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Selecting Rehabilitative Exercises for a Patient with Dysphagia
6/9/2026
A common misconception is that swallow studies are performed simply to determine appropriate diet textures. The primary purpose is actually to identify the physiological impairments, which then inform diet considerations and treatment planning.
Without knowing the physiological deficits of someone’s swallow function, you cannot develop an effective intervention plan.
Use the chart below to use the clinical finding on MBS/FEES to determine the physiological impairment and corresponding rehabilitative exercises.
| Clinical Finding | Physiological Impairment | Evidence-Based Exercises |
|---|---|---|
| Vallecular residue | Reduced base of tongue retraction | Masako, Effortful Swallow |
| Pharyngeal wall residue | Reduced pharyngeal stripping wave / pharyngeal wall squeeze | Masako, Effortful Swallow |
| Pyriform residue/Reduced UES opening | Reduced hyolaryngeal excursion (and/or impaired UES relaxation) | Effortful Swallow, Mendelsohn Maneuver, Shaker, EMST, CTAR |
| Incomplete epiglottic inversion | May be related to reduced base of tongue retraction, reduced hyolaryngeal excursion, reduced pharyngeal constriction, or structural obstruction (e.g., osteophytes, DISH) | Depends on the underlying physiological impairment identified on instrumental assessment |
| Aspiration before the swallow | Impaired oral control and coordination of the bolus | Oral motor bolus-control training |
| Aspiration during the swallow | Incomplete vocal fold closure | Supraglottic Swallow, Super-Supraglottic Swallow |
| Aspiration after the swallow | Typically due to pharyngeal residue or backflow from the esophagus | Select exercises targeting the reason for the pharyngeal residue; refer to ENT/GI for backflow |
| Ineffective cough | Insufficient respiratory support | EMST |
| Aspiration without reflexive cough | Impaired laryngeal sensation |