Rehabilitation Interventions

Rehabilitation interventions involve applying principles of neuroplasticity and motor learning to improve the physiology of swallowing behaviour. 

Oral sensorimotor interventions aim to develop awareness, strength, coordination, range of movement, and endurance of the lips, cheeks, tongue, and jaw (Sjögreen, et al., 2018). 

Direct oropharyngeal exercises include exercises involving the oropharyngeal musculature with the aim of changing participant swallowing physiology (e.g. strength-based exercises, respiratory coordination exercises, and skill-based programs). At present, the feasibility and effectiveness of using swallowing exercises with children remains inconclusive (Halfpenny, Stewart, Kelly, Conway, & Smith, 2021). 

Best evidence reinforces dysphagia rehabilitation approaches that include motor learning factors such as intensity, duration, task specificity, and generalization. 

At present, the strength of recommendations relating to oral sensorimotor interventions for children with dysphagia secondary to congenital or early-acquired disabilities is moderate due to lack of control groups, however, significant positive results are reported (Sjögreen, et al., 2018). Clinicians should always consider functional therapy tasks that directly impact eating and drinking ability and/or safety and closely parallel the desired task. See Table 8.

Table 8: Compensatory, Rehabilitative, and Habilitative Techniques for Dysphagia Management











Moderate the rate of intake by controlling or titrating the rate of presentation liquid or food provided, moderating the rate of presentation of food or liquid, and the time between bites or swallows

Encourage breathing (infants)

Discourage overfilling the oral cavity (children)


Modify texture

Offer moist, cohesive consistency

Reduce piecemeal deglutition, reduce choking risk


Modify liquid viscosity

Thickened liquids consistency

Reduce risk of aspiration


Modify position

Elevated side-lying positioning or semi-prone (for infants)

Maximize control of muscles for deglutition, reduce bolus flow, improve integration of suck-swallow-breathe sequence, reduce airway obstruction


Provide head or face posture support

Provide jaw, lip, or cheek assist

Reduce risk of aspiration


Use alternative equipment

Trial slow flow nipples

Reduce risk of aspiration


Use adaptive equipment


Trial flexible cut-out cup

Reduce risk of aspiration


Increase oral sensorimotor awareness

Alter food taste, temperature, tactile quality

Stimulate receptors of the tongue and oropharynx

Provide additional sensory input for swallowing






Practice biting and chewing

Offer transitional foods which quickly dissolve

Improve underlying oropharyngeal physiology


Refine bolus control and swallow

Offer small sips of water

Improve underlying oropharyngeal physiology


Practice swallowing Strengthen the jaw, lips, cheek, and tongue

Dry swallow or effortful swallow

Improve underlying oropharyngeal physiology (e.g. strengthen jaw, lips, cheek, and tongue)


Trial dysphagia exercises or maneuvers

Modified Shaker exercise, Effortful swallow, Masako Maneuver, Jaw Thrust*

*This list is not exhaustive

Change the timing or strength of movements of swallowing

Improve underlying oropharyngeal physiology

(e.g. modified Shaker exercise improves the amplitude of pharyngeal muscle contraction)



Trial biofeedback

Use surface electromyography, ultrasound, or nasendoscopy

Interpret visual information and make physiological changes during the swallowing process


Trial electrical stimulation


Use an electrical current to stimulate the peripheral nerve


Improve underlying oropharyngeal physiology (e.g., increase the velocity of hyoid bone movement and reduce the pyriform sinus stasis)






Support the development of oral sensorimotor skills that have yet be mastered


Offer oral stimulation with tastes, or time and volume limited oral feeding

Begin with foundational skills and practice within the infant or child’s zone of proximal development

Elicit the skills that emerge in the typical oral sensorimotor skill sequence


Responsive feeding—

Focus on the caregiver-and-child dynamic


Attempt to understand and read a child’s cues for both hunger and satiety and respect those communication signals



Emphasize communication rather than volume


Behavioural interventions based on principles of behavioural modification

Trial techniques such as antecedent shaping, prompting, modelling, stimulus fading, and differential reinforcement of alternate behaviour

Increase relevant actions or behaviours—including increasing compliance—and reduce maladaptive behaviours related to feeding and swallowing