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Liu M, Chen X, Ma P, Deng M. Summary of the best evidence for the management of dysphagia in elderly patients. Eur Arch Otorhinolaryngol 2024; 281:3893-3901. [PMID: 38459985 DOI: 10.1007/s00405-024-08530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To search for and summarize the best evidence for themanagement of elderly patients with dysphagia. METHODS Clinical decisions, recommended practices, evidence summaries, clinical practice guidelines, expert consensus, and systematic reviews on the management of dysphagia among elderly patients were systematically reviewed from domestic and foreign guideline websites, association websites, and Chinese and English databases according to the 6S model of evidence-based resources. The search period was between January 1, 2010 and November 1, 2023. Two researchers evaluated the quality of the included literature respectively and extracted evidence. RESULTS A total of 14 literatures were identified, including 2 guidelines, 2 clinical decisions, 5 evidence summaries, 3 expert consensus statements, and 2 systematic reviews. Twenty-four pieces of evidence from 7 aspects were summarized, including assessment, treatment and rehabilitation, medication care, nutrition management, oral care, complication management, and psychological care. CONCLUSION The best evidence-based recommendations for the management of dysphagia in elderly patients is summarized, it is suggested that the best evidence should be selected according to the actual situation of patients, and a personalized management plan should be formulated to improve the quality of life of patients and achieve high-quality nursing.
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Affiliation(s)
- Mengdan Liu
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Xushu Chen
- School of Nursing, Chengdu Medical College, Chengdu, 610000, Sichuan, China
| | - Peng Ma
- Intensive Care Unit, Longquanyi District Hospital of Chengdu University of Traditional Chinese Medicine, 783, Xindu Dadao, Xindu District, Chengdu, 610000, Sichuan, China
| | - Min Deng
- The Publicity Division, Neijiang First People's Hospital, Neijiang, 641000, Sichuan, China.
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Yaşaroğlu ÖF, Serel Arslan S, Cengiz E, Alıcı R, Demir N, Oğuz B, Düger T. Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study. PLoS One 2024; 19:e0299845. [PMID: 38527058 PMCID: PMC10962842 DOI: 10.1371/journal.pone.0299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024] Open
Abstract
The aim of this study was to design a new maneuver called the Mouth Open Swallowing Maneuver (MOSM), and to compare swallowing kinematics and submental muscles activation (SMA) between MOSM and two current approaches used in dysphagia rehabilitation. Fifty healthy volunteers were asked to perform three repetitions of dry swallowing (DS) (control task), the MOSM, the Mendelsohn Maneuver (MM), and the Tongue-Hold Maneuver (THM) during videofluoroscopic swallowing study accompanied with simultaneous SMA recording. Swallowing kinematics were measured by frame-by-frame analysis on hyolaryngeal movement using ImageJ. Swallowing with maximum hyolaryngeal movement and SMA during these tasks was used for comparative analysis. Vertical movement of the hyoid during the MOSM was significantly greater than those observed during the DS and the THM (p<0.001, p<0.001). Horizontal movement of the hyoid during DS and the THM was significantly greater than that observed during the MM (p = 0.001, p = 0.001). Vertical movement of the larynx during the MOSM was significantly greater than those observed during DS, MM, and THM (p<0.001). There was no significant difference between tasks in horizontal movement of the larynx (p = 0.785). SMA during the THM was significantly greater than that observed during MOSM (p = 0.002). No significant difference was found between other tasks in terms of SMA (p>0.05). The MOSM as a newly designed maneuver was significantly superior to other maneuvers in increasing vertical hyolaryngeal movement. The THM has as much effect on hyolaryngeal movement as the MM. In this study, the MOSM was shown to be effective in increasing hyolaryngeal movement. ClinicalTrials.gov Protocol Registration and Results System (PRS); the clinical trial registration number (NCT05579041).
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Affiliation(s)
- Ömer Faruk Yaşaroğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Emre Cengiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Rabia Alıcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Hospitals, Ankara, Türkiye
| | - Tülin Düger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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Pereira ASDM, Gatti M, Ribeiro VV, Taveira KVM, Berretin-Felix G. Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review. Codas 2023; 36:e20220339. [PMID: 38126592 PMCID: PMC10750894 DOI: 10.1590/2317-1782/20232022339pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/31/2023] [Indexed: 12/23/2023] Open
Abstract
There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.
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Affiliation(s)
- Asenate Soares de Matos Pereira
- Programa de Pós-graduação em Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | - Marina Gatti
- Programa de Pós-graduação em Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | | | | | - Giédre Berretin-Felix
- Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
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Gao M, Xu L, Wang X, Yang X, Wang Y, Wang H, Song J, Zhou F. Efficacy and safety of oropharyngeal muscle strength training on poststroke oropharyngeal dysphagia: a systematic review and meta-analysis. BMJ Open 2023; 13:e072638. [PMID: 37758672 PMCID: PMC10537832 DOI: 10.1136/bmjopen-2023-072638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES To investigate how oropharyngeal muscle strength training affected the safety and performance of swallowing in patients with poststroke oropharyngeal dysphagia. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central Register of Controlled of Trials, Web of Science, PubMed, Embase databases and ClinicalTrials.gov were systematically searched, for publications in English, from database inception to December 2022. ELIGIBILITY CRITERIA Studies comparing the effect of oropharyngeal muscle strength training with conventional dysphagia therapy in patients with poststroke. Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) were assessed as the main outcomes. DATA EXTRACTION AND SYNTHESIS Two researchers independently screened the literature, extracted data and evaluated the quality of the included studies, with disagreements resolved by another researcher. The Cochrane risk-of-bias tool was used to assess the risk of bias. Review Manager V.5.3 was employed for the meta-analysis. Random effect models were used for meta-analysis. RESULTS Seven studies with 259 participants were included in this meta-analysis. The results showed that oropharyngeal muscle strength training could reduce PAS score compared with conventional dysphagia therapy (mean difference=-0.98, 95% CI -1.34 to -0.62, p<0.0001, I2=28%). The results also showed that oropharyngeal muscle strength training could increase FOIS score (mean difference=1.04, 95% CI 0.55 to 1.54, p<0.0001, I2=0%) and the vertical displacement of the hyoid bone (mean difference=0.20, 95% CI 0.01 to 0.38, p=0.04, I2=0%) compared with conventional dysphagia therapy. CONCLUSION In patients with poststroke oropharyngeal dysphagia, oropharyngeal muscle strength training can improve swallowing safety and performance. PROSPERO REGISTRATION NUMBER CRD42022302471.
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Affiliation(s)
- Minxing Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Physical Medicine and Rehabilitation, Second Clinical College China Medical University, Shenyang, Liaoning, China
| | - Lingyuan Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoqiu Yang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Heying Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jinan Song
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Cho YS, Yoon TH, Park JS. Effects of suprahyoid muscle strengthening exercise using kinesiology taping on muscle activation and thickness in community-dwelling elderly: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e35166. [PMID: 37713858 PMCID: PMC10508572 DOI: 10.1097/md.0000000000035166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Recently, swallowing resistive exercise using kinesiology taping (KT) has been reported as a novel method for dysphagia rehabilitation However, clinical evidence is still unclear, and effects in the elderly have not been confirmed. OBJECTIVE This study aimed to investigate the effects of suprahyoid muscle strengthening exercise using KT on muscle activation and thickness in community-dwelling elderly. METHODS A total of 24 healthy older people were enrolled in this study and randomly assigned to an experimental group and a placebo group. In the experimental group, KT was attached to the front of the neck with a tension of about 70% to 80%, and a resistive swallowing exercise was performed. In the placebo group, the tape was applied similarly but without tension. Both groups performed resistive swallowing exercises 10 times a day (50 swallows per day) for 6 weeks. The activation and thickness of the suprahyoid muscles were measured using portable ultrasound equipment and an surface electromyelograph device. RESULTS The experimental group showed a significant increase in suprahyoid muscle activation (mean and peak) and muscle thickness (digastric and mylohyoid) than the placebo group (all, P < .05). CONCLUSION This study confirmed that suprahyoid muscle strengthening exercise using KT had a positive effect on the suprahyoid muscles in healthy older adults, thus suggesting the possibility of a therapeutic exercise method for dysphagia rehabilitation.
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Affiliation(s)
- Young-Seok Cho
- Department of Occupational Therapy, Hyejeon College, Hongseong-gun, Republic of Korea
| | - Tae-Hyung Yoon
- Department of Occupational Therapy, Dongseo University, Busan, Korea
| | - Ji-Su Park
- Research Institute for Korean Medicine, Pusan National University, Yangsan-si, Republic of Korea
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Eriksson H, Tuomi L, Finizia C. Voice Outcomes Following Head-Lift Exercises in Head and Neck Cancer: A Randomized Controlled Study. J Voice 2023; 37:226-233. [PMID: 33451891 DOI: 10.1016/j.jvoice.2020.12.015] [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: 10/27/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This prospective randomized study aimed to investigate whether patients with dysphagia after treatment for head and neck cancer improve their vocal function from doing head lift exercises (Shaker's exercise). METHODS Patients were randomized into an intervention group (n = 24) or a control group (n = 26). Patients in the intervention group performed the head lift exercise three times a day for 8 weeks. At baseline and at follow-up after 8 weeks, participants' voices were evaluated perceptually with the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale. Vocal fry (VF) was also perceptually evaluated and patients filled in the Voice Handicap Index (VHI). RESULTS Patients in the intervention group were perceptually evaluated as having less roughness and vocal fry in their voices at follow-up compared to the control group. There were no statistically significant changes between baseline and follow-up neither in the intervention nor the control group regarding GRBAS, VF, or VHI. Neither were there any statistically significant differences within the groups when results on the perceptual evaluations at baseline and follow-up were compared. CONCLUSIONS The voices of the participants in the intervention group were slightly better than the voices of the participants in the control group with less roughness and VF at follow-up. However, no improvement in the VHI or the remaining GRBAS variables was found. Therefore, this study can only give cautious support to the head lift exercise as a method for improving the voice of patients with dysphagia after treatment for head and neck cancer.
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Affiliation(s)
- Hedvig Eriksson
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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7
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Treatment with head-lift exercise in head and neck cancer patients with dysphagia: results from a randomized, controlled trial with flexible endoscopic evaluation of swallowing (FEES). Support Care Cancer 2023; 31:56. [PMID: 36526734 PMCID: PMC9758100 DOI: 10.1007/s00520-022-07462-z] [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] [Received: 09/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND This randomized study aimed to evaluate the effects of the Shaker head-lift exercise (HLE) to improve dysphagia following oncologic treatment for head and neck cancer (HNC). METHODS Patients with dysphagia following oncologic treatment for HNC were randomly assigned to intervention (n = 23) or control (standard dysphagia management, n = 24) groups. Swallowing was evaluated at baseline and at 8-week follow-up using flexible endoscopic evaluation of swallowing (FEES) and self-perceived swallowing with the Eating Assessment Tool (EAT-10). Analysis was performed regarding secretion, initiation of swallow, residue after swallowing, and penetration/aspiration. RESULTS Few statistically significant differences were found in the FEES analysis. Some improvement of self-perceived swallowing function was found in both groups. Adherence to training was high. CONCLUSIONS This randomized study regarding the effect of the HLE demonstrated that swallowing outcome measures used in assessment of FEES did not improve in patients treated with radiotherapy for patients with dysphagia following HNC.
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Possible Rehabilitation Procedures to Treat Sarcopenic Dysphagia. Nutrients 2022; 14:nu14040778. [PMID: 35215427 PMCID: PMC8878994 DOI: 10.3390/nu14040778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
Sarcopenic dysphagia requires the presence of both dysphagia and generalized sarcopenia. The causes of dysphagia, except for sarcopenia, are excluded. The treatment for sarcopenic dysphagia includes resistance training along with nutritional support; however, whether rehabilitation procedures are useful remains unclear. In this narrative review, we present possible rehabilitation procedures as a resistance training for managing sarcopenic dysphagia, including Shaker exercise, Mendelsohn maneuver, tongue-hold swallow exercise, jaw-opening exercise, swallow resistance exercise, lingual exercise, expiratory muscle strength training, neuromuscular electrical stimulation, and repetitive peripheral magnetic stimulation. We hope that some procedures mentioned in this article or new methods will be effective to treat sarcopenic dysphagia.
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Tuomi L, Dotevall H, Bergquist H, Petersson K, Andersson M, Finizia C. The effect of the Shaker head‐lift exercise on swallowing function following treatment for head and neck cancer: Results from a randomized, controlled trial with videofluoroscopic evaluation. Head Neck 2022; 44:862-875. [PMID: 35068016 PMCID: PMC9306707 DOI: 10.1002/hed.26982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/28/2021] [Accepted: 01/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Dysphagia is common following treatment for head and neck cancer (HNC) and intervention to improve swallowing function is warranted. This study aimed to evaluate the efficacy of the Shaker head‐lift exercise (HLE) to improve dysphagia in HNC patients. Methods Patients treated for HNC with radiochemotherapy and with subsequent dysphagia were randomly assigned to intervention (HLE, n = 25) and control (standard dysphagia management, n = 27) groups. Videofluoroscopic evaluation of penetration‐aspiration, initiation, residue, movement of selected structures, and self‐perceived swallowing function, before and after 8 weeks of treatment, were compared. Results Although adherence to training was high, no statistically significant differences in objectively measured swallowing function between the groups or within‐group changes were found. Self‐perceived swallowing function improved in the intervention group. Conclusions In this HNC population, neither HLE nor standard dysphagia management improved objectively measured swallowing function as evaluated after 8 weeks. Future research focusing on finding effective interventions for dysphagia is warranted.
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Affiliation(s)
- Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Henrik Bergquist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Kerstin Petersson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Mats Andersson
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Stockholm Sweden
- Department of Abdominal Radiology Karolinska University Hospital Stockholm Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
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Behavioral Interventions Targeting Insufficient Upper Esophageal Sphincter Opening During Swallowing: A Scoping Review. Dysphagia 2021; 37:699-714. [PMID: 34448028 DOI: 10.1007/s00455-021-10349-6] [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: 04/09/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
The upper esophageal sphincter (UES) plays a central role in safe swallowing. Impaired UES opening is commonly observed in individuals presenting with impaired swallowing and various interventions are available aiming to improve bolus passage across the UES during swallowing. This scoping review addressed the following question: Which behavioral interventions are available to improve UES opening for deglutition? We searched MEDLINE, CINAHL, Ovid Emcare, Web of Science, SCOPUS and ProQuest for studies that met the following criteria: i. behavioral interventions targeting UES opening ii. performed over a period of time, which iii. were assessed using UES specific outcome measures. Study quality was assessed using the Joanna Briggs Institute and GRADE frameworks. Data were extracted and synthesized into dominant themes. Of the 357 studies originally identified, 15 met inclusion criteria and reported interventions that were grouped into four intervention types: (1) floor of mouth exercises that were sub-categorized into the Shaker exercise and other strengthening exercises, (2) Mendelsohn maneuver, (3) lingual exercises and (4) mixed exercise paradigms. Across the included studies, varying levels of success in improving various aspects of UES opening metrics were reported. Nine of 15 studies evaluated patients with demonstrated swallowing impairment, whereas six studies evaluated healthy adults. Quality assessment revealed significant variability in study quality, unclear reporting of participant training and treatment fidelity, as well as training dosage. The evidence base for the four behavioral intervention approaches targeting deglutitive UES opening is limited. The translation of existing evidence to clinical practice is hindered by small sample sizes and methodological limitations. Further research in this space is warranted.
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The effect of laryngeal elevation training on swallowing function in patients with dysphagia. The Journal of Laryngology & Otology 2021; 135:574-578. [PMID: 34130763 DOI: 10.1017/s0022215121001481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the effect of laryngeal elevation training without highly loaded head lifting on swallowing function in patients with dysphagia. METHODS Fifty-seven patients with dysphagia (36 men; mean age, 78.5 ± 11.4 years) were included. All participants performed the swallowing forehead exercise and the chin push-pull manoeuvre for two months. Videoendoscopy to assess swallowing function, the peak expiratory flow test and the hand grip strength test were performed at the initial visit (time 1) and two months after the start of the intervention (time 2). We used the Hyodo score, a scoring method for videoendoscopic assessment, for evaluation of swallowing function. RESULTS The linear mixed model showed a significant main effect of time (the Hyodo score at time 1 was greater than the score at time 2). The effects of the co-variates were not significant. CONCLUSION The present study demonstrated the significant effect of laryngeal elevation training without head lifting on the Hyodo score.
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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13
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SEREL ARSLAN S, DEMIR N, KARADUMAN AA. Deglutition disorders from the perspective of healthcare professionals in Turkey. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.812290] [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]
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14
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation. Dysphagia 2021; 36:800-820. [PMID: 33399995 DOI: 10.1007/s00455-020-10218-8] [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: 06/27/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).
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15
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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]
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16
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Donohue C, Khalifa Y, Perera S, Sejdić E, Coyle JL. How Closely do Machine Ratings of Duration of UES Opening During Videofluoroscopy Approximate Clinician Ratings Using Temporal Kinematic Analyses and the MBSImP? Dysphagia 2020; 36:707-718. [PMID: 32955619 DOI: 10.1007/s00455-020-10191-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Clinicians evaluate swallow kinematic events by analyzing videofluoroscopy (VF) images for dysphagia management. The duration of upper esophageal sphincter opening (DUESO) is one important temporal swallow event, because reduced DUESO can result in pharyngeal residue and penetration/aspiration. VF is frequently used for evaluating swallowing but exposes patients to radiation and is not always feasible/readily available. High resolution cervical auscultation (HRCA) is a non-invasive, sensor-based dysphagia screening method that uses signal processing and machine learning to characterize swallowing. We investigated HRCA's ability to annotate DUESO and predict Modified Barium Swallow Impairment Profile (MBSImP) scores (component #14). We hypothesized that HRCA and machine learning techniques would detect DUESO with similar accuracy as human judges. Trained judges completed temporal kinematic measurements of DUESO on 719 swallows (116 patients) and 50 swallows (15 age-matched healthy adults). An MBSImP certified clinician completed MBSImP ratings on 100 swallows. A multi-layer convolutional recurrent neural network (CRNN) using HRCA signal features for input was used to detect DUESO. Generalized estimating equations models were used to determine statistically significant HRCA signal features for predicting DUESO MBSImP scores. A support vector machine (SVM) classifier and a leave-one-out procedure was used to predict DUESO MBSImP scores. The CRNN detected UES opening within a 3-frame tolerance for 82.6% of patient and 86% of healthy swallows and UES closure for 72.3% of patient and 64% of healthy swallows. The SVM classifier predicted DUESO MBSImP scores with 85.7% accuracy. This study provides evidence of HRCA's feasibility in detecting DUESO without VF images.
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Affiliation(s)
- Cara Donohue
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Subashan Perera
- Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA, 15260, USA.
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17
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Choi JB, Jung YJ, Park JS. Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift exercise for dysphagic stroke: A pilot study. Medicine (Baltimore) 2020; 99:e22136. [PMID: 32957335 PMCID: PMC7505362 DOI: 10.1097/md.0000000000022136] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the effect of the jaw opening exercise (JOE) on the thickness of the suprahyoid muscle and hyoid bone movement compared with the head lift exercise (HLE) in patients with dysphagia after strokeThis study recruited 30 patients with dysphagia after stroke. The JOE group performed a JOE using a resistance bar. The HLE group performed the traditional HLE. The total intervention duration was 6 weeks. We measured the thickness of the digastric and mylohyoid muscles using ultrasound. Two-dimensional motion analysis of the hyoid bone was performed using Image J software. The Borg rating of the perceived exertion scale was used to assess the intensity level of physical activity during the 2 exercises.Both groups showed a significant increase in the thickness of the digastric and mylohyoid muscles (P < .05). Hyoid bone motion was significantly increased in the anterior and superior movement in both groups (P < .05). After the intervention, there was no significant difference between the 2 groups. The Borg rating of perceived exertion scale for the JOE group was significantly lower than that of the HLE group (P < .05).In conclusion, this study demonstrated that the JOE and the HLE had similar effects with respect to increasing suprahyoid muscle thickness and improving hyoid bone movement. However, the JOE required less perceived exertion than the HLE.
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Affiliation(s)
- Jong Bae Choi
- Department of Occupational Therapy, Sangji University, Wonju, South Korea
| | - Young Jin Jung
- Department of Radiological Science at Health Sciences Division in DongSeo University, Busan, South Korea
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly, Industry, Dongseo University, Busan, South Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly, Industry, Dongseo University, Busan, South Korea
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18
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Krekeler BN, Rowe LM, Connor NP. Dose in Exercise-Based Dysphagia Therapies: A Scoping Review. Dysphagia 2020; 36:1-32. [PMID: 32140905 DOI: 10.1007/s00455-020-10104-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/25/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Optimal exercise doses for exercise-based approaches to dysphagia treatment are unclear. To address this gap in knowledge, we performed a scoping review to provide a record of doses reported in the literature. A larger goal of this work was to promote detailed consideration of dosing parameters in dysphagia exercise treatments in intervention planning and outcome reporting. METHODS We searched PubMed, Scopus[Embase], CINAHL, and Cochrane databases from inception to July 2019, with search terms relating to dysphagia and exercises to treat swallowing impairments. Of the eligible 1906 peer-reviewed articles, 72 met inclusionary criteria by reporting, at minimum, both the frequency and duration of their exercise-based treatments. RESULTS Study interventions included tongue exercise (n = 16), Shaker/head lift (n = 13), respiratory muscle strength training (n = 6), combination exercise programs (n = 20), mandibular movement exercises (n = 7), lip muscle training (n = 5), and other programs that did not fit into the categories described above (n = 5). Frequency recommendations varied greatly by exercise type. Duration recommendations ranged from 4 weeks to 1 year. In articles reporting repetitions (n = 66), the range was 1 to 120 reps/day. In articles reporting intensity (n = 59), descriptions included values for force, movement duration, or descriptive verbal cues, such as "as hard as possible." Outcome measures were highly varied across and within specific exercise types. CONCLUSIONS We recommend inclusion of at least the frequency, duration, repetition, and intensity components of exercise dose to improve reproducibility, interpretation, and comparison across studies. Further research is required to determine optimal dose ranges for the wide variety of exercise-based dysphagia interventions.
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Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA. .,Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA. .,Department of Communication Sciences and Disorders, Northwestern University, Swallowing Cross-Systems Collaborative, 2240 Campus Drive, Evanston, IL, 60208, USA.
| | - Linda M Rowe
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA.,Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall, 1300 University Ave, Madison, WI, 53706, USA.,Department of Surgery-Otolaryngology, Clinical Science Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA
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19
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Azzolino D, Passarelli PC, De Angelis P, Piccirillo GB, D’Addona A, Cesari M. Poor Oral Health as a Determinant of Malnutrition and Sarcopenia. Nutrients 2019; 11:E2898. [PMID: 31795351 PMCID: PMC6950386 DOI: 10.3390/nu11122898] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022] Open
Abstract
Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.
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Affiliation(s)
- Domenico Azzolino
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pier Carmine Passarelli
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Catholic University of Sacred Hearth, Fondazione Policlinico Universitario Gemelli, 00168 Rome, Italy; (P.C.P.); (P.D.A.); (G.B.P.); (A.D.)
| | - Paolo De Angelis
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Catholic University of Sacred Hearth, Fondazione Policlinico Universitario Gemelli, 00168 Rome, Italy; (P.C.P.); (P.D.A.); (G.B.P.); (A.D.)
| | - Giovan Battista Piccirillo
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Catholic University of Sacred Hearth, Fondazione Policlinico Universitario Gemelli, 00168 Rome, Italy; (P.C.P.); (P.D.A.); (G.B.P.); (A.D.)
| | - Antonio D’Addona
- Department of Head and Neck, Oral Surgery and Implantology Unit, Institute of Clinical Dentistry, Catholic University of Sacred Hearth, Fondazione Policlinico Universitario Gemelli, 00168 Rome, Italy; (P.C.P.); (P.D.A.); (G.B.P.); (A.D.)
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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20
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Ogawa M, Kagaya H, Nagashima Y, Mori S, Shibata S, Inamoto Y, Aoyagi Y, Toda F, Ozeki M, Saitoh E. Repetitive Peripheral Magnetic Stimulation for Strengthening of the Suprahyoid Muscles: A Randomized Controlled Trial. Neuromodulation 2019; 23:778-783. [PMID: 31667935 DOI: 10.1111/ner.13057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Head lift exercise is a widely known form of training in the rehabilitation of patients with dysphagia. This study aimed to compare muscular strength reinforcement training of the suprahyoid muscles using repetitive peripheral magnetic stimulation (rPMS) with head lift exercises in a randomized controlled trial. MATERIALS AND METHODS Twenty-four healthy adults were randomly assigned to either the magnetic stimulation group (M group) or the head lift exercise group (H group). Both groups underwent training five days a week for two weeks. The primary outcome was the cervical flexor strength, and secondary outcomes were jaw-opening force, tongue pressure, muscle fatigue of the hyoid and laryngeal muscles, displacement of the hyoid bone and opening width of the upper esophageal sphincter (UES) while swallowing 10 mL of liquid, training performance rate, and pain. RESULTS No dropouts were reported during the two-week intervention period. Cervical flexor strength significantly increased solely in the M group. Tongue pressure significantly improved in both groups. There were no significant differences in the jaw-opening force, median frequency rate of the anterior belly of the digastric muscle, sternohyoid muscle, sternocleidomastoid muscle, anterior and superior hyoid bone displacement, and UES opening width in both groups. CONCLUSIONS Two-week rPMS of the suprahyoid muscles increased the strength of these muscles compared with the head lift exercise during the same period.
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Affiliation(s)
- Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yuki Nagashima
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan.,Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan
| | - Shino Mori
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Fumi Toda
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Megumi Ozeki
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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21
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Poorjavad M, Talebian Moghadam S, Ansari NN. Effects of the head lift exercise and neuromuscular electrical stimulation on swallowing muscles activity in healthy older adults: a randomized pilot study. Clin Interv Aging 2019; 14:1131-1140. [PMID: 31417244 PMCID: PMC6594008 DOI: 10.2147/cia.s209055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/18/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Swallowing physiology exhibits several changes in advanced ages. The present study aimed to investigate and compare effects of a period of the head lift exercise (HLE) and neuromuscular electrical stimulation (NMES) on swallowing muscles activity in healthy elderly. PATIENTS AND METHODS A total of 23 older adults were randomized to either the HLE or NMES group for ten therapy sessions. They received pre- and post-therapy surface electromyography (sEMG) during water swallowing. RESULTS For the HLE group, duration of suprahyoid muscles activity was significantly reduced at post-intervention compared to pre-intervention (p=0.036). Moreover after treatments, duration and latency between onset and peak amplitude of suprahyoid muscles activity was significantly shorter in the HLE group compare to the NMES group (respectively, p=0.007 and p=0.003). CONCLUSION Our findings suggest that the HLE, against the NMES, may be effective in reducing some aging effects on the suprahyoid muscles activity, especially in elders who demonstrate prolonged duration and latency between onset and peak of the suprahyoid muscles activity during swallowing.
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Affiliation(s)
- Marziyeh Poorjavad
- Department of Speech Therapy, School of Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Talebian Moghadam
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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22
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Forehead against Resistance (FAR): Preliminary Findings from A Clinical Alternative to Shaker's Type of Exercise. Gastroenterol Res Pract 2019; 2019:9387578. [PMID: 31019531 PMCID: PMC6451806 DOI: 10.1155/2019/9387578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Reduced UES opening is a well-known risk factor for dysphagia. The Shaker exercise and the CTAR are the widely used intervention strategies to bring about effective UES opening. But there are well-known difficulties with the clinical use of these two exercise regimes. The present study proposes a clinical alternative to Shaker's exercise and CTAR called the forehead against resistance (FAR) and its variants without altering the central principles of these two regimes. The aim of the present study was to investigate the efficacy of FAR and its variants in bringing about UES opening. Method The study used a comparative cross-sectional study design, with the nonrandomized convenient sampling that included 27 healthy adults. MBS was carried out in the anterior-posterior and lateral views, while the participants performed FAR and its variants. The UES diameter was measured in the baseline and with the subjects performing FAR maneuver and its variants. Results The result revealed that the participants had greater UES opening on FAR and its variant than the baseline swallow. Also, mean values of UES opening were greater for FAR with chin tuck when compared to FAR alone, although there was no significant main effect with exercise. Conclusion FAR and its variant could be one of the options for increasing UES opening in individuals with dysphagia.
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23
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Fujiki RB, Oliver AJ, Malandraki JB, Wetzel D, Craig BA, Malandraki GA. The Recline and Head Lift Exercises: A Randomized Clinical Trial Comparing Biomechanical Swallowing Outcomes and Perceived Effort in Healthy Older Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:631-643. [PMID: 30950743 PMCID: PMC6802897 DOI: 10.1044/2018_jslhr-s-18-0117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose The aim of this study was to compare biomechanical swallowing outcomes and perceived effort as well as detraining effects of the established Head Lift Exercise (HLE) and the novel Recline Exercise (RE) in healthy older adults. Method Twenty-two healthy older adults were randomized to perform either the RE or the HLE for a period of 6 weeks. Subjects underwent videofluoroscopic swallowing studies at 3 time points (baseline, postexercise, and following a 6-week detraining period). Primary outcome measures included biomechanical measures of superior and anterior hyoid excursion and upper esophageal sphincter opening, obtained using kinematic analyses on the recorded swallows. Perceived exertion ratings during exercise, as measured by the Borg scale, were included as a secondary outcome measure. Linear mixed-effects models were utilized to compare exercise groups and evaluation time points. Results The 2 exercise groups did not differ significantly in age, body mass index, or body fat percentage at baseline. Significant postexercise increases were seen in superior hyoid excursion, F(2, 36.7) = 24.01, p ≤ .0001, and anterior hyoid excursion, F(2, 36.7) = 5.40, p = .0088, for both exercise groups. Upper esophageal sphincter opening did not increase significantly following the exercise regimens, F(2, 36.5) = 2.14, p = .1322. Both groups displayed a significant decrease in perceived exertion levels over the course of the exercises, F(5, 98) = 23.73, p ≤ .0001. On average, Borg ratings were 20% lower for the RE group than the HLE group at all time points, F(5, 20) = 7.94, p = .0106, indicating that this exercise was perceived as easier to perform. Eighteen participants were followed after detraining, and no differences in detraining effects were seen between groups. In general, gains in biomechanical measures were better maintained on larger bolus types. Conclusions In healthy older adults, the HLE and the RE produced similar gains and detraining effects in biomechanical swallow outcomes. The RE exercise, however, required significantly less effort. These findings suggest that the RE is easier to perform for healthy older adults and thus may be a valuable treatment option for individuals who have difficulty performing the HLE. Further investigation in patients with dysphagia is warranted. Supplemental Material https://doi.org/10.23641/asha.7742897.
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Affiliation(s)
- Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Abby J. Oliver
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Jaime Bauer Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Dawn Wetzel
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Bruce A. Craig
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
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24
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Fujishima I, Fujiu-Kurachi M, Arai H, Hyodo M, Kagaya H, Maeda K, Mori T, Nishioka S, Oshima F, Ogawa S, Ueda K, Umezaki T, Wakabayashi H, Yamawaki M, Yoshimura Y. Sarcopenia and dysphagia: Position paper by four professional organizations. Geriatr Gerontol Int 2019; 19:91-97. [DOI: 10.1111/ggi.13591] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Ichiro Fujishima
- Department of Rehabilitation Medicine; Hamamatsu City Rehabilitation Hospital; Hamamatsu Japan
| | - Masako Fujiu-Kurachi
- Department of Speech and Hearing Sciences; International University of Health and Welfare; Narita Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology; Obu Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology; Kochi Medical School; Kochi Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine; Fujita Health University; Toyoake Japan
| | - Keisuke Maeda
- Palliative Care Center; Aichi Medical University; Nagakute Japan
| | - Takashi Mori
- Department of Oral and Maxillofacial Surgery; Southern Tohoku General Hospital; Koriyama Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services; Nagasaki Rehabilitation Hospital; Nagasaki Japan
| | - Fumiko Oshima
- Department of Rehabilitation; Japanese Red Cross Society Suwa Hospital; Suwa Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Koichiro Ueda
- Department of Dysphagia Rehabilitation; Nihon University School of Dentistry; Tokyo Japan
| | - Toshiro Umezaki
- Department of Speech and Hearing Sciences; International University of Health and Welfare, and the Voice and Swallowing Center, Fukuoka Sanno Hospital; Fukuoka Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
| | - Masanaga Yamawaki
- Department of General Medicine; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine; Kumamoto Rehabilitation Hospital; Kumamoto Japan
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Oh JC. Effect of the head extension swallowing exercise on suprahyoid muscle activity in elderly individuals. Exp Gerontol 2018; 110:133-138. [PMID: 29894751 DOI: 10.1016/j.exger.2018.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/28/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
Aging causes motor function deterioration in the elderly population, which in turn can cause weakness in the muscles associated with swallowing. Swallowing-related problems in elderly individuals can be prevented or their symptoms can be improved with strengthening exercises for the muscles involved in swallowing. The existing strengthening exercises for the suprahyoid muscle have their limitations. Therefore, it is necessary to find another exercise that can be performed by individuals whose personal characteristics make it difficult for them to perform the existing exercises. In this study, we investigated the changes in suprahyoid muscle activation, tongue strength, and thickness of the suprahyoid muscle after 8 weeks of the head extension swallowing exercise (HESE). A total of 23 healthy elderly individuals participated in an 8-week exercise program (20 min/session, 2 times/week for 8 weeks). Suprahyoid muscle activation during effortful swallowing and the effortful-normal ratio were significantly increased at 8 weeks compared to the baseline values (p = 0.002, and 0.033, respectively). Tongue tip pressure, tongue base pressure, normal swallowing pressure, effortful swallowing pressure, and tongue tip endurance were significantly increased at 8 weeks compared with baseline (p = 0.014, 0.004, 0.046, 0.009, and 0.004, respectively). The thickness of the digastric muscle and that of the mylohyoid muscle were significantly increased at 8 weeks compared with baseline (p = 0.000 and 0.004, respectively). This study showed that HESE can be a good option for improving the suprahyoid muscle and tongue strength in the elderly population. Additionally, this exercise does not require any additional equipment and has the advantage of being able to be performed anytime and anywhere. A variety of exercise options tailored according to individual characteristics may be helpful in choosing the most appropriate exercise.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, Cheongju, Chungcheongbuk-do, Republic of Korea.
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Koshi N, Matsumoto H, Hiramatsu T, Shimizu Y, Hagino H. Influence of backrest angle on swallowing musculature activity and physical strain during the head lift exercise in elderly women compared with young women. J Oral Rehabil 2018; 45:532-538. [PMID: 29761543 DOI: 10.1111/joor.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2018] [Indexed: 11/27/2022]
Abstract
The head lift exercise (HLE) is the most common exercise for strengthening the swallowing musculature in clinical situations. This study investigated whether a change in the backrest angle of a bed influences swallowing musculature activity and physical strain during the HLE and whether it can generate an appropriate exercise load for swallowing musculature activity for older women compared with younger women. Participants were 10 elderly women and 10 young women, each of whom performed the HLE with a backrest randomly angled at 0°, 15°, 30° and 45°. The activity of the suprahyoid, infrahyoid and sternocleidomastoid muscles was assessed with electromyography. The perception of fatigue was measured with the Borg Rating of Perceived Exertion Scale. The activity of the infrahyoid and sternocleidomastoid muscles in elderly women was significantly lower when the angle of the backrest was raised to 45° vs 0°. In both groups, the Borg rating decreased significantly at the 30° and 45° backrest positions vs the 0° and 15° positions. The activity required for the suprahyoid and infrahyoid muscles in elderly women at a 30° backrest position was almost equal to the activity required by these muscles in young women at a 0° backrest position. In elderly women, it is possible that the HLE with the backrest at a 30° angle may be easier and provide a more appropriate exercise load for strengthening the swallowing muscles.
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Affiliation(s)
- N Koshi
- School of Health Science, Tottori University Graduate School of Medicine, Yonago, Tottori, Japan
| | - H Matsumoto
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - T Hiramatsu
- Department of Speech Pathology and Audiology, Tottori City Medical Nursing College, Tottori, Japan
| | - Y Shimizu
- Rehabilitation Division, Tottori University Hospital, Yonago, Tottori, Japan
| | - H Hagino
- Rehabilitation Division, Tottori University Hospital, Yonago, Tottori, Japan.,School of Health Science, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
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Wakabayashi H, Matsushima M, Momosaki R, Yoshida S, Mutai R, Yodoshi T, Murayama S, Hayashi T, Horiguchi R, Ichikawa H. The effects of resistance training of swallowing muscles on dysphagia in older people: A cluster, randomized, controlled trial. Nutrition 2018; 48:111-116. [PMID: 29469011 DOI: 10.1016/j.nut.2017.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examined the effects of resistance training of swallowing muscles in community-dwelling older individuals with dysphagia. METHODS A cluster randomized controlled trial was performed in day-service and day-care facilities. The participants were older (≥65 y) community-dwelling individuals with dysphagia. The intervention group performed a tongue resistance exercise and a head flexion exercise against manual resistance. Both groups received a brochure on dysphagia rehabilitation. The primary endpoint was an improvement in dysphagia assessed by the Eating Assessment Tool (EAT-10) score. Tongue pressure was the secondary endpoint. RESULTS Participants included 47 men and 57 women, with a mean age ± standard deviation of 80 ± 7 y. At baseline, the median EAT-10 score was 7 (interquartile range, 5-12). A total of 91 patients, 43 in the intervention group (8 clusters) versus 48 in the control group (11 clusters), were assessed postintervention. The percentage of participants with EAT-10 scores <3 was not statistically significantly different between the two groups (intervention group, 23% versus control group, 19%, P = 0.598). Postintervention median EAT-10 scores were 6 (interquartile range, 3-10) in each group (P = 0.665) and mean tongue pressure was 23.9 ± 10.0 versus 25.9 ± 10.9 kPa (P = 0.376). The intervention did not significantly affect the EAT-10 score or tongue pressure in a mixed effects random intercept model. The Mini Nutritional Assessment Short Form score correlated significantly with the postintervention EAT-10 score. CONCLUSIONS Resistance training of swallowing muscles did not improve dysphagia in this study. Better nutritional status correlated independently with improved swallowing function.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, Yokohama, Japan; Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
| | - Masato Matsushima
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Shuhei Yoshida
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Rieko Mutai
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Toshifumi Yodoshi
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Shinichi Murayama
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuro Hayashi
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Ryoko Horiguchi
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroko Ichikawa
- Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan
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Moon JH, Jung JH, Hahm SC, Jung KS, Suh HR, Cho HY. Effects of chin tuck exercise using neckline slimmer device on suprahyoid and sternocleidomastoid muscle activation in healthy adults. J Phys Ther Sci 2018; 30:454-456. [PMID: 29581670 PMCID: PMC5857457 DOI: 10.1589/jpts.30.454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/22/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effect of chin tuck exercise (CTE) using a neckline
slimmer device on suprahyoid (SH) and sternocleidomastoid (SCM) muscle activation in
healthy adults. [Subjects and Methods] We measured activation of the SH and SCM muscles
using surface electromyography in 20 healthy adults during head lift exercise (HLE) and
CTE using a neckline slimmer device. The order of exercises was randomized and the mean
and peak values of each muscle’s activation were assessed. [Results] During the CTE using
a neckline slimmer device, SH activation was significantly greater and SCM activation was
significantly lower than during the HLE. [Conclusion] This study suggest that chin-tuck
exercise using a neckline slimmer device may be more helpful than HLE for swallowing
training.
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Affiliation(s)
- Jong-Hoon Moon
- Department of Occupational Therapy, Graduate School, Gachon University, Republic of Korea
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
| | - Suk-Chan Hahm
- Department of Rehabilitation Standard and Policy, National Rehabilitation Research Institute, National Rehabilitation Center, Republic of Korea
| | - Kyoung-Sim Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
| | - Hye Rim Suh
- Department of Physical Therapy, Baekseok University: 76 Munam-ro, Dongnam-gu, Cheonan-si 31065, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, Gachon University: 191 Hambangmoe-ro, Yeonsu-gu, Incheon 21936, Republic of Korea
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ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-396. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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Cho YS, Oh DH, Paik YR, Lee JH, Park JS. Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study. J Phys Ther Sci 2017; 29:1815-1816. [PMID: 29184294 PMCID: PMC5684015 DOI: 10.1589/jpts.29.1815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/12/2017] [Indexed: 12/05/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of self-exercise on oropharyngeal swallowing function in patients with dysphagia. [Subjects and Methods] Nine patients with dysphagia after stroke were recruited. Self-exercise including effortful swallowing, tongue strengthening, and shaker exercise was performed 5 times a week for 4 weeks. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) based on a videofluoroscopic swallowing study. [Results] There were significant differences in both the oral and pharyngeal phases of the VDS before and after the intervention. [Conclusion] This study demonstrated that bedside self-exercise is a positive method to improve oropharyngeal swallowing function in patients with dysphagia after stroke.
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Affiliation(s)
- Young-Seok Cho
- Department of Occupational Therapy, Hyejeon College, Republic of Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy, Kyungdong University, Republic of Korea
| | - Young-Rim Paik
- Department of Occupational Therapy, Doowon Technical University, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Occupational Therapy, St. Paul Catholic University, Republic of Korea
| | - Ji-Su Park
- Department of Rehabilitation Science, Graduate School of Inje University: 197 Inje-ro, Gimhae, Gyeongsangnam-do 621-749, Republic of Korea
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Effect of Modified Shaker Exercise on the Amplitude and Duration of Swallowing Sounds: Evidence from Cervical Auscultation. Rehabil Res Pract 2017; 2017:6526214. [PMID: 29082044 PMCID: PMC5610851 DOI: 10.1155/2017/6526214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/12/2017] [Accepted: 07/31/2017] [Indexed: 12/04/2022] Open
Abstract
Objective Anecdotal evidence shows that the Shaker exercise and its modifications improve pharyngeal muscle contraction. However, there is no experimental evidence for the same. Thus, the present study examined the effect of modified Shaker exercise on the amplitude and duration of pharyngeal muscle contraction using cervical auscultation. Design The study follows a cross-sectional study design, where 50 healthy individuals (23 males and 27 females) performed modified Shaker exercise and noneffortful swallow during 10 ml water swallowing. Swallow sound characteristics were analyzed with and without modified Shaker exercise using cervical auscultation. Results The results of mixed ANOVA revealed significant differences for the amplitude of swallow sound with modified Shaker exercise (mean = 47.24, SD = 20.64) when compared to noneffortful swallow (mean = 28.19, SD = 10.26) at p < 0.05. However, no significant difference was obtained for the swallow sound duration with (mean = 0.19, SD = 0.07) and without (mean = 0.18, SD = 0.07) modified Shaker exercise at p > 0.05. No significant difference across the genders was also noted at p > 0.05. Conclusion The outcomes of the study suggest that modified Shaker exercise improves the amplitude of pharyngeal muscle contraction. Further studies are needed to confirm this finding using gold standard tools like videofluoroscopy.
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Characterization of Swallowing Sound: Preliminary Investigation of Normal Subjects. PLoS One 2016; 11:e0168187. [PMID: 27959902 PMCID: PMC5154546 DOI: 10.1371/journal.pone.0168187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to characterize the swallowing sound and identify the process of sound generation during swallowing in young healthy adults. METHODS Thirty-three healthy volunteers were enrolled and allocated into three experimental groups. In experiment 1, a microphone was attached to one of eight cervical sites in 20 subjects, participants swallowed 5 ml water, and the sound waveform was recorded. In experiment 2, 10 subjects swallowed either 0, 5, 10, or 15 ml water during audio recording. In addition, participants consumed the 5 ml bolus in two different cervical postures. In experiment 3, the sound waveform and videofluoroscopy were simultaneously recorded while the three participants consumed 5 ml iopamidol solution. The duration and peak intensity ratio of the waveform were analyzed in all experimental groups. RESULTS The acoustic analysis of the waveforms and videofluoroscopy suggested that the swallowing sound could be divided into three periods, each associated with a stage of the swallowing movement: the oral phase comprising posterior tongue and hyoid bone movement; the pharyngeal phase comprising larynx movement, hyoid bone elevation, epiglottis closure, and passage of the bolus through the esophagus orifice; and the repositioning phase comprising the return of the hyoid bone and larynx to their resting positions, and reopening of the epiglottis. CONCLUSION Acoustic analysis of swallowing sounds and videofluoroscopy suggests that the swallowing sound could be divided into three periods associated with each process of the swallowing movement: the oral phase comprising the posterior movement of the tongue and hyoid bone; the pharyngeal phase comprising the laryngeal movement, hyoid bone elevation, epiglottis closure, and the bolus passage to the esophagus orifice; and the repositioning phase comprising the repositioning of the hyoid bone and larynx, and reopening of the epiglottis.
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Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography--Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise. Dysphagia 2016; 31:195-205. [PMID: 26837612 DOI: 10.1007/s00455-015-9678-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
In this study, the efficacy of two dysphagia interventions, the Chin Tuck against Resistance (CTAR) and Shaker exercises, were evaluated based on two principles in exercise science-muscle-specificity and training intensity. Both exercises were developed to strengthen the suprahyoid muscles, whose contractions facilitate the opening of the upper esophageal sphincter, thereby improving bolus transfer. Thirty-nine healthy adults performed two trials of both exercises in counter-balanced order. Surface electromyography (sEMG) recordings were simultaneously collected from suprahyoid muscle group and sternocleidomastoid muscle during the exercises. Converging results using sEMG amplitude analyses suggested that the CTAR was more specific in targeting the suprahyoid muscles than the Shaker exercise. Fatigue analyses on sEMG signals further indicated that the suprahyoid muscle group were equally or significantly fatigued (depending on metric), when participants carried out CTAR compared to the Shaker exercise. Importantly, unlike during Shaker exercise, the sternocleidomastoid muscles were significantly less activated and fatigued during CTAR. Lowering the chin against resistance is therefore sufficiently specific and intense to fatigue the suprahyoid muscles.
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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]
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Kim SJ, Cheon HJ, Lee HN, Hwang JH. Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer. J Electromyogr Kinesiol 2015; 28:208-13. [PMID: 26705964 DOI: 10.1016/j.jelekin.2015.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/22/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of this study is to reveal the mechanism of esophagectomy-mediated swallowing motion disorders. Forty-seven patients who underwent 3-stage esophagectomy with cervical anastomosis and VFSS for esophageal cancer were selected. Twenty-three patients displayed subglottic aspiration (aspiration group) and the other 24 patients did not show any aspiration or penetration in the videofluoroscopic swallowing study after esophagectomy (no aspiration group). For comparison, 27 healthy volunteers (normal group) were included. Maximal anterior displacement of the hyoid (MADH), maximal superior displacement of the hyoid (MSDH), maximal rotation of the epiglottis (MRE) and pharyngeal delay time (PDT) were measured by image J software. MADH, MRE, and PDT in normal group were significantly different from those in aspiration and no aspiration groups (P<0.001). The normal group displayed a significantly different PDT compared to the no aspiration and aspiration groups, and the no aspiration group had a significantly different PDT compared to the aspiration group (P<0.001). The mechanism of swallowing motion disorders caused by the esophagectomy in esophageal cancer includes the decreased anterior movement of the hyoid and rotation of the epiglottis caused by the prolonged operation time and delayed pharyngeal reflex caused by the laryngeal sensory disturbance. Among them, the main mechanism of subglottic aspiration after esophagectomy is the delayed pharyngeal reflex.
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Affiliation(s)
- Sang Jun Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - Hee Jung Cheon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - Han Nah Lee
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
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Mano T, Katsuno M, Banno H, Suzuki K, Suga N, Hashizume A, Araki A, Hijikata Y, Tanaka S, Takatsu J, Watanabe H, Yamamoto M, Sobue G. Head Lift Exercise Improves Swallowing Dysfunction in Spinal and Bulbar Muscular Atrophy. Eur Neurol 2015; 74:251-8. [DOI: 10.1159/000431088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/03/2015] [Indexed: 11/19/2022]
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Momosaki R, Abo M, Watanabe S, Kakuda W, Yamada N, Kinoshita S. Repetitive Peripheral Magnetic Stimulation With Intensive Swallowing Rehabilitation for Poststroke Dysphagia: An Open-Label Case Series. Neuromodulation 2015; 18:630-4; discussion 634-5. [PMID: 25950817 DOI: 10.1111/ner.12308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/04/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this pilot study was to determine the safety and feasibility of a six-day protocol of in-hospital repetitive peripheral magnetic stimulation combined with intensive swallowing rehabilitation (rPMS-ISR) for poststroke dysphagia. METHODS The subjects were eight patients with dysphagia caused by bilateral cerebral infarction (age: 62-70; time from onset of stroke: 27-39 months). rPMS was applied to the suprahyoid muscles, at strength set at 90% of the minimal intensity that elicited pain with a parabolic coil. One train of stimuli comprised 20 Hz for 3 sec followed by 27-sec rest. A single session included delivery of repetitive 20 trains of stimuli over 10 min, followed by 20 min of swallowing rehabilitation. Each patient received this combination treatment twice daily, morning and afternoon, over six consecutive days. Swallowing function was evaluated before and after intervention. RESULTS rPMS-ISR induced significant improvement in swallowing ability, laryngeal elevation delay time, penetration aspiration scale, and swallowing quality of life (p < 0.01), but had no significant effect on the functional oral intake scale. CONCLUSION The six-day in-hospital RPMS-ISR protocol seems safe and feasible for poststroke patients with dysphagia. The combination protocol improved swallowing function. Further larger studies are needed to confirm its efficacy.
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Affiliation(s)
- Ryo Momosaki
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Shu Watanabe
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Shoji Kinoshita
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 2014; 22:172-80. [PMID: 24675153 DOI: 10.1097/moo.0000000000000055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review recent literature depicting a shift in dysphagia rehabilitation in adults. Distinguishing rehabilitation from compensation in dysphagia management, a review of basic exercise principles is followed by description of recent publications depicting exercise-based therapies. Subsequently, transcutaneous electrical stimulation (TES) is reviewed as it may contribute to exercise-based dysphagia rehabilitation in adults. RECENT FINDINGS Surveys have documented extensive variability in the clinical application of dysphagia therapy techniques. Despite this variability, two trends are emerging in dysphagia rehabilitation research: documentation of physiologic and functional changes within the swallowing mechanism subsequent to therapy; and prophylactic exercise-based therapies. In addition, extensive efforts have emerged describing the potential application of TES in dysphagia rehabilitation. Though results of these efforts are conflicted, TES may serve a useful role as an adjunct to well developed exercise-based rehabilitation for dysphagia. SUMMARY The focus of dysphagia rehabilitation in adults is changing. Current efforts indicate that exercise-based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. TES may function as an adjunctive modality; however, current practices should be evaluated to develop additional parameters of stimulation that are focused toward specific dysphagia impairments.
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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]
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Kondo E, Jinnouchi O, Ohnishi H, Kawata I, Nakano S, Goda M, Kitamura Y, Abe K, Hoshikawa H, Okamoto H, Takeda N. Effects of aural stimulation with capsaicin ointment on swallowing function in elderly patients with non-obstructive dysphagia. Clin Interv Aging 2014; 9:1661-7. [PMID: 25328387 PMCID: PMC4198277 DOI: 10.2147/cia.s67602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In the present study, an attempt was made to examine the effects of aural stimulation with ointment containing capsaicin on swallowing function in order to develop a novel and safe treatment for non-obstructive dysphagia in elderly patients. DESIGN A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment. SETTING Secondary hospitals. PATIENTS AND METHODS The present study included 26 elderly patients with non-obstructive dysphagia. Ointment containing 0.025% capsaicin (0.5 g) was applied to the external auditory canal with a cotton swab under otoscope only once or once a day for 7 days before swallowing of a bolus of colored water (3 mL), which was recorded by transnasal videoendoscopy and evaluated according to the endoscopic swallowing score. RESULTS After a single application of 0.025% capsaicin ointment to the right external auditory canal, the endoscopic swallowing score was significantly decreased, and this effect lasted for 60 minutes. After repeated applications of the ointment to each external auditory canal alternatively once a day for 7 days, the endoscopic swallowing score decreased significantly in patients with more severe non-obstructive dysphagia. Of the eight tube-fed patients of this group, three began direct swallowing exercises using jelly, which subsequently restored their oral food intake. CONCLUSION These findings suggest that stimulation of the external auditory canal with ointment containing capsaicin improves swallowing function in elderly patients with non-obstructive dysphagia. By the same mechanism used by angiotensin-converting enzyme inhibitors to induce cough reflex, which has been shown to prevent aspiration pneumonia, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in dysphagia patients via Arnold's ear-cough reflex stimulation.
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Affiliation(s)
- Eiji Kondo
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan ; Department of Otolaryngology, Kochi National Hospital, Kochi, Japan
| | - Osamu Jinnouchi
- Department of Otolaryngology, Anan Kyoei Hospital, Anan, Japan
| | - Hiroki Ohnishi
- Department of Otolaryngology, Anan Kyoei Hospital, Anan, Japan
| | - Ikuji Kawata
- Department of Otolaryngology, Anan Kyoei Hospital, Anan, Japan
| | - Seiichi Nakano
- Department of Otolaryngology, Kochi National Hospital, Kochi, Japan
| | - Masakazu Goda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Yoshiaki Kitamura
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Koji Abe
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Hiroshi Hoshikawa
- Department of Otolaryngology, Kagawa University School of Medicine, Kagawa, Japan
| | - Hidehiko Okamoto
- Department of Sensori-Motor Integration, National Institute for Physiological Sciences, Okazaki, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
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Wakabayashi H, Sashika H, Matsushima M. Head lifting strength is associated with dysphagia and malnutrition in frail older adults. Geriatr Gerontol Int 2014; 15:410-6. [DOI: 10.1111/ggi.12283] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
- Division of Clinical Epidemiology; Jikei University School of Medicine; Tokyo Japan
| | - Hironobu Sashika
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology; Jikei University School of Medicine; Tokyo Japan
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Abstract
The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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