1
|
Barikroo A. Effortful Swallow Maneuver and Modifications on Swallow Dynamics in Healthy Adults. Folia Phoniatr Logop 2024:1-7. [PMID: 38697023 DOI: 10.1159/000539171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/28/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Effortful swallow (ES) is a widely used technique in dysphagia management, believed to strengthen oropharyngeal muscles and enhance swallowing safety and efficiency. Although its impact on the oral phase of swallowing is well documented, its effects on pharyngeal swallowing physiology remain inconsistent. This study aimed to elucidate the effects of ES on swallowing kinematics and timing, addressing existing inconsistencies in the literature. METHODS This study involved 22 healthy adults using archived videofluoroscopic swallowing studies. Participants performed three swallow trials of 10 mL puree under regular conditions and with the ES maneuver. The outcome measures comprised swallow timing and kinematic measures. Swallow timing parameters included time to maximum hyoid and laryngeal excursion, laryngeal vestibule closure (LVC) reaction and duration, pharyngeal constriction duration, pharyngoesophageal segment (PES) opening duration, and swallow duration. Swallow kinematic parameters encompassed hyoid and laryngeal excursions, pharyngeal constriction ratio, and maximum PES width. All variables were analyzed via videofluoroscopy. Paired t tests were used to examine the effect of ES on each outcome measure, with a significance threshold set at p < 0.004. RESULTS The ES maneuver significantly increased the duration of LVC, pharyngeal constriction, PES opening, and overall swallow duration. It also improved the pharyngeal constriction ratio. However, there were no significant changes in hyoid and laryngeal excursions. Submental muscle activity showed a notable increase during ES. CONCLUSION The study demonstrates that ES can effectively modify certain temporal and kinematic aspects of swallowing, particularly by prolonging key phases and enhancing pharyngeal constriction. These findings suggest the potential utility of ES in dysphagia rehabilitation, especially in cases that require prolonged pharyngeal constriction, LVC, and PES opening. However, the limited impact on hyoid and laryngeal excursions along with LVC reaction time indicates that ES may not address all aspects of dysphagia. The findings highlight the need for tailored therapeutic approaches in dysphagia management, considering individual physiological impairment profiles.
Collapse
Affiliation(s)
- Ali Barikroo
- Swallowing Physiology and Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, Ohio, USA
| |
Collapse
|
2
|
Kadri W, Halfpenny R, Whiten B, Mulkerrin S, Smith C. Dysphagia therapy in adults with a tracheostomy: A scoping review protocol. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38533839 DOI: 10.1111/1460-6984.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Swallowing impairment (dysphagia) and tracheostomy coexist. Research in this area has often provided an overview of dysphagia management as a whole, but there is limited information pertaining to specific dysphagia therapy in the tracheostomy population. The aim of this scoping review is to provide a detailed exploration of the literature with regard to dysphagia therapeutic interventions in adults with a tracheostomy. The scoping review will describe current evidence and thus facilitate future discussions to guide clinical practice. METHODS A scoping review using the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews guideline will be used. Ten electronic databases from inception to December 2023 and grey literature will be searched. From identified texts forward and backward citation chasing will be completed. Data extraction will compose of population demographics, aetiology and dysphagia therapy (type, design, dose and intensity). A number of citations and papers included in the scoping review will be presented visually. DISCUSSION The scoping review aims to expand upon the existing literature in this field. A detailed description of the evidence is required to facilitate clinical discussions and develop therapeutic protocols in a tracheostomised population. The results of this scoping review will support future research in dysphagia therapy and provide the basis for the development of best practice guidelines. WHAT THIS PAPER ADDS What is already known on this subject There is an abundance of evidence available regarding dysphagia therapy targeting impairments of the swallowing sequence in a variety of populations including stroke, head and neck cancer, progressive neurological conditions and critical illness. However, there is a paucity in the literature with regard to identifying dysphagia therapy for adults with a tracheostomy. What this study adds The study protocol aims to describe the methodological features that need to be extracted from existing studies to outline dysphagia therapy for adults with a tracheostomy. To the researchers' knowledge, this is the first study protocol to describe the methodological features of dysphagia therapy for people with a tracheostomy from the literature using a standardised approach (Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guideline). This will ensure that the protocol is replicable for other researchers to use and demonstrates transparency in research methods. What are the clinical implications of this work? The development of a robust protocol is necessary in order to facilitate the scoping review to describe the current evidence and thus facilitate future discussions to guide clinical practice for speech and language therapists working with adults who have a tracheostomy and dysphagia. The publication of the scoping review protocol allows future clinical researchers in the area of tracheostomy and dysphagia management a blueprint with which to narrow their own research questions and it also enables replicability as the principles of good research practice dictate.
Collapse
Affiliation(s)
- Waiza Kadri
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, England
- University College London (UCL), Division of Psychology and Language Sciences, London, England
| | - Rhiannon Halfpenny
- University College London (UCL), Division of Psychology and Language Sciences, London, England
- Great Ormond Street Hospital, London, England
| | - Breege Whiten
- University College London (UCL), Division of Psychology and Language Sciences, London, England
| | - Siofra Mulkerrin
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Christina Smith
- University College London (UCL), Division of Psychology and Language Sciences, London, England
| |
Collapse
|
3
|
Gandhi P, Peladeau-Pigeon M, Simmons M, Steele CM. Exploring the Efficacy of the Effortful Swallow Maneuver for Improving Swallowing in People With Parkinson Disease-A Pilot Study. Arch Rehabil Res Clin Transl 2023; 5:100276. [PMID: 37744193 PMCID: PMC10517353 DOI: 10.1016/j.arrct.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objectives To determine the immediate (compensatory) and longer term (rehabilitative) effect of the effortful swallow (ES) maneuver on physiological swallowing parameters in Parkinson disease. Design Virtual intervention protocol via Microsoft Teams with pre- and post-videofluoroscopic swallowing studies. Setting Outpatient hospital setting, with intervention performed virtually. Participants Eight participants (median age 74 years [63-82])with Parkinson disease (years post onset 3-20) with a Hoehn and Yahr scale score between 2 and 4 (N=8). Interventions ES maneuver, initiated using a maximum effort isometric tongue-to-palate press, with biofeedback provided using the Iowa Oral Performance Instrument. The protocol included 30 minute sessions twice daily, 5 days/week for 4 weeks. Main Outcome Measures Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, total pharyngeal residue, and pharyngeal area at maximum constriction as seen on lateral view videofluoroscopy. Results No consistent, systematic trends were identified in the direction of improvement or deterioration across Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, pharyngeal area at maximum constriction, or total pharyngeal residue. Conclusions Heterogeneous response to the ES as both a compensatory and rehabilitative technique. Positive response on the compensatory probe was predictive of positive response after rehabilitation.
Collapse
Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
| | - Michelle Simmons
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Hansen T, Laursen LB, Hansen MS. Early Feasibility of an Activity-Based Intervention for Improving Ingestive Functions in Older Adults with Oropharyngeal Dysphagia. Geriatrics (Basel) 2023; 8:geriatrics8020044. [PMID: 37102970 PMCID: PMC10137850 DOI: 10.3390/geriatrics8020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/26/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
There is growing awareness about the use of combined strength- and skill-based swallowing training for improving swallowing physiology in the event of dysphagia. Such an approach involves focusing on coordination and timing as well as swallowing strengthening in the context of increased exercise complexity in eating and drinking activities. This study aimed to determine the early feasibility of a newly developed 12-week intervention, named the ACT-ING program (ACTivity-based strength and skill training of swallowing to improve INGestion), in older adults with dysphagia and generalized sarcopenia. In a multiple-case-study design, seven participants above 65 years of age (five women and two men) with slight to severe dysphagia and indications of sarcopenia underwent the intervention during hospitalization and in the community after discharge. The ACT-ING program met most of the feasibility marks in terms of demand (73.3% of those invited accepted participation), safety (100%), no reports of adverse events, tolerance (85.7%), usability (100%), and acceptability (100%). Three putative mediators of change (experienced autonomy support, in-therapy engagement, and perceived improvement in swallowing capacity) appeared to have been best accomplished in participants with slight to moderate dysphagia. The ACT-ING program showed preliminary evidence of early feasibility, warranting further early-phase dose articulation and proof-of-concept trials.
Collapse
Affiliation(s)
- Tina Hansen
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Louise Bolvig Laursen
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Maria Swennergren Hansen
- Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| |
Collapse
|
5
|
Baudelet M, Duprez F, Van den Steen L, Nuyts S, Nevens D, Goeleven A, Vandenbruaene C, Massonet H, Vergauwen A, Bollen H, Deschuymer S, Wouters K, Peeters M, Van Laer C, Mariën S, Van den Brekel M, van der Molen L, Vauterin T, van Dinther J, Verstraete H, Hutsebaut I, Meersschout S, Vanderveken O, De Bodt M, Van Nuffelen G. Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial. Dysphagia 2022; 38:886-895. [PMID: 36121560 PMCID: PMC9484351 DOI: 10.1007/s00455-022-10513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022]
Abstract
Background Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence. Methods A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. Results Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. Conclusions PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. Trial Registration Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
Collapse
Affiliation(s)
- Margot Baudelet
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium. .,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Fréderic Duprez
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
| | - Sandra Nuyts
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | - Ann Goeleven
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Heleen Bollen
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,KU Leuven, Louvain, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Steven Mariën
- Antwerp University Hospital, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Joost van Dinther
- Department of ENT-HNS, European Institute for ORL-HNS, Sint-Augustinus Hospital, GZA, Antwerp, Belgium
| | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | | | | | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
| | | |
Collapse
|
6
|
Barikroo A, McLean MT. Submental transcutaneous electrical stimulation can impact the timing of laryngeal vestibule closure. J Oral Rehabil 2022; 49:817-822. [PMID: 35607888 PMCID: PMC9545302 DOI: 10.1111/joor.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/15/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
Background Laryngeal vestibule closure (LVC) is one of the critical airway protection mechanisms during swallowing. LVC timing impairments during swallowing are among the common causes of airway invasion in patients with dysphagia. Objectives To understand whether using submental transcutaneous electrical stimulation (TES) with varying pulse durations can impact the LVC reaction time (LVCrt) and LVC duration (LVCd) measures in healthy adults. Methods Twenty‐six healthy adults underwent three TES conditions while receiving three trials of 10 ml pureed: no TES, TES with short pulse duration (300 μs) and TES with long pulse durations(700 μs). Two pairs of electrodes were placed diagonally on the submental area. For each active TES condition, the stimulation was increased up to the participant's self‐identified maximum tolerance. Each swallow trial was recorded using videofluoroscopic swallowing study. All data were extracted and analysed offline using VideoPad Video Editor program. Results Submental TES reduced LVCrt during swallowing [F (2, 46) = 7.234, p < .007, ηp2 = .239] but had no significant impact on LVCd [F (2, 50) = .1.118, p < .335, ηp2 = .043]. Furthermore, pulse duration had no distinguished impact on any LVC timing measures. Conclusion Transcutaneous electrical stimulation may benefit patients with dysphagia who suffer from delayed LVC during swallowing. Future studies should seek whether the same physiologic effect can be observed in patients with dysphagia.
Collapse
Affiliation(s)
- Ali Barikroo
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, Ohio, USA
| | - Mitchell T McLean
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, Ohio, USA
| |
Collapse
|
7
|
da Silva MA, Mangilli LD. Transcutaneous electrical nerve stimulation in speech therapy rehabilitation of voice and swallowing function in adults-a systematic review. Clin Exp Dent Res 2021; 7:1131-1143. [PMID: 34587375 PMCID: PMC8638275 DOI: 10.1002/cre2.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In recent years, a number of clinical trials have been published comparing transcutaneous electrical nerve stimulation (TENS) and traditional speech therapy treatment of voice and swallowing functions, but results have been conflicting. OBJECTIVE Assess the methodological quality of studies and determine whether TENS is an efficient therapeutic strategy for speech therapy treatment of healthy adults or those with dysphonia and/or dysphagia. METHODS The databases used were Medical Literature Analysis and Retrieval System Online (MedLine), Biblioteca Virtual em Saúde (BVS), Cochrane Library and Web of Science (ISI Web of Knowledge). The study was conducted between May 2018 and January 2019, in line with Cochrane Handbook guidelines, and included studies on the use of TENS in healthy adults or those with compromised voice and/or swallowing function. RESULTS After the search and extraction of studies, the following were identified: TENS + VOICE: 7 articles; TENS + SWALLOWING: 5 articles. The studies exhibited medium quality and are heterogeneous, making it difficult to determine their effectiveness and the parameters to be used in future research. There were no statistically significant differences between the use of TENS alone or associated with another therapeutic technique for voice. For swallowing function, one study proved better results in cases of associated techniques - TENS + traditional therapy. DISCUSSION Speech therapy should increase the number of studies published and improve their methodological quality, reassessing methodological criteria. Current clinical practice is not grounded in evidence-based science. CLINICAL MESSAGE: the studies analyzed exhibited medium methodological quality; there are variations in the time, number and periodicity of the therapeutic sessions for TENS; there were no statistically significant differences between the use of TENS alone or associated with another therapeutic technique in voice; there were statistically significant differences between the use of TENS associated with traditional therapeutic in swallowing function.
Collapse
Affiliation(s)
- Milena Assis da Silva
- Rehabilitation Sciences Program, Faculdade de Ceilândia, University of Brasília, Brasília, Brazil
| | - Laura Davison Mangilli
- Rehabilitation Sciences Program, Faculdade de Ceilândia, University of Brasília, Brasília, Brazil
| |
Collapse
|
8
|
A comparison of the head lift exercise and recline exercise in patients with chronic head and neck cancer post-radiation. Support Care Cancer 2021; 29:5409-5416. [PMID: 33694087 DOI: 10.1007/s00520-020-05925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients who undergo surgery and adjuvant radiation treatment for head and neck cancer often develop dysphagia as a result of this treatment. Improvements in swallow function may be achieved with exercise. The goal of this pilot study was to compare the effectiveness and perceived difficulty of using the head lift exercise and the recline exercise to activate the suprahyoid musculature in 8 individuals with a history of head and neck cancer. METHOD Muscle activation using surface electromyography was examined to determine if the recline exercise activates the suprahyoid muscle groups to the same degree as the head lift exercise. Participants also rated the exertion they experienced to assess how easily patients are able to complete the exercises. RESULTS The majority of participants completed both exercises in their entirety on their first attempt. However, ratings of perceived exertion were significantly lower for the recline exercise than the head lift exercise. The head lift exercise activated the suprahyoid musculature to a significantly greater degree than the recline exercise. CONCLUSION The recline exercise, in comparison with the head lift exercise, is easier for participants to complete and results in significantly reduced perceptions of fatigue. Results of this study indicate that the recline exercise may be a good potential substitute for the head lift exercise in patient populations that are incapable of performing the head lift exercise, but that the head lift exercise should be prescribed whenever it is viable as it activates target musculature more effectively than the recline exercise.
Collapse
|
9
|
Barikroo A, Clark AL. Effects of Varying Transcutaneous Electrical Stimulation Pulse Duration on Swallowing Kinematics in Healthy Adults. Dysphagia 2021; 37:277-285. [PMID: 33656633 DOI: 10.1007/s00455-021-10276-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Prior research in swallowing physiology has suggested that using submental transcutaneous electrical stimulation (TES) with short pulse duration (PD) (300 μs) may enhance the impact on deep extrinsic tongue muscles, thereby pulling the tongue down during swallowing. However, it was unclear whether that same TES protocol could have a differential impact on hyolaryngeal kinematics and timing. This study aimed to compare the effect of submental TES with varying PDs on anterior and superior hyolaryngeal kinematics and timing both at rest and during swallowing in healthy adults. Twenty-four healthy adults between the ages of 22 and 77 participated in this study. Anterior and superior hyolaryngeal excursion magnitude and duration measures were collected using videofluoroscopic swallowing study. Each subject swallowed three 10 ml pudding trials under three conditions: no TES, TES with short PD (300 μs), and TES with long PD (700 μs). TES was delivered using two-channel surface electrodes in the submental area. In both short and long PD conditions, TES amplitude was gradually increased until participants reached their maximum tolerance level. Videofluoroscopic data were analyzed using VideoPad Video Editor and Image J programs. One-way repeated measure ANOVAs were conducted to identify within-subject effect of TES condition. For hyoid movement, TES with short PD selectively placed the hyoid bone on a more anterior position at rest and reduced anterior hyoid excursion during swallowing compared with the no TES condition. Regarding laryngeal movement, both TES protocols resulted in the larynx taking on a more anterior position at rest and reduced anterior laryngeal excursions during swallowing when compared with the no TES condition. Varying PDs had no significant effect on the superior hyoid and laryngeal movements at rest and during swallowing. Both TES protocols induced shorter hyoid elevation duration during swallowing Findings suggest that though both TES protocols demonstrated a comparable impact on reducing anterior laryngeal excursions, the TES protocol with short PD had an enhanced effect on reducing anterior hyoid excursion during swallowing. This reduced range of motion may result from stimulating the deep submental muscles, which primarily place the hyoid and larynx into a more forward position before swallowing onset. Overall, the TES protocol with short PD may have an increased benefit in facilitating swallowing in patients with dysphagia.
Collapse
Affiliation(s)
- Ali Barikroo
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA. .,Speech Pathology & Audiology Program, School of Health Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
| | - Alexis L Clark
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA
| |
Collapse
|
10
|
Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
11
|
Zimmerman E, Carnaby G, Lazarus CL, Malandraki GA. Motor Learning, Neuroplasticity, and Strength and Skill Training: Moving From Compensation to Retraining in Behavioral Management of Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1065-1077. [PMID: 32650656 DOI: 10.1044/2019_ajslp-19-00088] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Learning a motor skill and regaining a motor skill after it is lost are key tenets to the field of speech-language pathology. Motor learning and relearning have many theoretical underpinnings that serve as a foundation for our clinical practice. This review article applies selective motor learning theories and principles to feeding and swallowing across the life span. Conclusion In reviewing these theoretical fundamentals, clinical exemplars surrounding the roles of strength, skill, experience, compensation, and retraining, and their influence on motor learning and plasticity in regard to swallowing/feeding skills throughout the life span are discussed.
Collapse
Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA
| | - Giselle Carnaby
- Department of Communication Science and Disorders, University of Central Florida, Orlando
| | - Cathy L Lazarus
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| |
Collapse
|
12
|
Wall LR, Ward EC, Cartmill B, Hill AJ, Isenring E, Byrnes J, Porceddu SV. Prophylactic swallowing therapy for patients with head and neck cancer: A three-arm randomized parallel-group trial. Head Neck 2020; 42:873-885. [PMID: 31903689 DOI: 10.1002/hed.26060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intensive prophylactic swallowing therapy can mitigate dysphagia in patients with oropharyngeal (OP) SCC, however, presents service challenges. This trial investigated the clinical efficacy of three service models delivering prophylactic swallowing therapy during (chemo)radiotherapy ([C]RT). METHODS Patients (n = 79) with OPSCC receiving (C)RT were were randomized to: (a) clinician-directed face-to-face therapy (n = 26); (b) telepractice therapy via "SwallowIT" (n = 26); or (c) patient self-directed therapy (n = 27). Swallowing, nutritional, and functional status were compared at baseline, 6-weeks, and 3-months post-(C)RT. Patients' perceptions/preferences for service-delivery were collated posttreatment. RESULTS Service-delivery mode did not affect clinical outcomes, with no significant (P > .05) between-group differences or group-by-time interactions observed for swallowing, nutrition, or functional measures. Therapy adherence declined during (C)RT in all groups. SwallowIT and clinician-directed models were preferred by significantly (P = .002) more patients than patient-directed. CONCLUSIONS SwallowIT provided clinically equivalent outcomes to traditional service models. SwallowIT and clinician-directed therapy were preferred by patients, likely due to higher levels of therapy support.
Collapse
Affiliation(s)
- Laurelie R Wall
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Elizabeth Isenring
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sandro V Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia.,School of Medicine, The University of Queensland, Queensland, Australia
| |
Collapse
|
13
|
Tay MJ, Tham SL. Oropharyngeal recovery in a patient with the pharyngeal cervical brachial variant of Guillain–Barré syndrome. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019. [DOI: 10.4103/jisprm.jisprm_46_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Serel Arslan S, Azola A, Sunday K, Vose A, Plowman E, Tabor L, Singer M, Robison R, Humbert IA. Effects of Submental Surface Electrical Stimulation on Swallowing Kinematics in Healthy Adults: An Error-Based Learning Paradigm. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1375-1384. [PMID: 30076418 PMCID: PMC6436455 DOI: 10.1044/2018_ajslp-17-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Hyoid bone and laryngeal approximation aid airway protection (laryngeal vestibule closure) while moving toward their peak superior and anterior positions during swallowing. Submental surface electrical stimulation (SES) is a therapeutic technique that targets the muscles that move the hyoid bone during swallowing. It is unknown whether submental SES only increases peak hyoid bone swallowing positions but not peak laryngeal swallowing positions, which could require faster or greater laryngeal movement to achieve adequate laryngeal vestibule closure. METHOD We examined the effects of submental SES on hyo-laryngeal kinematics in 30 healthy adults who swallowed 50 times using an error-based learning paradigm. RESULTS Submental SES did not alter any hyo-laryngeal swallowing kinematic. However, submental SES significantly changed the starting position of the hyoid bone just prior to the swallow onset (more anterior; p = .003). On average, submental SES immediately prior to swallow onset can position the hyoid approximately 20% closer to its peak swallowing point. CONCLUSIONS These findings indicate that electrical stimulation of the agonists for hyoid movement might not alter swallowing outcomes tested in this study. However, submental SES could have clinical utility by minimizing swallowing impairments related to reduced hyoid swallowing range of motion in individuals with dysphagia.
Collapse
Affiliation(s)
| | - Alba Azola
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kirstyn Sunday
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Alicia Vose
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Emily Plowman
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Lauren Tabor
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Michele Singer
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Raele Robison
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | | |
Collapse
|
15
|
Huckabee ML, Lamvik-Gozdzikowska K. Reconsidering Rehabilitation for Neurogenic Dysphagia: Strengthening Skill in Swallowing. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0193-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
16
|
You H, Hu S, Ye QP, Wang F, Huang JP, Yang YL, Fu WB, Xu NG, Liu JH. Role of 5-HT1A in the nucleus of the solitary tract in the regulation of swallowing activities evoked by electroacupuncture in anesthetized rats. Neurosci Lett 2018; 687:308-312. [PMID: 29958914 DOI: 10.1016/j.neulet.2018.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
Somatic stimulation therapy, such as electroacupuncture (EA), has been widely applied in the clinic to treat dysphagia. However, its underlying mechanism has remained unknown. In the present study, the effect of EA at acupoints Fengfu (DU16) and Lianquan (RN23) on swallowing activities and the involvement of 5-HT1A in the nucleus of the solitary tract (NTS) were examined in anesthetized rats. EA at DU16 and RN23 significantly evoked myoelectric activity of the mylohyoid muscle, which was attenuated by injection of 10 nmol 5-HT1A antagonist (WAY-100635) into the NTS. Meanwhile, 5-HT1A expression in the NTS increased following EA. The results suggested that EA at DU16 and RN23 promotes swallowing activity, and 5-HT1A in the NTS may play an important role in the excitatory effects.
Collapse
Affiliation(s)
- Hui You
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China; Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Shaowen Hu
- Clinical School of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Qiu-Ping Ye
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Feng Wang
- Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
| | - Jian-Peng Huang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Yi-Ling Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Wen-Bin Fu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Neng-Gui Xu
- Clinical School of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Jian-Hua Liu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China.
| |
Collapse
|
17
|
Electrical stimulation therapy for dysphagia: a follow-up survey of USA dysphagia practitioners. Int J Rehabil Res 2018; 40:360-365. [PMID: 28704266 DOI: 10.1097/mrr.0000000000000241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare current application, practice patterns, clinical outcomes, and professional attitudes of dysphagia practitioners regarding electrical stimulation (e-stim) therapy with similar data obtained in 2005. A web-based survey was posted on the American Speech-Language-Hearing Association Special Interest Group 13 webpage for 1 month. A total of 271 survey responses were analyzed and descriptively compared with the archived responses from the 2005 survey. Results suggested that e-stim application increased by 47% among dysphagia practitioners over the last 10 years. The frequency of weekly e-stim therapy sessions decreased while the reported total number of treatment sessions increased between the two surveys. Advancement in oral diet was the most commonly reported improvement in both surveys. Overall, reported satisfaction levels of clinicians and patients regarding e-stim therapy decreased. Still, the majority of e-stim practitioners continue to recommend this treatment modality to other dysphagia practitioners. Results from the novel items in the current survey suggested that motor level e-stim (e.g. higher amplitude) is most commonly used during dysphagia therapy with no preferred electrode placement. Furthermore, the majority of clinicians reported high levels of self-confidence regarding their ability to perform e-stim. The results of this survey highlight ongoing changes in application, practice patterns, clinical outcomes, and professional attitudes associated with e-stim therapy among dysphagia practitioners.
Collapse
|
18
|
Maltser S, Cristian A, Silver JK, Morris GS, Stout NL. A Focused Review of Safety Considerations in Cancer Rehabilitation. PM R 2017; 9:S415-S428. [PMID: 28942913 PMCID: PMC5627359 DOI: 10.1016/j.pmrj.2017.08.403] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022]
Abstract
Cancer and its treatments introduce various adverse effects that may affect survivors' physical, cognitive and psychological functioning. Frequently both tolerance to activity and exercise are affected as well. Rehabilitation providers should have substantive knowledge about the effect of cancer progression and common side effects associated with antineoplastic treatment to safely integrate rehabilitation interventions. Rehabilitation may mitigate loss of function and disability; however, these patients are among the most medically complex that providers treat. This report provides a focused review that synthesizes the current evidence regarding disease progression and oncology-directed treatment side effects within the context of safety considerations for rehabilitation interventions throughout the continuum of cancer care. Descriptive information regarding the evidence for precautions and contraindications is provided so that rehabilitation providers can promote a safe plan of rehabilitation care. It is incumbent upon but also challenging for rehabilitation providers to stay up to date on the many advances in cancer treatment, and there are many gaps in the literature regarding safety issues. Although further research is needed to inform care, this review provides clinicians with a framework to assess patients with the goal of safely initiating rehabilitation interventions.
Collapse
Affiliation(s)
- Susan Maltser
- Department of Physical Medicine and Rehabilitation, Hofstra Northwell School of Medicine, Hempstead, NY; Long Island Jewish Medical Center, Manhasset, NY(∗)
| | - Adrian Cristian
- Department of Rehabilitation Medicine, Northwell-Glen Cove Hospital, Glen Cove, NY(†)
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital Network, Boston, MA; Massachusetts General Hospital, Boston, MA; Physiatry, Brigham and Women's Hospital, Boston, MA(‡)
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, NC(§)
| | - Nicole L Stout
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Office of Strategic Research, Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, MSC 1604, 10 Center Dr, Bethesda, MD 20892-1604(‖).
| |
Collapse
|
19
|
Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery. Curr Opin Otolaryngol Head Neck Surg 2017; 25:182-187. [PMID: 28306585 DOI: 10.1097/moo.0000000000000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). RECENT FINDINGS Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. SUMMARY Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.
Collapse
|
20
|
Park JS, Hwang NK, Oh DH, Chang MY. Effect of head lift exercise on kinematic motion of the hyolaryngeal complex and aspiration in patients with dysphagic stroke. J Oral Rehabil 2017; 44:385-391. [DOI: 10.1111/joor.12492] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J. S. Park
- Department of Rehabilitation Science; Graduate School; Inje University; Gimhae Korea
| | - N. K. Hwang
- Department of Occupational Therapy; Seoul North Municipal Hospital; Seoul Korea
| | - D. H. Oh
- Department of Occupational Therapy; Kyung-dong University; Wonju Korea
| | - M. Y. Chang
- Department of Occupational Therapy; Inje University; Gimhae Korea
| |
Collapse
|
21
|
Lobo MB, De Luccia N, Nogueira AC, Silvério CC. O efeito da eletroestimulação neuromuscular na contração da musculatura supra-hióidea durante a deglutição de indivíduos com disfagia. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618524715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: verificar o efeito da Eletroestimulação Neuromuscular na contração da musculatura supra-hióidea durante a deglutição em indivíduos pós-Acidente Vascular Cerebral com disfagia orofaríngea. Métodos: participaram da pesquisa oito indivíduos pós-Acidente Vascular Cerebral com disfagia, de ambos os sexos, encaminhados para terapia fonoaudiológica com objetivo de trabalhar a função da deglutição, em início de processo terapêutico. Anteriormente ao início da primeira sessão, foi realizada a mensuração do tempo e amplitude da atividade elétrica muscular através da Eletromiografia de Superfície de Biofeedback. Os pacientes foram divididos aleatoriamente em dois grupos: Grupo Experimental (n=4): pacientes que receberam a fonoterapia tradicional e aplicação da Eletroestimulação Neuromuscular; Grupo Controle (n=4): pacientes que receberam a fonoterapia tradicional. Após oito sessões, todos os pacientes passaram novamente pela Eletromiografia de Superfície de Biofeedback para verificar a atividade elétrica da musculatura supra-hióidea. Os registros dos exames pré e pós intervenção foram comparados nos dois grupos. Resultados: comparando-se as médias das variáveis de amplitude e tempo da atividade elétrica muscular durante a deglutição de saliva e nas duas deglutições de pastoso, não foram observadas diferenças estatisticamente significantes entre os grupos estudados, na comparação dos valores pré e pós intervenção. Conclusões: o uso da Eletroestimulação Neuromuscular nos parâmetros e na metodologia empregada não mostrou-se eficiente em promover maior contração da musculatura supra-hióidea durante a deglutição em indivíduos pós-Acidente Vascular Cerebral com disfagia orofaríngea. Os dados encontrados podem ser decorrentes da metodologia utilizada nesta pesquisa com relação ao protocolo de aplicação da técnica e à forma de mensuração dos resultados.
Collapse
|
22
|
Shaker R, Sanvanson P, Balasubramanian G, Kern M, Wuerl A, Hyngstrom A. Effects of laryngeal restriction on pharyngeal peristalsis and biomechanics: Clinical implications. Am J Physiol Gastrointest Liver Physiol 2016; 310:G1036-43. [PMID: 27079611 PMCID: PMC4935483 DOI: 10.1152/ajpgi.00010.2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/12/2016] [Indexed: 01/31/2023]
Abstract
To date, rehabilitative exercises aimed at strengthening the pharyngeal muscles have not been developed due to the inability to successfully overload and fatigue these muscles during their contraction, a necessary requirement for strength training. The purpose of this study was to test the hypothesis that applying resistance against anterosuperior movement of the hyolaryngeal complex will overload the pharyngeal muscles and by repetitive swallowing will result in their fatigue manifested by a reduction in pharyngeal peristaltic amplitude. Studies were done in two groups. In group 1 studies 15 healthy subjects (age: 42 ± 14 yr, 11 females) were studied to determine whether imposing resistance to swallowing using a handmade device can affect the swallow-induced hyolaryngeal excursion and related upper esophageal sphincter (UES) opening. In group 2, an additional 15 healthy subjects (age 56 ± 25 yr, 7 females) were studied to determine whether imposing resistance to the anterosuperior excursion of the hyolaryngeal complex induces fatigue manifested as reduction in pharyngeal contractile pressure during repeated swallowing. Analysis of the video recordings showed significant decrease in maximum deglutitive superior laryngeal excursion and UES opening diameter (P < 0.01) due to resistive load. Consecutive swallows against the resistive load showed significant decrease in pharyngeal contractile integral (PhCI) values (P < 0.01). Correlation analysis showed a significant negative correlation between PhCI and successive swallows, suggesting "fatigue" (P < 0.001). In conclusion, repeated swallows against a resistive load induced by restricting the anterosuperior excursion of the larynx safely induces fatigue in pharyngeal peristalsis and thus has the potential to strengthen the pharyngeal contractile function.
Collapse
Affiliation(s)
- Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Patrick Sanvanson
- 1Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | | | - Mark Kern
- 1Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Ashley Wuerl
- 1Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Allison Hyngstrom
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| |
Collapse
|
23
|
Crary MA. Treatment for Adults. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
24
|
Howle AA, Baguley IJ, Brown L. Management of Dysphagia Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0064-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|