Patent Publication Number: US-2023158354-A1

Title: Rehabilitation device

Description:
FIELD OF THE INVENTION 
     This invention pertains in general to a rehabilitation device. More particularly, the present invention pertains to an exercise device for swallowing rehabilitation, e.g. to use for swallow exercises and for jaw exercises. 
     BACKGROUND OF THE INVENTION 
     Swallowing is a complex action involving muscles and nerves within oral cavity, pharynx and esophagus, as well as a swallowing centre in the brain that is connected to the pharynx and esophagus by nerves. 
     Dysphagia is dysfunction of the swallowing and is in general terms described as an inability to move food, or liquid, from the mouth to the stomach. Dysphagia is a symptom of many different causes and may result from congenital abnormalities, structural damage, and/or medical conditions. For example, it may occur after head and neck cancer (HNC) treatment. Dysphagia may also occur after total laryngectomy as muscles involved in swallowing are removed or transected. 
     The impact on the quality of life for dysphagia patients may be substantial. For example, subjects suffering from dysphagia may be affected by chronic malnutrition, dehydration, failure to thrive, aspiration pneumonia, and exacerbation of chronic lung disease. 
     There are many ways to treat dysphagia and conventional therapies for dysphagia generally include dietary modification, compensatory techniques like postural alterations, indirect therapy like strengthening exercises for swallowing muscles, direct therapy like exercises during swallowing and medical therapy. The aim of the treatment is to maintain adequate nutritional and hydrational intake and to maximize airway protection. With strengthening therapy, the swallowing muscles may be exercised and the swallowing function improved. This may result in that feeding tube dependency and diet modification may be reduced. Additionally, the risk of aspiration pneumoniae and trismus may be reduced. By reducing the listed issues, a higher quality of life may be achieved. 
     However, there are problems associated with current strengthening therapy. There currently does not exist any exercise device, or rehabilitation device, that is suitable for persons that have undergone a total laryngectomy. Traditionally, dysphagia for these persons has mainly been treated by surgical methods, pharmacological methods and coping strategies. For this reason, existing exercise devices do not target all of the necessary muscles for persons that have undergone total laryngectomy. Additionally, as existing exercising devices are not intended for persons that have undergone total laryngectomy, these exercise devices are not suitable for a user having tracheostoma. Existing exercise devices may cover the tracheostoma and/or make breathing difficult during use of the exercise device. 
     Furthermore, there currently does not exist any exercise devices, or rehabilitation devices, that is possible to use for different exercises. In order to exercise different muscles, different exercise devices have to be used. Thus, a user needs to have several different rehabilitation devices for different purposes. In addition to this, existing exercise devices generally also have the drawback that the resistance used for training is unknown and that the resistance is not possible to vary. The lack of knowledge of the used resistance and the possibility to vary the resistance is also a problem for exercises that do not need an exercise device at all. These exercises usually also have the disadvantages that they often are performed in unfeasible positions, such as laying down etc. 
     Hence, an improved exercise device would be advantageous, and in particular, an exercise device allowing for increased user comfort, which is possible to use for different exercises and which additionally also is suitable for a person that has undergone total laryngectomy. 
     SUMMARY OF THE INVENTION 
     Accordingly, the present invention preferably seeks to mitigate, alleviate or eliminate one or more of the above-identified deficiencies and disadvantages, singly or in any combination, and solves at least the above-mentioned problems by providing an exercise device for swallowing rehabilitation. Said exercise device comprises a curved exerciser body forming a support and holding means mounted to said exerciser body. The exercise device further comprises chin receiving means movably connected to said holding means and exercising means for creating resistance when the chin receiving means is moved towards the exerciser body. The exercising means is configured to extend between said exerciser body and said chin receiving means. 
     According to an aspect, there is provided an exercise device for swallowing rehabilitation with a variable resistance, the exercise device comprising an exerciser body forming a support, chin receiving means movably connected to the exerciser body, exercising means for creating resistance when the chin receiving means is moved towards the exerciser body, and a lever arm connected to the exerciser body via a fulcrum and configured to interact with the exercising means, wherein the exercising means or the fulcrum is displaceable to provide a variable resistance against movement of the chin receiving means towards the exerciser body. 
     Optionally, the exerciser body comprises a chest resting plate adapted to engage with a chest of a user of the exercise device. Optionally, the at least a part of the chest resting plate is provided with a padding. 
     Optionally, the chin receiving means comprises a chin receiving plate for receiving a chin of a user of the exercise device. Optionally, the at least a part of the chin receiving plate is provided with a padding. 
     Optionally, the exercising means comprises a spring or an elastomer member. Optionally, the exercising means is slidable along the exerciser body to provide the variable resistance. Optionally, the exercising means is arranged to extend between the exerciser body and the lever arm. 
     Optionally, one end of the exercising means is connected to the exerciser body with an attachment device. Optionally, one end of the exercising means is connected to the lever arm with an attachment device. Optionally, the exercising means is detachably attached to the exerciser body and/or the chin receiving means with the attachment device, thereby making the exercising means replaceable. Optionally, a length of the exercising means is adjustable by the attachment device to provide the variable resistance. 
     Optionally, the exercise device further comprises a holding means comprising an elongated member, wherein the elongated member is secured to the exerciser body at one end and configured to receive the lever arm at the other end. Optionally, the lever arm is pivotally connected to the elongated member by the fulcrum, around which the lever arm is pivotal. 
     Optionally, the exercise device further comprises a handle, wherein the handle is attached to the respective ends of the exerciser body, thereby forming a closed loop with the exerciser body. 
     Optionally, the fulcrum is displaceable to provide the variable resistance. Optionally, the fulcrum is displaceable to adjust a lever ratio of the lever arm. Optionally, the fulcrum is displaceable between a number of pivot positions. Optionally, the number of pivot positions are defined by a rack of the lever arm. 
     Optionally, the exercise device further comprises a holding means secured to the exerciser body, wherein the holding means is configured to receive the lever arm. Optionally, the lever arm is coupled to the holding means via the fulcrum. 
     Optionally, the exercising means is disposed between the exerciser body and the adjustment lever. Optionally, the exercise device further comprises a handle disposed between the exerciser body and the adjustment lever, wherein the exercising means is disposed inside the handle. 
     Optionally, the lever arm comprises an elongate member having a first end and a second end, wherein the lever arm is connected to the exercising means at the first end and is configured to interact with the chin receiving means at the second end. Optionally, the chin receiving means comprises a connection member pivotal around a fulcrum/pin. Optionally, the connection member comprises a first arm configured to interact with the lever arm, and a pair of second arms configured to receive the lever arm between them when the lever arm pivots about the fulcrum. Optionally, the lever arm is configured to interact with the chin receiving means via a roller. Optionally, the lever arm is connected to the exercising means via a loading arrangement, and the loading arrangement is configured to compress the exercising means when the lever arm pivots about the fulcrum. Optionally, the loading arrangement comprises a connecting element and a stop, wherein the connecting element has a first end connected to the lever arm and a second end connected to the stop, the exercising means is disposed between the lever arm and the stop, and the stop configured to compress the exercising means when the lever arm pivots about the fulcrum by movement of the connecting element. 
     Also disclosed herein is an exercise device for swallowing rehabilitation with a variable resistance, the exercise device comprising an exerciser body forming a support, a chin receiving means movably connected to the exerciser body, exercising means for creating resistance when the chin receiving means is moved towards the exerciser body, and a lever arm connected to the exerciser body via a fulcrum and configured to interact with the exercising means, wherein the exercising means is displaceable to provide a variable resistance against movement of the chin receiving means towards the exerciser body. 
     Also disclosed herein is an exercise device for swallowing rehabilitation with a variable resistance, the exercise device comprising an exerciser body forming a support, chin receiving means movably connected to the exerciser body, exercising means for creating resistance when the chin receiving means is moved towards the exerciser body; and a lever arm connected to the exerciser body via a fulcrum and configured to interact with the exercising means, wherein the fulcrum is displaceable to provide a variable resistance against movement of the chin receiving means towards the exerciser body. 
     Thereby, an exercise device for adjustable swallowing rehabilitation, which is possible to use for a plurality of exercises, and with a variable resistance, is provided. The provided exercise device additionally provides an increased user comfort. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other aspects, features and advantages of which the invention is capable of will be apparent and elucidated from the following description of embodiments of the present invention, reference being made to the accompanying drawings, in which 
         FIG.  1   a    is a side view of an exercise device according to an embodiment of the present invention; 
         FIG.  1   b    is a perspective view of an exercise device according to an embodiment of the present invention; 
         FIG.  2   a    illustrates an exercise device according to an embodiment of the present invention in use; 
         FIG.  2   b    illustrates an exercise device according to an embodiment of the present invention in use; 
         FIG.  2   c    illustrates an exercise device according to an embodiment of the present invention in use; 
         FIG.  2   d    illustrates an exercise device according to an embodiment of the present invention in use; 
         FIG.  3   a    is a side view of an exercise device according to an embodiment of the present invention; 
         FIG.  3   b    is a perspective view of an exercise device according to an embodiment of the present invention; 
         FIG.  4    illustrates an exercise device according to an embodiment of the present invention in use. 
         FIG.  5   a    is a perspective cross-sectional view of an exercise device according to an embodiment of the present invention; 
         FIG.  5   b    is a perspective view of an exercise device according to an embodiment of the present invention; 
         FIG.  5   c    is a perspective cross-sectional view of an exercise device according to an embodiment of the present invention; and 
         FIG.  6    illustrates an exercise device according to an embodiment of the present invention in use. 
     
    
    
     DESCRIPTION OF THE EMBODIMENTS 
     The following description focuses on an embodiment of the present invention applicable to an exercise device and in particular to an exercise device for swallowing rehabilitation. However, it may be appreciated that the exercise device is suitable also for other purposes than swallowing rehabilitation. Examples of such purposes may be voice training, general jaw training, swallowing training, and other dysphagia conditions. 
       FIG.  1   a    shows a side view of an exercise device  10  for swallowing rehabilitation according to a first embodiment of the present disclosure. Swallowing rehabilitation may include, for example, performing swallow exercises or other jaw exercises. As illustrated in  FIG.  1     a,  the exercise device  10  comprises an exerciser body  20  forming a support. The exercise body  20  is curved and is adapted to engage with a user using said exercise device  10 . In some embodiments, the exercise body  20  may comprise a chest resting plate  23  adapted to engage with a chest of a user using the exercise device  10 . Thus, when the exerciser device  10  is in use, the chest resting plate  23  of the exerciser body  20  may rest against the chest of the user. At least a part of the chest resting plate  23  may be provided with a padding  25 . The padding  25  may be of a softer material than the exerciser body  20  and may thus be more comfortable to have against the chest than the rest of the exerciser body  20 . This may improve the user comfort. The padding  25  may be, for example, a foam padding. 
     The exercise device  10  further comprises holding means  40  mounted to the exercise body  20 . As seen in  FIG.  1     a,  the holding means  40  is extending from the exercise body  10 . The holding means  40  is configured to hold a chin receiving means  30 . The exercise device  10  comprises the chin receiving means  30  and the chin receiving means  30  is movably connected to the holding means  40 . The holding means  40  secures the chin receiving means  30  to the exercise device  10  in a way such that the chin receiving means  30  is movable relative the exercise device  10 . The chin receiving means  30  is adapted to engage with a chin, or a jaw, of a user using the exercise device  10 . As illustrated in  FIG.  1     a,  the chin receiving means  30  may comprise a chin receiving plate  31  for receiving a chin of a user using the exercise device  10 . The chin receiving means  30  may further comprise a connection member  32  for movably connecting said chin receiving plate  31  to said holding means  40 . In some embodiments, at least a part of the chin receiving plate  31  of the chin receiving means  30  may be provided with a padding  33 . The padding  33  may be of a softer material than the rest of the chin receiving means  30  and may thus improve the user comfort. The padding  33  may be, for example, a foam padding. 
     The holding means  40  may be realized in different ways and  FIGS.  1   a  and  1   b    illustrate one example embodiment. The holding means  40 , according to this example embodiment, comprises an elongated member. The elongated member extends in an upward direction from the exerciser body  20 . The elongated member is secured to the exerciser body  20  at one end and is configured to receive the chin receiving means  30  at the other end. Thus, the holding means  40  is firmly mounted to the exerciser body  20  at one end. The chin receiving means  30  received at the other end may be received such that it is pivotally attached to the elongated member, i.e. the chin receiving means  30  is movably connected to the holding means  40 . As illustrated in  FIG.  1     b,  the chin receiving means  30  may be pivotally connected to said elongated member by at least one pin  45 , or joint. The chin receiving means  30  is pivotal around said at least one pin  45 . 
     The exercise device  10  further comprises exercising means  50  for creating resistance when the chin receiving means  30  is moved towards the exerciser body  10 , i.e. for creating a resistance to a user using the exercise device  10 . The exercising means  50  is arranged to extend between said exerciser body  20  and said chin receiving means  30 . According to the embodiment illustrated in  FIG.  1     a,  one end of the exercising means  50  is fixed to the exerciser body  20  by an attachment device  55 . The other end of the exercising means  20  may be connected to the chin receiving means  30 , but without being attached with any fastening means. The chin receiving means  30  is adapted to rest at this other end of the exercising means  50 . Thus, in the embodiment illustrated in  FIG.  1     a,  the exercising means  50  is not securely fixed to the chin receiving means  30 . The exercising means  50  and the chin receiving means  30  are only connected to each other by the physical contact that arises when they touch each other, but without being physically attached with any fastening means. It may thus be possible to lift the chin receiving means  30  in an upwards direction away from the exercising means  50  such that the exercising means  50  and the chin receiving means  30  are no longer connected to each other. It may be realized that according to another embodiment, the exercising means  50  may be securely fixed to the chin receiving means  30  by an attachment device, but not fixed to the exerciser body  20 . In still another embodiment, the exercising means  50  may be securely fixed at both ends, to both the exerciser body  20  and the chin receiving means  30 . 
     In some embodiments, the exercising means  50  may be detachably attached to the exerciser body and/or the chin receiving means  30  with the attachment device  55 , thereby making the exercising means  50  replaceable. This makes it possible to replace, or exchange, the exercising means  50  by another exercising means  50 . This may be usable in case the exercising means  50  breaks. This may also be used for changing the load, or the resistance, created by said exercising means  50 . For example, if a user finds an exercising means  50  with a certain stiffness or resistance too easy to exercise with, the exercising means  50  may be replaced by another exercising means  50 , which has another, higher, stiffness, or resistance. Thereby an amount of resistance created by said exercising means  50  may be changed. By changing the resistance, or the load, of the exercise device  10 , a user using the exercise device  10  may continue exercising at 60-70% of maximum capacity. This may ensure that the user&#39;s strength will continue to increase. 
     In some embodiments, the exercising means  50  may be adjustably attached to the exerciser body and/or the chin receiving means  30  with the attachment device  55 . In such embodiments, the attachment device  55  may be disposed in an elongate slot  60 , as illustrated in  FIG.  1     b.  The attachment device  55  is slidable along the length of the elongate slot  60 . As such, the position of the exercising means  50  relative to the holding means  40  and the at least one pin  45  is adjustable. By adjusting the position of the exercising means  50  relative to the holding means  40  and the at least one pin  45 , the resistance may be changed. In such embodiments, the exercising means  50  and the chin receiving means  30  are only connected to each other by the physical contact that arises when they touch each other, but without being physically attached with any fastening means. According to another embodiment, the exercising means  50  may be adjustably attached to the chin receiving means  30  by an attachment device  55 , with a corresponding elongate slot  60  present in the connection member  32 , but not fixed to the exerciser body  20 . In still another embodiment, the exercising means  50  may be adjustably attached at both ends, to both the exerciser body  20  and the chin receiving means  30 . 
     According to the previously described embodiment, the load of the exercising device  10  may be changed by exchanging, or replacing, the exercising means  50 . According to another embodiment, a length of the exercising means  50  for creating resistance may be adjustable by the attachment device  55  with which the exercising means  50  is attached. Thereby, an amount of resistance created by said exercising means  50  may be changed. The length of the exercising means  50  may also be adjusted in order to adjust the height of the exercise device  10 , such that it is more suitably adapted to the user using the exercise device  10 . 
     The exercising means  50  may comprise, for example, a spring. An example of such embodiment is illustrated in  FIGS.  1   a    and  1   b.  As seen in  FIGS.  1   a    and  1   b,  the spring is secured at one end to the exerciser body  20  with the attachment device  55 . The chin receiving means  30  is resting at the other end of the spring. As is known, different springs may have different spring constants. Different spring constants cause different stiffness and thereby causes different resistances. Thereby, by choosing a spring with a certain spring constant, i.e. stiffness, the resistance of the exercise device  10  may be regulated. 
     According to another embodiment, the exercising means  50  may comprise an elastomer member such as a silicone block. Depending on the size, shape, stiffness and density of the elastomer member, the resistance of the exercise device  10  may be regulated. 
     The exercise device  10  according to the present disclosure achieves an increased user comfort. The construction of the exercise device  10  makes it possible for a user to perform swallowing rehabilitation in comfortable positions, e.g. in an upright position. Thus, the user does not have to lay down in order to perform the exercises. Additionally, the provided exercise device  10  comprises a construction with an exerciser body  20 , which does not cover a tracheostoma when it is in use. This makes it easy to breathe when using the exercise device  10  and makes the provided exercise device  10  suitable for users having undergone a total laryngectomy. In some embodiments, in order to improve the user comfort for a user with a tracheostoma even further, the exercise device  10  may additionally comprise an opening, for example a hole or a fork in the exerciser body  20 . The opening makes it possible for air to freely flow through the hole of the exerciser body  20  in and out from the tracheostoma. 
     Furthermore, with the chin receiving means  30 , which is movable relative the exerciser body  20 , the user may receive tactile feedback while performing swallowing rehabilitation. By receiving direct feedback while performing swallowing rehabilitation, the user experience may be improved, which may motivate the user to continue using the exercise device  10 . 
     In some embodiments, the exercise device  10  may further comprise a handle  65 . The handle  65  may be attached to the respective ends of the curved exerciser body  20 . By providing a handle that connects the exterior ends of the exerciser body  20 , the exerciser body  20  and the handle  65  form a closed loop and thus provide a solid and secure construction of the exercise device  10 . With a handle  65  that a user may grip during use of the exercise device  10 , the exercise device  10  may also be easier to operate and to hold in the right position during exercise. 
       FIG.  2   a    illustrates the exercise device  10  in use. In  FIG.  2   a   , the user holds the exerciser device  10  in a start position, i.e. before any swallowing rehabilitation has begun. The exercise device  10  according to this embodiment comprises a handle  65  that the user holds during the use. As seen in the figure, the chest resting plate  23  of the exerciser body  20  rests against the chest of the user and the user&#39;s chin is resting on the chin receiving plate  31  in the start position. 
     One of the advantages with the exercise device  10  presented herein is that the exercise device  10  may be used for a plurality of different exercises. The exercises start from the previously described start position and from this position the plurality of different exercises may be performed. Some of these exercises will now be described with reference to  FIG.  2   b   - 2   d.    
       FIG.  2   b    shows a user performing an exercise herein referred to as “chin tuck against resistance”. The exercise is performed by pressing the chin downwards, towards the chest of the user, using the exercise device  10 . The chin rests at the chin receiving means  30 . When the user presses their chin downwards, the chin receiving means  30  pivots around the pin  45  and chin receiving means  30  is moved towards the exerciser body  20 . The final position, when the chest receiving means  30  is completely pushed towards the exerciser body  20 , is shown in  FIG.  2   b   . The exercising means  50  creates a resistance so that the user has to use a force to push the chin receiving means  30  downwards. The purpose of this exercise is to strengthen muscles that pull the larynx and hyoid up and forward, and improve the ability to swallow. The chin tuck exercise targets the same muscles as the generally known “shaker exercises”, also referred to as “head-lifting exercises”. In these exercises, a user rests in a supine position and lifts the head to look at the toes. Compared to the shaker exercises, the chin tuck exercise, performed with the exercise device  10 , may be performed in a much more comfortable position, e.g. in an upright position. Additionally, with a replaceable or adjustable exercising means  50 , the load that the user is exposed to may be known and adjustable. 
     Another exercise, which may be performed with the exercise device  10 , is illustrated in  FIG.  2   c   .  FIG.  2   c    shows an exercise herein referred to as “jaw opening against resistance”. The exercise is performed by pressing the lower jaw downwards, towards the exerciser body  20  of the exercise device  10 . The chin rests at the chin receiving means  30 . When the user opens the mouth and presses the lower jaw downwards, the chin receiving means  30  pivots around the pin  45  and chin receiving means  30  is moved towards the exerciser body  20 . The exercising means  50  creates a resistance so that the user has to use a force to push the chin receiving means  30  downwards with the lower jaw.  FIG.  2   c    shows the final position of the jaw opening exercise, i.e. when the lower jaw has pushed the chin receiving means  30  all the way down to the exerciser body  20 . The jaw opening exercise targets the same muscles as the generally known “Masako exercise”. The intent is to improve movement and strength of the posterior pharyngeal wall during swallowing. The exercise may also improve tongue base movement and improve the muscular pressures generated on foods and liquids during swallowing. 
     Still another exercise, which may be performed with the exercise device  10 , is illustrated in  FIG.  2   d   .  FIG.  2   d    shows an exercise, which may be referred to as “effortful swallow”. The exercise increases tongue base retraction and pharyngeal pressure during the swallow for reduced residue in the valleculae. The aim of the exercise is to improve the contact and coordination between the different muscles used while swallowing. As seen in  FIG.  2   d   , the exercise is performed by pressing the chin at the chin receiving means  30  and then swallowing. 
     Taken together, the three previously described exercises may target suprahyoid and infrahyoid muscles—for larynx elevation, sternocleidomastoid muscle and lateral pterygoid—mouth opening and trismus prevention-treatment. Thus, by using the provided exercise device  10 , the anterior tongue strength may be increased, the maximum mouth opening may be increased, and volume and strength of muscles may be increased. Thus, the provided exercise device  10  targets all the muscles that may be trained by a person that has undergone a total laryngectomy. Additionally, as the load of the exercising means  50  may be known, it is possible to choose an exercise device  10  with a suitable load for a certain user and potentially also increase the load as the muscles become stronger. 
     Another embodiment of the present disclosure will now be described with reference to  FIG.  3   a   . The exercise device  10  according to this embodiment is embodied in a corresponding way as the ones illustrated in the previous figures, but with a different construction of the holding means  40 . As illustrated in  FIG.  3   a   , the holding means  40  of the exercise device  10  comprises two slightly curved members. The two curved members are secured to the exerciser body  20  at one end. They extend in a direction away from the exerciser body  20 . Each of the two curved members comprises a guide track  41  configured to receive the chin receiving means  30 .  FIG.  3   b    is a perspective view of the exercise device  10  according to this embodiment. As seen in  FIG.  3   b   , the holding means  40  comprises two curved members firmly mounted to the exerciser body  20  at one end. The chin receiving means  30  is movably connected to the curved members, such that the chin receiving means  30  may move within the guide tracks  41 . In some embodiments, the chin receiving means  30  may comprise two engaging means  35 . The engaging means  35  may be radially extending from the chin receiving means  30  and configured to engage with the guide tracks of the holding means  40  such that the engaging means  35  is kept within the guide track during movement of the chin receiving means  30 . 
       FIG.  4    illustrates the previously described embodiment in use. As understood from  FIG.  4   , when the user pushes their chin downwards, i.e. towards the chest, the chin receiving means  30  will slide inside the guide tracks towards the exerciser body  20 . While the chin receiving means  30  is pushed downwards, the exercising means  50  will create a resistance acting towards the chin receiving means  30 , forcing the user to push harder. As seen in  FIG.  4   , the chin receiving means  30  will pivot around a center located at the neck of the user using the exercise device  10 . The described embodiment provides a solid and sustainable construction of the exercise device  10 . 
       FIG.  5   a    shows a cross-sectional view of an exercise device  10  for swallowing rehabilitation according to a third embodiment of the present disclosure. The exercise device  10  shown in  FIG.  5   a    comprises an adjustment lever  70  that allows adjustment of a resistance against movement of a chin receiving means. 
     As illustrated in  FIG.  5   a   , the exercise device  10  comprises an exerciser body  20  for supporting the device  10  during use. The exerciser body  20  may have a chest resting plate  23  adapted to engage with a chest of a user using the exercise device  10 . The chest resting plate  23  may have a padding (not shown), such as the padding  25  shown in  FIG.  1   . 
     The exercise device  10  also comprises a chin receiving means  30  movably connected to the exerciser body  20 . The chin receiving means  30  comprises a chin resting plate  31  and padding (not shown), such as the padding  33  shown in  FIG.  1   . The chin receiving means  30  also comprises a connection member  32  connected to the exerciser body  20 . In the embodiment of  FIG.  5   a   , the chin receiving means  30  is connected to the exerciser body  20  via a holding means  40  (shown in  FIG.  5   b   ) and a pin  45 . The chin receiving means  30  is pivotable about the pin  45 . 
     The exercise device  10  also comprises an adjustment lever  70 . The adjustment lever  70  comprises an elongate member that is pivotable about an adjustment pin  75 . The adjustment lever  70  is connected to the exerciser body  20  via the holding means  40  and the adjustment pin  75 . The adjustment lever  70  comprises a roller  80  at one end that is in contact with a lower surface of the connection member  32  of the chin receiving means  30 . In operation, the chin receiving means  30  interacts with the roller  80  such that the adjustment lever  70  is pivoted about the adjustment pin  75  when the chin receiving means  30  is moved towards the exerciser body  20 . 
     In the embodiment of  FIG.  5   a   , an exercising means  50  is disposed between the exerciser body  20  and the adjustment lever  70 . The exercising means  50  may be a compression spring, similar to those used in the previously described embodiments, or an elastomer member such as a silicone block. As shown  FIG.  5   a   , in some embodiments the exercising means  50  is disposed inside a handle  65  of the exercise device  10 . 
     A loading arrangement is provided to connect the adjustment lever  70  to the exercising means  50 . The loading arrangement may comprise a connecting element  85 , for example a wire or cable, connected to the adjustment lever  70  at the opposite end of the adjustment lever  70  to the roller  80 . The loading arrangement may also comprise a stop  90 , for example a spring washer, connected to the other end of the connecting element  85 . The exercising means  50  is disposed between the lever arm  70  and the stop  90 . For example, the connecting element  85  may run through an axis of the exercising means  50 . The adjustment lever  70 , the connecting element  85  and the stop  90  are operable to compress the exercising means  50  during operation of the device  10 , as will be discussed in relation to  FIG.  5     c.    
     The exercise device  10  shown in  FIG.  5   a    provides for adjustable or variable resistance against movement of the chin receiving means  30  towards the exerciser body  20 . To achieve this, the pivot position of the adjustment lever  70  is adjustable. As shown in  FIG.  5   a   , the adjustment lever  70  comprises a rack  95  configured to receive the adjustment pin  75 . The rack  95  comprises a number of adjacent positions for receiving the adjustment pin  75 , which define different pivot positions for the adjustment lever  70 . The adjustment pin  75  is placed in one of the positions in the rack  95 , and provides a pivot for the adjustment lever  70  about that position. As such, the pivot position is adjustable along the length of the adjustment lever  70  by movement the adjustment pin  75  between the positions in the rack  95 . It will be appreciated that the pivot position of the adjustment lever  70  may be adjustable in any suitable way, for example by a sliding mechanism. 
     By adjusting the pivot position of the adjustment lever  70 , the resistance provided by the device  10  can be increased or decreased as desired. This is because adjusting the pivot position of the adjustment lever  70  changes the length of the adjustment lever  70  either side of the pivot. If the adjustment lever  70  has a length x and the distance from one end of the adjustment lever  70  to the pivot position is y, the lever ratio is defined as y/(x−y). As such, by changing the pivot position, the distance y and the lever ratio can be changed without changing the length of the adjustment lever. There is therefore no requirement for an extendible or retractable lever arm that may not always be used. This allows for a compact design that still can still provide a wide range of resistance against movement of the chin receiving means  30  towards the exerciser body  20 . 
     Each pivot position may increase or decrease the resistance with respect to an adjacent position by a set amount. For example, when the adjustment pin  75  is in a minimum resistance position closest to the exercising means  50 , the resistance may be of the order of 20N. Each consecutive pivot position may increase the resistance by around 20N, until a maximum resistance position furthest from the exercising means  50 , where the resistance may be of the order of 160N. 
       FIG.  5   b    shows a perspective view of the exercise device according to this embodiment. As shown in  FIG.  5   b   , the holding means  40  connects the chin receiving means  30  to the exerciser body  20  via the pin  45 . The holding means  40  also connects the adjustment lever  70  to the exerciser body  20  via the adjustment pin  75   
     As also shown in  FIG.  5   b   , an adjustment knob  100  is present which enables movement of the adjustment pin  75  between the positions in the rack  95 . The adjustment knob  100  can be turned to an open position to enable movement of the adjustment pin  75  between the pivot positions. The adjustment knob  100  can then be turned to a closed position to lock the adjustment pin  75  in place. 
       FIG.  5   b    also shows that the connection member  32  of the chin receiving means  30  has a forked structure at one end. That is to say, the connection member  32  comprises a single arm  32   a  that connects to the chin receiving plate  31  and two parallel arms  32   b  connected to the pin  45 . This structure allows one end of the adjustment lever  70  to pass between the arms  32   b  when the adjustment lever  70  pivots about the adjustment pin  75 . This will be discussed in relation to  FIG.  5     c.    
       FIG.  5   c    shows a cross-sectional view of the previously described embodiment in use. When the user pushes their chin downwards, i.e. towards the chest, the chin receiving means  30  will pivot about the pin  45 . This causes the roller  80  to move along the lower surface of the arm  32   a  of the connection member  32 , which in turn causes the adjustment lever  70  to pivot in an anticlockwise sense about the adjustment pin  75 . In turn, an end of the adjustment lever  70  passes upwards between the arms  32   b  of the chin receiving means  30 , and pulls the connecting element  85  and the stop  90  upwards. This causes compression of the exercising means  50 , which provides resistance against the user pushing their chin downwards. As such, the user can perform the exercises discussed above to exercise the relevant muscles. As discussed above, the resistance of the exercise device  10  can be adjusted by changing the position of the adjustment pin  75 . 
     In some examples, the exercising means  50  may comprise a plurality of springs, which may each be individually activated. The plurality of springs may be arranged in a magazine arrangement. Each spring may have an individual resistance, and a maximum resistance may be dependent on the number of springs used. For example, the spring magazine may comprise eight springs each having a 20 N resistance. Due to the individual activation of the springs, a resistance range of 20N to 160 N can be achieved. 
       FIG.  6    illustrates the exercise device  10  in use. In  FIG.  6   , the user holds the exerciser device  10  in a start position, i.e. before any swallowing rehabilitation has begun. The user holds the handle  65  during use. As seen in  FIG.  6   , the chest resting plate  23  of the exerciser body  20  rests against the chest of the user and the user&#39;s chin is resting on the chin receiving plate  31  in the start position. The exercise device  10  may be used for a plurality of different exercises starting from this start position. 
     Although the present invention has been described above with reference to specific embodiments, it is not intended to be limited to the specific form set forth herein. Rather, the invention is limited only by the accompanying claims and, other embodiments than the specific above are equally possible within the scope of these appended claims. 
     In the claims, the term “comprises/comprising” does not exclude the presence of other elements or steps. Furthermore, although individually listed, a plurality of means, elements or method steps may be implemented by e.g. a single unit or processor. Additionally, although individual features may be included in different claims, these may possibly advantageously be combined, and the inclusion in different claims does not imply that a combination of features is not feasible and/or advantageous. In addition, singular references do not exclude a plurality. The terms “a”, “an”, “first”, “second” etc. do not preclude a plurality. Reference signs in the claims are provided merely as a clarifying example and shall not be construed as limiting the scope of the claims in any way.