Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in adults

Effects of Neuromuscular Electrical Stimulation (NMES) Plus Upper Cervical Spine Mobilization on Forward Head Posture and Swallowing Function in Stroke Patients with Dysphagia

After a stroke, forward head posture occurs, resulting in swallowing dysfunction. Neuromuscular electrical stimulation (NMES) combined with upper cervical spine mobilization has demonstrated enhanced recovery of the swallowing function in stroke patients. This study investigated the therapeutic effects of NMES in conjunction with upper cervical mobilization in stroke patients with dysphagia. Thirty-four stroke patients were recruited (in a randomized controlled clinical trial) and divided into an experimental group (n = 17; NMES plus upper cervical spine mobilization) and a control group (n = 17; NMES plus sham mobilization). Forward head posture was measured by craniocervical flexion test (CCFT) and craniovertebral angle (CVA). Swallowing function was measured by variations in video fluoroscopic dysphagia scale (VDS) and penetration–aspiration scale (PAS) scores using the video fluoroscopic swallowing study (VFSS). All measurements were done at baseline and after four weeks of NMES plus mobilization. A significant increase was observed in CCFT, CVA, VDS (total VDS score, oral stage score, pharyngeal stage score), and PAS score in all variations in the experimental group. The CCFT, CVA, pharyngeal stage score, total VDS, and PAS score were significantly higher in the experimental group when compared to the control group. NMES plus upper cervical spine mobilization can be regarded as a promising method to improve swallowing function and forward head posture changes in stroke patients with dysphagia.

Effects of sitting posture and bolus volume on activation of swallowing-related muscles

BACKGROUND

The pharyngeal phase is a particularly important clinical factor related to swallowing dysfunctions. Head and neck posture, as well as bolus volume, are important factors affecting the pharyngeal stages of normal swallowing.

OBJECTIVE

The aim of our study was to identify the effects of sitting posture and bolus volume on the activation of swallowing-related muscles.

MATERIALS AND METHODS

Twenty-four subjects participated in the study. The subjects were positioned in three sitting postures-slump sitting (SS), lumbo-pelvic upright sitting (LUS), and thoracic upright sitting (TUS). While sitting in the chair, the subject was instructed to swallow 10 and 20 mL of water. Surface electromyography (EMG) was used to measure the muscle activity of the supra-hyoid (SH) and infra-hyoid (IH) muscles. Also, sitting posture alignment (head, cervical and shoulder angle) was also performed. Data were analysed with a repeated measures analysis of variance (RMANOVA) using a generalised linear model.

RESULTS

There was no significant difference in terms of the head angle (P = .395). However, significant differences were found in relation to the cervical angle (P < .001) and shoulder angle (P < .001). The TUS produced the lowest SH EMG activity (P = .001), in comparison to SS and LUS. The bolus volume for 20 mL showed greater SH and IH EMG activity (P < .001) than did the bolus volume for 10 mL.

CONCLUSIONS

Correcting sitting posture from SS to TUS may better assist swallowing-related muscles with less effort, irrespective of the bolus volume.

How a personalised transportable folding device for seating impacts dysphagia

PURPOSE

A personalised transportable folding device for seating (DATP) on a standard seat was developed by an occupational therapist at the Toulouse University Hospital Centre (patent no. WO 2011121249 A1) based on the hypothesis that the use of a seat to assist with better positioning on any chair during meals modifies the sitting posture and has an impact on cervical statics which increases the amplitude of movements of the axial skeleton (larynx and hyoid bone) and benefits swallowing. The aim of this work is to demonstrate that an improvement in sitting posture with the help of the DATP, through Hyoid bone motion, has an impact on the quality of swallowing in a dysphagic population which benefits from the device in comparison to a dysphagic population which does not benefit from the device after 1 month of care. The secondary endpoints concern the evaluation of the impact on other characteristics of swallowing, posture, the acceptability of the device and the quality of life.

METHODOLOGY

This is a randomised comparative clinical trial. The blind was not possible for the patients but the examiner who evaluated the outcome criterion was blinded to the group to which the patient belonged. The outcome criterion was the measurement of the hyoid bone movement during swallowing. The other criteria were collected during the videofluoroscopic examination of swallowing and by use of a questionnaire. Fifty-six (56) patients were included: 30 in the group without device (D-) and 26 in the group with the device (D+). All the patients benefited from a training course on seating. Only the D+ patients participated in this course where the use of the device was explained and the device was then kept for use at home for 1 month.

RESULTS

A significant improvement was noted in the postural criteria before and after use, in favour of a better posture for the two groups (p < 0.001) and more hyoid bone motion in the D+ group. The difference was significant in the bivariate analysis for horizontal movement (p = 0.04). After adjustment of potential factors of confusion, we noted a significant mean difference for the three distances in the D+ group in comparison to the D- group, of + 0.33 (95% CI [+ 0.17; + 0.48]) for horizontal movement, + 0.22 (95% CI [+ 0.03; + 0.40]) for vertical movement and + 0.37 (95% CI = [+ 0.20; + 0.53]) for horizontal movement. However, the other parameters, and notably the other swallowing markers were not significantly modified by the use of the device.

CONCLUSION

The personalised transportable folding device for seating developed to reduce dysphagia has an action on hyoid bone motion during swallowing. However, this positive effect on an intermediate outcome criterion of the quality of swallowing was not associated with an improvement in swallowing efficiency in the study population. The diversity of diseases with which the patients in this study were afflicted is a factor to be controlled in future studies with this device.

Open Mouth-Maximal Isometric Press: Development and Norms for Clinical Swallowing Evaluations and Treatment

Purpose The aims of this study were to (a) describe the development and utility of the Open Mouth-Maximal Isometric Press (OM-MIP), a tool designed for the quantitative assessment of suprahyoid-infrahyoid muscle strength; (b) examine the effects of age and sex on the OM-MIP; and (c) establish age- and sex-based OM-MIP norms. Method Two hundred sixteen healthy male and female volunteers were recruited. Participants performed the OM-MIP, and the maximum of 3 trials that were within 10% of each other was recorded. Rest between each trial was allowed to avoid fatigue. Multiple regression examined the influence of age and sex on the OM-MIP. Descriptive statistics outlined normative OM-MIP values for young adult (aged 18-39 years), middle-aged adult (aged 40-59 years), old adult (aged 60-79 years), and very old adult (aged ≥ 80 years) men and women. Two-way analysis of variance determined if normative data differed significantly between the age and sex groups. Results Age and sex significantly influenced the OM-MIP, although no significant interaction effect was identified. Women had lower mean OM-MIPs when compared with men ( p < .0005), and very old adults had lower mean OM-MIPs when compared with young ( p = .001), middle-aged ( p < .0005), and old ( p = .013) adults. Conclusions This study establishes age- and sex-based OM-MIP norms and outlines its potential utility during clinical swallowing evaluations and treatment. By providing these norms, clinicians can begin to quantitatively measure suprahyoid and infrahyoid strength, individualize resistance training programs to patients' OM-MIP 1 repetition maximum, and track strength changes over time in response to therapeutic interventions.