Swallowing Exercises- Lip-Closure-Lip-Seal Exercises

What are lip-closure/lip-seal exercises?

Lip-closure exercises are also known as lip-seal or lip-press exercises. They are done to help improve swallowing. These exercises are a type of treatment when you have trouble swallowing (dysphagia). Lip-closure exercises may help increase lip strength and mobility over time. They may also help the ability to swallow and help prevent drooling. These exercises are sometimes used with other types of swallowing exercises.

Before you swallow, you chew your food to a size, shape, and texture that can be swallowed. When you swallow this material, it passes through your mouth and down through parts of your throat called the pharynx and larynx. From here, the food or liquid passes through a long tube (esophagus) before entering your stomach. This movement requires a series of actions from the muscles in these areas.

Muscle weakness in these areas can make it hard to swallow correctly. A speech-language pathologist (SLP) may prescribe specific swallowing exercises to improve your swallowing. Swallowing exercises can give increased strength, mobility, and control to these muscles. Over time, this may help you to swallow normally again and help prevent drooling.

Why might I need lip-closure/lip-seal exercises?

You might need to use lip-closure exercises if you have dysphagia. Dysphagia can lead to food or fluid going into the airways or lungs (aspiration). This can lead to pneumonia and other problems. Because of this, it’s important to promptly identify and treat your dysphagia if you have it. Symptoms of dysphagia may include:

• Trouble swallowing

• Trouble "starting to" swallow

• Gagging or coughing when swallowing

• Drooling

• Problems with or poor tongue control

• Weak voice

• Choking due to the feeling of food getting stuck in your throat

• Food getting caught in the lungs

• Liquid or fluids coming from the nose when trying to swallow

Health conditions can lead to dysphagia. Some examples are:

• Stroke

• Brain or spinal cord injury

• Dementia

• Conditions that reduce saliva such as Sjögren syndrome

• Parkinson disease or other nervous system conditions

• Muscular dystrophies

• Blockage in the esophagus such as from a tumor

• History of radiation, chemotherapy, or both to the neck or throat for cancer

An SLP may be more likely to prescribe lip-closure exercises if they think you are having trouble with your first phase of swallowing. For example, this might happen from a mouth lesion or after a stroke.

What are the risks of lip-closure/lip-seal exercises?

Lip-closure exercises are safe. If you have any discomfort during the exercises, you can stop doing them. Let your healthcare provider or therapist know right away. Don’t practice these exercises unless someone from your medical team prescribes them to you.

How do I get ready for lip-closure/lip-seal exercises?

Before you start lip-closure exercises, you and your SLP will determine the body position for each exercise. Your SLP will also give you instructions on how to do this, if needed. For example, it may be better to do these exercises while out of bed.

It's also helpful to remove distractions from your environment. Turn off the TV and do the exercises at a time when you won’t have visitors. This will let you focus on your exercises and get the most benefit from them. You and your SLP can figure out the best time to do these exercises. Your SLP will let you know if there's anything else you need to do before getting started.

What happens during lip-closure/lip-seal exercises?

The exercises will depend on the exact nature of your swallowing problem. For example, you may have a problem with the first phase of swallowing, before the food material leaves your mouth. If so, you may benefit from working the muscles in this region. This includes your cheeks, tongue, and lips. In this case, lip-closure exercises may help you keep your food inside your mouth, manipulate your food, and move the material into your pharynx. If you have a problem with later stages of swallowing, your SLP might give you different swallowing exercises.

You can do these exercises in your hospital room or at home. Often you can do them on your own, but you may also work with a healthcare provider to practice these exercises.

Your SLP can show you the exercises you should do and explain how often to do them. For example, you may be asked to:

• Press your lips tightly together for 5 seconds. Relax and then repeat 5 times.

• Tightly press your lips around a tongue depressor, lip-closure spoon, or other approved device in the center of your lips while someone tries to remove it, for 5 seconds. Relax and then repeat 5 times. Don't hold the tongue depressor with your teeth or gums. Repeat this exercise on the left side and the right side of the lips.

• Fill your cheeks with air and move the air from one cheek to the other 5 times, with no air escaping from the lips or nose. Relax and then repeat 5 times.

Your SLP can tell you how to do each exercise and how often you should practice it. In many cases, you’ll need to practice your exercises several times a day for the most benefit.

You will likely be doing lip-closure exercises along with other types of swallowing exercises. If so, do these in the same order each time. This will help make sure you don’t forget any exercises.

What happens after lip-closure/lip-seal exercises?

You can go back to your normal activities right after you finish practicing your lip-closure and other exercises.

As part of your treatment plan, your healthcare provider and SLP may prescribe other treatments. These may include changes to your diet, changes in eating position, medicine, or surgery.

It’s a good idea to keep a record every time you do your swallowing exercises. This serves as a reminder to you to do your exercises as prescribed. It also provides helpful feedback on your progress to your SLP. Make a note of what exercises you did and when you did them. Also note any problems, so you can discuss them with your SLP.

Your SLP and medical team may change your exercises as they watch your progress over time. You may have bedside swallowing exams. And you may have imaging tests, such as a fiberoptic evaluation of swallowing (FEES) test. It may take a few weeks to notice an improvement in your swallowing.

As your ability to swallow improves, your risk of aspiration will decrease. Your SLP may be able to change your diet and allow you to eat certain types of food again. This can improve your nutrition, your overall health, and your quality of life. You may still have problems with swallowing even after practicing these exercises regularly. Your SLP will tell you what kind of progress to expect.

Continue to practice all your swallowing exercises as prescribed by your SLP. If you skip practice sessions, your progress will slow. Work closely with all the members of your healthcare team. This will help your chance of having a good outcome.

Next steps

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• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

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