Effects of the head lift exercise and neuromuscular electrical stimulation on swallowing muscles activity in healthy older adults: a randomized pilot study

Smartphone-based combined oral and whole-body exercise programme aimed at improving oral functions: A randomized clinical trial

OBJECTIVES

To investigate the effects of a smartphone-based oral and whole-body exercise programme on oral function in older adults.

METHODS

Individuals aged 65 years or above were randomized into three groups (non-app use, app use and control group), and a combined oral and whole-body exercise programme was conducted for 5 weeks. Oral muscle strength, saliva flow rate, Oral Health Impact Profile-14 (OHIP-14), and Geriatric Oral Health Assessment Index (GOHAI) were measured before and after the intervention. The changes in each group were analysed at the end of the programme using paired sample t-tests, and the differences among the groups were analysed using the chi-square test, Fisher's exact test and ANOVA.

RESULTS

The anterior tongue strength increased by 2.80 kPa after the intervention in the non-app use group; however, the change was not statistically significant. In the app use group, the anterior tongue strength significantly increased by 4.48 kPa. The saliva flow rate increased by 0.54 and 0.71 g/min in the non-app and app use groups, respectively, after the intervention (p < 0.05), and the change was greater in the app use group than in the other groups (p < 0.01). There were no significant changes in the posterior tongue strength, cheek strength, OHIP-14 or GOHAI scores over the course of the study.

CONCLUSIONS

A smartphone-based combined oral and whole-body exercise programme can improve anterior tongue strength and saliva flow rate in older participants. The programme, however, did not result in significant changes in posterior tongue strength, cheek strength and perceived oral health.

Effects of oropharyngeal exercises on the swallowing mechanism of older adults: A systematic review

PURPOSE

Age-related changes to the swallowing mechanism, or presbyphagia, may put older adults at a higher risk for developing diseases and dysphagia. Maintaining swallowing functions could help prevent frailty and facilitate healthy ageing. This review summarises and appraises the effects of oropharyngeal exercises on the swallowing functions of healthy older adults without dysphagia. It is hypothesised that these exercises will strengthen and improve the structures and functions of the normal ageing swallow.

METHOD

This review was reported according to the PRISMA 2020 guidelines. Five electronic databases (Medline, Embase, Cochrane Library, Web of Science, CINAHL) and Google Scholar were searched in June 2021. A rerun was done in January 2023. Study selection, data extraction, and quality assessment were done by two independent raters.

RESULT

A total of 23 studies were reviewed. Meta-analysis was not conducted due to the heterogenous training protocols and outcomes. Majority (n = 21) had fair quality due to incomplete reporting. Exercises targeting oral structures were implemented the most (n = 15), followed by variations of the head lift (n = 4), and effortful swallow exercise (n = 1). Others implemented combined or multiapproach exercise studies (n = 3). Apart from surface electromyography findings, statistically significant improvements in oral and pharyngeal phase swallowing outcomes such as increased lingual isometric and swallowing pressures, bite force, muscle thickness, hyolaryngeal excursion, and upper oesophageal sphincter opening diameter were reported in 95% of the studies (n = 22).

CONCLUSION

Collective evidence suggests that strength training for swallowing-related structures leads to increases in structural strength, endurance, and muscle mass. The effects of exercises on overall swallowing efficiency and safety remain unclear. Results should be interpreted with caution due to methodological limitations. Further research should examine the long-term effects of these exercises in preventing frailty and reducing the burden of dysphagia in older adults.

Comparison of sEMG activity of submental muscles between the head-lift exercise, tongue-press exercise and the head extension tongue-press exercise in healthy young adults

BACKGROUND

Swallowing is a complex function that requires precise coordination between different muscles. Weakness in submental muscles can lead to complications such as pharyngeal residue and aspiration. Therefore, exercise interventions targeting these muscles, such as the Head-Lift Exercise (HLE), are clinically important but pose challenges.

OBJECTIVE(S)

This study aimed to compare the myoelectric activity of submental muscles during traditional Head-Lift Exercise (HLE), Tongue-Press Exercise (TPE) and Head Extension Tongue-Press Exercise (HETPE), providing potential alternatives to HLE.

METHODS

Thirty healthy volunteers (22 females and 8 males, mean age 25.63 ± 5.27 years) participated in this cross-sectional study. Surface electromyography (sEMG) recorded activity of the submental muscles bilaterally during HLE, TPE and HETPE. Participants performed each manoeuvre for 14 s, repeated three times in a counterbalanced order. Statistical analyses assessed differences in mean, maximum and median frequency of the sEMG signals among manoeuvres using repeated-measures analysis of variance (RM-ANOVA). The experienced irritation levels by participants during manoeuvres were also compared by the Friedman test.

RESULTS

HETPE exhibited significantly higher maximum sEMG activity compared to HLE and TPE (p < .05). Mean sEMG activity was significantly increased during HETPE compared to TPE. Median frequency was significantly lower during HETPE compared to the two other exercises, indicating greater muscle fatigue. Participants reported similar levels of irritation for HLE and HETPE, and significantly lower levels during TPE.

CONCLUSION

These results indicate that HETPE is effective in activating and strengthening submental muscles, potentially serving as a viable alternative to HLE without added difficulty. Further research is recommended to assess the long-term impacts on swallowing physiology in patients with dysphagia.

Orofacial and cervical myofunctional intervention programmes for older adults: A scoping review

INTRODUCTION

Senescent stomatognathic systems undergo anatomical changes that are not always compensated by physiology due to associated factors such as poorly fitted dentures, dental changes, and clinical conditions that trigger sarcopenia. When these conditions are not properly addressed, they can lead to nutritional deficiencies. Hence, this study aimed to map orofacial and cervical myofunctional intervention programmes for older adults, evaluate the current research in this area, and formulate suggestions for further investigation.

METHODS

Scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and grey literature databases were systematically searched. Studies addressing therapeutic programmes, myofunctional exercises, and their influence on the stomatognathic system of older adults were included. Studies with populations younger than 60 years, residing in long-term care facilities, homes, or hospital care, and with associated comorbidities were excluded, as well as secondary studies.

RESULTS

A total of 3098 studies were retrieved. After applying the eligibility criteria, nine studies were eligible for this review. The nine studies were published in English between 2008 and 2021 in the United States, Japan, and South Korea. The participants' mean ages ranged from 64 to 81 years, with a preponderance of females. Six of the studies divided the sample into intervention and control groups. Two studies referred to programmes to promote oral function through facial expression and tongue muscle exercises, salivary gland massage, and swallowing biomechanics. Seven studies report the positive influence of myofunctional exercises on the stomatognathic system.

CONCLUSION

The mapping concluded that therapeutic programmes, including educational actions, help prevent orofacial myofunctional disorders, and improve the functionality of the stomatognathic system.

Therapeutic effects of deep pharyngeal electrical stimulation combined with modified masako maneuver on aspiration in patients with stroke

BACKGROUND

Stroke patients often experience difficulty swallowing.

OBJECTIVE

To assist in the improvement of dysphagia symptoms by introducing a novel approach to the treatment of patients with post-stroke aspiration.

METHODS

A total of 60 patients with post-stroke aspiration were enrolled and divided into an experimental group (n = 30) and a control group (n = 30). The control group received standard treatment, sham intraoral stimulation, and the Masako maneuver, while the experimental group was administered standard treatment, deep pharyngeal electrical stimulation (DPES), and a modified Masako maneuver. Changes in their Functional Oral Intake Scale (FOIS) and Rosenbek scale scores were observed.

RESULTS

The FOIS scores of both groups increased significantly after treatment (p < 0.01, respectively). The Rosenbek scale scores of both groups decreased significantly after treatment, with the experimental group scoring significantly lower than the control group (1.01±0.09 vs. 2.30±0.82) (p < 0.05). After treatment, the overall response rate in the experimental group (93.33%) was significantly higher than that in the control group (83.33%) (p < 0.001).

CONCLUSION

In terms of effectively improving dysphagia in aspiration patients after stroke, DPES combined with modified Masako maneuver is clinically recommended.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

INTRODUCTION

Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS.

METHODS

In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated.

RESULTS

MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants.

CONCLUSION

NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Review of the effectiveness of neuromuscular electrical stimulation in the treatment of dysphagia - an update

BACKGROUND

Neuromuscular electrical stimulation (NMES) has been used as a treatment option in the therapy of dysphagia for several years. In a previous review of the literature, it was concluded that NMES might be a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. However, due to different stimulation protocols, electrode positioning and various underlying pathological conditions, it was difficult to compare the studies which were identified and it was concluded that more empirical data is needed to fully understand the benefits provided by NMES. The purpose of this systematic review is, therefore, to evaluate recent studies regarding a potential effectiveness of transcutaneous NMES applied to the anterior neck as a treatment for dysphagia considering these different aspects.

METHOD

For this systematic review, a selective literature research in PubMed has been carried out on 5^th May 2021 using the terms electrical stimulation AND dysphagia and screened for inclusion criteria by two reviewers in Rayyan. The search resulted in 62 hits.

RESULTS

Studies were excluded due to their publication language; because they did not meet inclusion criteria; because the topical focus was a different one; or because they did not qualify as level 2 studies. Eighteen studies were identified with varying patient groups, stimulation protocols, electrode placement and therapy settings. However, 16 studies have reported of beneficial outcomes in relation with NMES.

DISCUSSION

The purpose of this systematic review was to evaluate the most recent studies regarding a potential effectiveness of NMES as a treatment for oropharyngeal dysphagia considering different aspects. It could generally be concluded that there is a considerable amount of level 2 studies which suggest that NMES is an effective treatment option, especially when combined with TDT for patients with dysphagia after stroke and patients with Parkinson's disease, or with different kinds of brain injuries. Further research is still necessary in order to clarify which stimulation protocols, parameters and therapy settings are most beneficial for certain patient groups and degrees of impairment.

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.

A comparison of the head lift exercise and recline exercise in patients with chronic head and neck cancer post-radiation

BACKGROUND

Patients who undergo surgery and adjuvant radiation treatment for head and neck cancer often develop dysphagia as a result of this treatment. Improvements in swallow function may be achieved with exercise. The goal of this pilot study was to compare the effectiveness and perceived difficulty of using the head lift exercise and the recline exercise to activate the suprahyoid musculature in 8 individuals with a history of head and neck cancer.

METHOD

Muscle activation using surface electromyography was examined to determine if the recline exercise activates the suprahyoid muscle groups to the same degree as the head lift exercise. Participants also rated the exertion they experienced to assess how easily patients are able to complete the exercises.

RESULTS

The majority of participants completed both exercises in their entirety on their first attempt. However, ratings of perceived exertion were significantly lower for the recline exercise than the head lift exercise. The head lift exercise activated the suprahyoid musculature to a significantly greater degree than the recline exercise.

CONCLUSION

The recline exercise, in comparison with the head lift exercise, is easier for participants to complete and results in significantly reduced perceptions of fatigue. Results of this study indicate that the recline exercise may be a good potential substitute for the head lift exercise in patient populations that are incapable of performing the head lift exercise, but that the head lift exercise should be prescribed whenever it is viable as it activates target musculature more effectively than the recline exercise.