# Immediate Effects of the Forehead Exercise for Suprahyoid Muscles: A Case Series

## TL;DR

A single forehead exercise session improved swallowing safety in patients at risk of aspiration, suggesting it could be a helpful preparatory technique.

## Contribution

Demonstrated immediate effectiveness of a simple forehead exercise in reducing aspiration risk during swallowing.

## Key findings

- Median Penetration-Aspiration Scale score decreased significantly after a single FESM session.
- 10 out of 12 patients showed improved swallowing safety following the exercise.
- The exercise involved isometric chin-tuck contractions and was performed immediately before swallowing.

## Abstract

Introduction

Dysphagia is common in older adults and individuals with neurological disorders and is often associated with aspiration pneumonia and reduced quality of life. The Forehead Exercise for Suprahyoid Muscles (FESM, also known as Enge-Odeko-Taiso) is a simple, non-invasive technique aimed at strengthening the suprahyoid muscles. However, its immediate effect on swallowing function is not well understood. We aimed to determine whether a single session of FESM, performed during a videofluoroscopic swallowing study (VFSS), could immediately reduce the risk of penetration and aspiration, as measured by the Penetration-Aspiration Scale (PAS).

Methods

This small retrospective case series included 12 patients (mean age 76.6 ± 11.3 years) who underwent VFSS at Hamamatsu City Rehabilitation Hospital between December 1, 2024, and April 1, 2025. Patients were included if they had a baseline PAS score ≥2 and performed the FESM during the same VFSS session. Patients performed at least five repetitions of the FESM, which involved isometric chin-tuck contractions, immediately before the post-intervention swallow. Body position, bolus type, and imaging parameters were kept consistent before and after the exercise. Pre- and post-FESM PAS scores were compared using the Wilcoxon signed-rank test (significance set at p < 0.05).

Results

The median PAS score significantly decreased from 3.5 (interquartile range (IQR), 2.75-8.00) to 1.0 (IQR, 1.00-2.25) following FESM (p = 0.025). Among the 12 patients, 10 showed improvement, one showed no change, and one worsened.

Conclusion

A single FESM session performed immediately prior to swallowing significantly reduced penetration and aspiration events. These findings suggest that FESM may be a practical, low-effort preparatory exercise to reduce the risk of airway invasion during swallowing. Further controlled trials are needed to confirm these effects and to investigate potential dose-response relationships and long-term benefits.