Range+of+Movement,Resistance+and+Control+Exercises

= Range of Motion, Resistance and Control Exercises = 
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__**Range of motion Exercises**__ Normal range of motion of the tongue lips, cheeks and jaw and are often effected in patients who have undergone treatment for cancer to the head and neck because of either surgical resection, reconstruction of the structures or fibrosis induced by radiation therapy ( Pauloski, 2008). Range of motion exercises are designed to improve the target structure by extending it in a certain direction until a strong stretch is felt (Pauloski, 2008). Tongue range of motion exercises have been found to improve the swallowing function in surgically treated oral cancer patients (Byron et al., 2006). A study conducted by Logemann et al.,(1997), showed that patients who performed tongue range of motion exercises three months post surgery had a better swallowing function then those who did not. Some tongue exercises include retracting the tongue as far back as possible in the oral cavity- this will exercise the tongue base (Pauloski, 2008). Gargling and pretending to yawn are also often used which also help elicit tongue base retraction (Veis, Logemann, Colangelo, 2000).

__**Resistance Exercises**__ These are used to build or maintain strength in the oral tongue. They are based on the rationale that stronger tongue muscles will function better in the swallowing mechanism (Pauloski, 2008). These exercises usually involve getting the tongue to push against some type of resistance (often a tongue depressor or the back of a small teaspoon are used), and to hold the position for several seconds (Logemann, 1998). Usually the clinician holds up the object and asks the patient to push against it as hard as they can for as long as they can before they cause themselves pain (Pauloski, 2008). Depending on the patients range of motion, the tongue may be extended outside the cheeks and moved to either side to depress against the depressor, resist the force of the depressor and relax. If range of motion is very poor you can instruct the patient to move the tongue from side to side inside the mouth trying to bulge out the cheeks with the tongue (Pauloski, 2008). One final exercise is that the patient be instructed to push down on the tongue using the tongue depressor while simultaneously pushing up with the tongue, resisting the force of the depressor. Pauloski (2008), recommends that each exercise be repeated five to ten times per session, aiming for five to ten sessions per day.

__**Lingual Control Exercises**__

====These exercises can be used to improve bolus control for chewing. These exercises often involve manipulation of a material within the oral cavity to work on bolus seal, bolus retrieval from the teeth and propelling the bolus posteriorlly in the oral cavity, (Byron et al., 2006). ====

==== Swallowing Maneuvers ====