Swallowing exercise for upper esophageal sphincter dysfunction in stroke patient with dysphagia: A systematic review

Abstract

Dysphagia is common in patients with stroke. Patients may experience deficits in oral, pharyngeal and upper esophageal sphincter (UES) function, including insufficiency in chewing and mastication, weak pharyngeal constriction, UES and pharyngeal incoordination, and abnormal UES relaxation. The UES is usually closed except during swallowing phase. The suprahyoid muscles make the larynx move upward and forward to open the UES. Many studies have reported the swallowing exercise for the UES dysfunction, this systematic review aims to appraise the evidence of the swallowing exercise to facilitate the suprahyoid muscle and open the UES for stroke patients with dysphagia. A systematic search of Pubmed, Embase, Medline, Web of Science, The Cochrane Library, and ProQuest databases was conducted from January 2007 to December 2017. The following four areas of research were reviewed: –(1) studies including specific swallowing exercise for improving suprahyoid muscles activity; –(2) studies examining the efficacy of each swallowing exercise with a device in healthy adults; –(3) studies examining the efficacy of specific swallowing exercise with a device as a dysphagia treatment in stoke patients with dysphagia; –(4) studies comparing the difference between those swallowing exercise in healthy adults and stroke patients. A narrative analysis of the results was conducted. Five types of swallowing exercise including Shaker Exercise, Chin tuck against resistance, Jaw open Exercise, Modified Jaw open Exercise and Head extension Exercise may facilitate the suprahyoid muscle and the opening of the UES. With the strengthened suprahyoid muscles, the amount of upward and forward movement was increased to facilitate the opening of UES and decrease the time of pharynx passage. Though many studies have reported the swallowing exercise is efficacious for suprahyoid muscles, the Modified Jaw Opening Exercise holds more potential in training the suprahyoid muscle among the five swallowing exercise for stroke patients with dysphagia.