Swallowing rehabilitation is a branch of therapy that addresses not only musculoskeletal issues but also sensory, perceptual, and behavioral problems. It focuses on improving the strength, coordination, awareness, and mobility of the oral-motor muscles. To enhance independent eating, sucking, swallowing, and chewing skills, facial and oral massages, tongue, jaw, and lip exercises, oral-motor exercises and activities, as well as intraoral sensory applications are utilized.

Nutrition, one of the most basic human needs, is carried out through the swallowing function. Like all areas of human development, the swallowing function also follows a developmental progression. In the first two years of life, children’s oral-motor and swallowing skills involve sucking liquids and taking soft foods from a spoon. Over time, as oral movements increase and the consistency of consumed foods varies, chewing skills develop. Oral-motor movements enable swallowing and speech functions through the coordinated work of many muscles in the face, mouth, and throat. Chewing, which is part of the oral motor developmental stages, is the final stage of the swallowing skill. Oromotor exercises and activities are used to shape speech and oral functions by strengthening the mouth muscles

Some oral motor problems are related to motor planning. Motor planning involves the coordination of gross motor movements, fine motor movements, and oral-motor movements. A child’s motor planning does not develop well unless their oral awareness improves.

Feeding and swallowing disorders may arise in various forms and degrees due to impaired sensory functions—such as food refusal, resistance during meals, reduced intake of food by mouth, or delayed development of age-appropriate swallowing and feeding skills.

Common medical conditions in which swallowing problems are observed:

• Early experiences such as oral and pulmonary suctioning, intubation, and nasogastric feeding. Newborns with medical complications are exposed to procedures that cause trauma in the oropharyngeal area.
• Prolonged absence of oral feeding: Oral stimulation is a critical developmental period for the development of sensory processes within and around the mouth. The loss of oral experience may be one of the easiest sensory defenses to manage.
• Neurological disorders directly affecting sensory pathways: neurologically immature infants, cerebral palsy, autism, Down syndrome
• Developmental delays
• Hemiplegia
• Cleft lip and palate

Common oral-motor problems include:

• Lack of tongue lateralization
• Decreased saliva control
• Increased gag reflex
• Oral-motor coordination deficits
• Functional motor impairment of the swallowing function
• Difficulties in forming solid or liquid food into a bolus
• Abnormal reflexes in sucking, chewing, and tongue movements
• Weak sucking
• Persistent tongue thrust
• Hyperactive gag reflex
• Incomplete lip closure
• Gagging, coughing, and choking
• Aspiration
• Prolonged oral transit time

Oral-motor problems are treated with individualized rehabilitation programs based on findings obtained through both subjective and objective assessment methods. To support the development of independent eating, sucking, swallowing, and chewing skills, therapy may include facial and oral massages, exercises for the tongue, jaw, and lips, oral-motor exercises and activities, and intraoral sensory stimulation. Oral-motor rehabilitation also involves mobilization techniques, maneuvers, electrical stimulation, and postural compensation strategies.