Physical Rehabilitation Medicine/Acquired Brain Injury


QUESTION: At age 56 I had a brain injury and CT scan results showed cerebellar and cerebral damage for the brain trauma.  Now at 68 yrs I still have swallowing problems especially when my muscles are tired generally from use.  I can even choke on liquid or my saliva.  I have told my doctor that this has occurred over the past 12 years and I have learnt to manage this problem.  Sometimes my pronouncing of words are difficult.  When I am asked to smile for a photo my smile does not look right.  I prefer to smile with my lips closed as this uses less mouth muscles and my smile looks more natural. (Q.)  Shouldn't I do what makes me feel better about myself.  I was diagnosed with Ataxia and speech problems after this head injury.  My left eye muscles can be problematic.  Eye focusing can be difficult.

ANSWER: Hi, Estelle,

Difficulty swallowing liquids and saliva tells me that the back part of your tongue is weak and not forming an adequate seal against the back wall of your throat. Such a seal is needed for safe swallowing.

Exercising the area in combination with adopting a chin tuck should not only increase strength and endurance, it will keep the material in your mouth until you can trigger the swallow. This prevents the coughing you experience with liquids.

Exercises consist of sucking, tongue retraction practice, and throat-wall activity.

1. Sucking: This activity will strengthen the lips, tongue and soft palate. Put one end of a straw in your mouth. Cover the other end with a finger. While your finger is occluding the end of the straw, suck for ten seconds. At the end of the 10 seconds, release your finger from the end of the straw while you are still actively sucking; you should feel a "pop". Repeat 10 times in succession.
2. Posterior tongue strengthening: repeat, "kah, kah, kah,...", ten times, as well.
3. Throat wall strengthening: repeat, "hawk, hawk, hawk...", times 10, too.
4. Exercises 2 and 3 should be done with as MUCH emphasis on the /k/ sound as you can. For example, it would be, "hawK", and "Kaw". Repeat each 10 times.
5. Do all series of exercises once every hour while awake. You can do them while watching TV, riding in the car, in the loo--- anywhere, really.

As you can see, you'll be doing about 300 repetitions a day; that's why it's broken up the way it is. You'll have a chance to recover in between sets.

Tuck your chin to your chest when taking liquids. Keep it there until you complete the swallow. You may use a straw as long as you don't take more than 1 1/2 teaspoons in at a time. Carry water with you so you can get a large enough amount to wash down your saliva, as the mass (bolus) of saliva is too small to be easily swallowed at this point, so it needs a bit of help.

I hope that helps. Let me know how it goes.

Best of luck,


---------- FOLLOW-UP ----------

QUESTION: Thank you so much.  I will probably sound funny if I am overhead but I won't worry about that.

I have trouble with my food with swallowing....I chew chew chew but I seem to have a half swallow or lazy swallow and the food gets stuck in what feels like my windpipe.  I had to swallow a tablet one night and it got stuck in my throat and I had to ring the ambulance.  My airtake was affected and I could hardly get a word out to the Ambulance intake person.
I told my doctor that once the food is stuck I do not try to swallow it but I attempt to get it back up.  My food pieces are kept tiny on my plate.  When my muscles are tired generally from use sometimes my jaw just moves involuntarily sideways and I bite my tongue or inside of my mouth.  It slides with a jerk.   My jaw was crushed in the assault and I could not get solid foods into my mouth for a week.  The head injury was also caused by this assault by my then husband who I am no longer with so you will understand that independence is very important to me.  So far it is the only thing he has not taken from me.  Sorry about the sad story.  Can you give me any pointers on these issues.  If so, you are an angel.

Dear Estelle,
Sorry about the delay in answering. I didn't realize there was a follow-up question.
Difficulty with solids suggests one of two things: either you have GERD with stomach acid rising in your esophagus that causes the muscles at the top of your esophagus to clamp shut, or there is weakness, slowness, and/or incoordination resulting from the cerebellar injury (ataxia), or both.
Swallowing solids can be improved not only from exercises, but from taking a larger bolus of food assisted by a large gulp of water in the same swallow. It sounds scary, but it increases the stimulation of the nerves associated with the control of swallowing.
If I can assist in any way, please let me know.
Best regards,

Physical Rehabilitation Medicine

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Nancy Brough, MA, former speech pathologist


I can answer any question about swallowing disorders and acquired and/or developmental communication disorders. Examples are aphasia, brain injury (traumatic or from strokes), and degenerative neurologic diseases. I also have specialized knowledge in craniofacial disorders (i.e., cleft palate.)


Experience in the area: I practiced as a speech pathologist for 20 years.

BA/MA Communicative Disorders, CSUN 1981/1986 Clinical training at UCLA and West Los Angeles Veterans Administration Medical Center.

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