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Home Swallowing Exercise Programme for HK Patients

Swallowing rehabilitation does not have to be confined to hospital or clinic sessions. Evidence consistently shows that a structured home exercise programme, when prescribed and monitored by a registered Speech-Language Therapist (SLT), produces meaningful improvements in swallowing muscle strength and coordination. This guide outlines an evidence-based home programme aligned with Hospital Authority (HA) SLT practice in Hong Kong.

Important: SLT Prescription Required

Do not begin any of the exercises in this guide without first being assessed by a registered SLT. An incorrect exercise can worsen symptoms or cause injury. HA SLT departments are accessible via General Outpatient Clinic (GOPC) referral from a doctor, or through ward referral for inpatients.

Programme Principles

Training frequency

Environment

Exercise log

Core Home Swallowing Exercises

1. Shaker Exercise (Head Raise Exercise)

Target: Strengthens suprahyoid muscles; improves upper oesophageal sphincter (UOS) opening

Technique:

  1. Lie flat on your back with shoulders on the floor or bed
  2. Raise only your head to look at your toes — keep shoulders down
  3. Hold for 1 minute (sustained contraction)
  4. Rest for 1 minute
  5. Repeat the 1-minute hold 3 times
  6. Then perform 30 rapid head raises and lowering movements (isokinetic contractions)

Caution: Patients with cervical spine conditions must obtain medical clearance before attempting this exercise.

2. Masako Manoeuvre (Tongue-Hold Swallow)

Target: Strengthens posterior pharyngeal wall contraction

Technique:

  1. Gently hold the tip of the tongue between the front teeth (tongue slightly extended)
  2. Keeping the tongue held, perform a complete swallowing movement
  3. Begin with dry swallows; add a small amount of water only after SLT confirms it is safe
  4. 10 repetitions per set, 3 sets per day

Note: This manoeuvre should be demonstrated by an SLT in clinic before home practice begins.

3. Effortful Swallow

Target: Increases overall swallowing muscle force and tongue base retraction

Technique:

  1. Hold a small amount of saliva or water in the mouth (only after SLT confirms safety)
  2. Swallow as hard as possible — muscles of the throat and neck should feel fully engaged
  3. A normal swallow uses minimal effort; an effortful swallow requires 3–4 times that effort
  4. 10 repetitions per set, 3 sets per day

4. Mendelsohn Manoeuvre (Prolonged Laryngeal Elevation)

Target: Increases the extent and duration of laryngeal elevation, improving oesophageal opening

Technique:

  1. Place your hand on the larynx (Adam’s apple) to feel movement during swallowing
  2. Begin a swallow, and as the larynx reaches its highest point, actively hold it there using muscle effort
  3. Maintain the elevated position for 2–3 seconds before completing the swallow
  4. 5–10 repetitions per set, 2–3 sets per day

This manoeuvre is technically demanding. Practise in clinic with the SLT first and only move to home practice once the technique is confirmed to be correct.

Tracking Progress

Use the following subjective indicators in your exercise log:

IndicatorPre-programme (1–10)After 4 weeks (1–10)
Throat-clearing sensation after swallowing
Coughing frequency during meals
Time required per meal
Overall swallowing effort

Hospital Authority SLT Services in Hong Kong

Public hospital referral pathways

Private SLT practice

Community support

A consistent home programme combined with regular SLT follow-up is the most evidence-supported path to meaningful swallowing improvement. Commit to the prescribed schedule and bring your exercise log to every appointment so your SLT can progress the programme appropriately.