue with my fingers and gently pull and we will hold it for 3 seconds
- One Mississippi…Two Mississippi…Three Mississippi
- Now, pull back your tongue slightly as I let go.
- Now I am going to push on the tip of your tongue with this slightly damp swab or tongue depressor to try to push your tongue to the back of your mouth but I want you to resist for 3 seconds
- One Mississippi…Two Mississippi…Three Mississippi
- Now, I want you to swallow hard squeezing your tongue and throat muscles (Usually, at the end of #6, they have an urge to swallow anyway)Good, that is one. Lets do nine more!!! The above has included the act of swallowing and outside of “don’t touch my tongue again” the patient usually feels like they got a workout, one they have never experienced before.Hope this simple adaptation is helpful. Not rocket science and not my invention, but a routine I find beneficial in the appropriate situation.
