What is the Shaker (head-raising) exercise designed to strengthen, and what is its effect on swallowing?

• A. Suprahyoid muscles; increases anterior laryngeal excursion and improves opening of the upper esophageal sphincter.
• B. Infrahyoid muscles; reduces pharyngeal residue.
• C. Esophageal sphincter; increases lower esophageal sphincter tone.
• D. Cortical swallow center; increases swallow frequency.

Answer: (A)

Shaker exercise strengthens the suprahyoid muscles, the group that lifts the hyoid bone and larynx during swallowing. By performing the head-raising movements while lying down, these muscles gain strength and endurance. When a swallow occurs, the stronger suprahyoid muscles pull the larynx anteriorly and superiorly, increasing anterior laryngeal excursion and widening the opening of the upper esophageal sphincter (cricopharyngeus). That better UES opening helps the bolus move from the pharynx into the esophagus more efficiently and can reduce residue and aspiration risk. This effect is specific to the suprahyoids; it does not target the infrahyoid muscles, nor does it directly change lower esophageal sphincter tone or cortical swallow drive.