Head Lift Exercise Research Articles

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.

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. 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. 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. 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. 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.

Effect of Head Lift Exercise on Knowledge, Practice, and Swallowing Function among Patients with Dysphagia

Effect of Head Lift Exercise on Knowledge, Practice, and Swallowing Function among Patients with Dysphagia

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)

BackgroundThis 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).MethodsPatients 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.ResultsFew 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.ConclusionsThis 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.

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.

BackgroundDysphagia 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.MethodsPatients 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.ResultsAlthough 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.ConclusionsIn 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.

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

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. 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. 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. 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.

Voice Outcomes Following Head-Lift Exercises in Head and Neck Cancer: A Randomized Controlled Study

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). 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). 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. 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.

Repetitive Peripheral Magnetic Stimulation for Strengthening of the Suprahyoid Muscles: A Randomized Controlled Trial

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. 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. 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. Two-week rPMS of the suprahyoid muscles increased the strength of these muscles compared with the head lift exercise during the same period.

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

PurposeSwallowing 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 methodsA 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.ResultsFor 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).ConclusionOur 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.

Effect of Shaker Exercises on Swallowing Disturbance among Patients with Hyperthyroidism at a Selected University Hospital

Background: Apparently; the most common causes of hyperthyroidism represent in Graves’ disease. Shaker Exercises implementation through head lift exercise and tongue strengthening exercises aim to improve motility and strength the muscles of the neck and enhance swallowing capabilities as well. Aim of the current study was to examine the effect of shaker exercises on swallowing disturbance among patients with hyperthyroidism at a selected University Hospital, Egypt. Design: A quazi-experimental design time series Non-equivalent design was utilized, the study conducted at surgical departments at one of University Hospital; Egypt. Research hypothesis: H1: Study group who received the Shaker Exercises will have a significant lower mean swallowing disturbance score than the control group who received only routine hospital care. H2 (a,b,c & d): Study group who received the Shaker Exercises will have higher correlation between total swallowing disturbance score and selected related sub-Items than the control group who received only routine hospital care. Sample: 60 adult male and female patients divided randomly into two equal groups, control group (n=30 patients) received the routine hospital of the hyperthyroidism, and study group (n=30 patients) received routine hospital in addition to the Shaker Exercises. Tools: Tool I: Demographic and medical data sheet. Tool II: Swallowing Disturbance Questionnaire (SDQ). Results: there was a statistical significant difference among study group comparing to control group regarding the swallowing disturbance after shaker exercise interventions. Conclusion: study group patients who received the Shaker Exercise in addition to their routine hospital care which was medical treatment was improved significantly comparing to the control group who received only their medical treatment. Recommendation: Replicate the study on a larger group to add to solid evidence practice and replicate the study on other disease rather than hyperthyroidism that interfere with swallowing function.

Effects of game-based chin tuck against resistance exercise vs head-lift exercise in patients with dysphagia after stroke: An assessor-blind, randomized controlled trial.

To compare the effects of game-based chin-tuck against resistance exercise and head-lift exercise on swallowing function and compliance of patients with dysphagia after stroke. A total of 37 patients with stroke were randomly assigned to 2 groups. The experimental group performed game-based chin tuck against resistance exercise, whereas the control group performed traditional head-lift exercise. The videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) were used to evaluate swallowing function. In addition, the functional oral intake scale (FOIS) was used for dietary assessment. Finally, the numerical rating self-report scale was used to assess compliance (motivation, interest/enjoyment, physical effort needed, muscle fatigue) with the 2 exercises. After intervention, there was no significant difference in VDS, PAS, and FOIS between the 2 groups. Comparing the compliance with the 2 exercises, the scores for motivation and interest/enjoyment items were significantly higher, and the scores for physical effort needed and muscle fatigue were significantly lower, in the experimental group than in the control group. Game-based chin-tuck against resistance exercise not only has a similar effect to head-lift exercise on swallowing function of patients with dysphagia, but is also a less strict and more enjoyable and interesting method.

The Effects of Head-lift Exercise on Swallowing Function in Patients with Stroke

The Effects of Head-lift Exercise on Swallowing Function in Patients with Stroke

Influence of backrest angle on swallowing musculature activity and physical strain during the head lift exercise in elderly women compared with young women.

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.

Effects of chin tuck exercise using neckline slimmer device on suprahyoid and sternocleidomastoid muscle activation in healthy adults.

[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.

Effect of head lift exercise on kinematic motion of the hyolaryngeal complex and aspiration in patients with dysphagic stroke.

The head lift exercise (HLE) is a head-raising workout performed in a supine position. This exercise facilitates activation of the submental muscles located above the hyoid bone in front of the neck. HLE is a potential method to improve the movement of the hyolaryngeal movement and swallowing functions. The purpose of this study was to investigate the effect of HLE on the hyolaryngeal movement and aspiration in patients with dysphagic stroke. A total of 27 patients with stroke were randomly assigned either into the experimental (n = 13) or the control group (n = 14). The experimental group performed HLE 5 days a week for 4 weeks (a total of 20 sessions). Both groups received the same conventional dysphagia therapy. Two-dimensional analysis of the hyolaryngeal movement was carried out using Image J program based on a videofluoroscopic swallowing study. Penetration-aspiration was assessed using Penetration-Aspiration Scale (PAS). The experimental group showed a significant increase in the only superior movements of the hyoid bone compared with the control group (P = 0·033). Aspiration in liquid also exhibited a significant decrease in the experimental group compared with the control group (P = 0·044). Findings from this study confirmed that HLE is an effective intervention to improve hyoid movement and decrease aspiration.

Head Lift Exercise Improves Swallowing Dysfunction in Spinal and Bulbar Muscular Atrophy

Background: Dysphagia due to bulbar involvement is a major symptom of patients with spinal and bulbar muscular atrophy (SBMA). The aim of this pilot study was to test the efficacy and safety of the head lift exercise for swallowing dysfunction in SBMA. Methods: We enrolled 6 subjects with genetically confirmed SBMA and instructed them to perform the head lift exercise for 6 weeks. The efficacy outcome measures were the changes from baseline in tongue pressure, the scores of swallowing functional questionnaires, and the motor functional scales and parameters of videofluorography (VF). Results: All subjects completed the study and no major adverse effects were recorded. Tongue pressure significantly increased by 19.2 ± 0.15% (p < 0.05) after the 6-week head lift exercise. The scores for oral dysphagia also improved, although there was no significant change in VF parameters or other variables examined pre- and post-exercise. Conclusion: Our findings suggested that the head lift exercise may improve swallowing dysfunction, particularly tongue pressure, in SBMA.

The Recline Exercise: Comparisons with the Head Lift Exercise in Healthy Adults.

The aim of this investigation was to examine the comparative effectiveness of the new Recline Exercise (RE) and the traditional Head Lift Exercise (Shaker Exercise) on submental muscle activity, tongue strength, and perceived exertion in 40 healthy young adults (mean age=24.5years, SD 2.6years). Both groups participated in a 6-week exercise regimen. Outcome variables evaluated pre- and post-exercise included: duration and peak amplitude of submental muscle activity during swallowing measured via surface electromyography (sEMG); anterior and posterior isometric lingual pressures measured with the Iowa Oral Performance Instrument; and perceived exertion levels measured with the Borg category-ratio scale of perceived exertion. Results indicated no significant pre-post differences within or between groups in swallow duration and peak amplitude. In addition, the RE group demonstrated significant post-treatment increases in anterior and posterior tongue strength [p=0.009; p<0.001]; however, these increases were of small magnitude (d=0.132; d=0.319). Both groups showed marked improvements in perceived exertion levels [p<0.001]. Our findings indicate that healthy young adults who perform the RE or the HLE do not have significant swallow duration or amplitude gains, most likely due to the reduced need for such gains in the healthy head/neck musculature for submaximal tasks. Furthermore, the significant lingual strength gains seen with the RE indicate that additional musculature is being engaged during its completion. These results are encouraging; however, future research in older adults and patients with dysphagia with examination of swallowing biomechanics is needed to determine its full potential as a rehabilitative regimen.

Measurement of Hyolaryngeal Muscle Activation Using Surface Electromyography for Comparison of Two Rehabilitative Dysphagia Exercises

ObjectiveTo investigate the effects of a resistance-based chin-to-chest (CtC) exercise on measures of hyolaryngeal muscle activation compared with a head-lift exercise. DesignWithin-subject, repeated-measures design. SettingAcademic research laboratory. ParticipantsHealthy young women (N=20) without a history of dysphagia, cervical spine conditions, neurologic disease, or head/neck cancer (mean age, 22.5y). InterventionsAll participants performed an isometric jaw-opening exercise against resistance (CtC) and an isometric head-lift exercise, both targeting activation in the hyolaryngeal (suprahyoid) muscles. The CtC exercise required jaw opening into a chin brace secured against the upper torso for a duration of 10 seconds. The isometric head-lift exercise required lifting and holding the head from a supine position for 10 seconds. The degree to which each exercise activated the suprahyoid muscles was measured using surface electromyography (sEMG). Main Outcome MeasuresMicrovolts as measured from sEMG sensors placed on the skin surface above the hyolaryngeal muscles (surface of skin above geniohyoid, mylohyoid, and anterior digastric). Dependent variables included the peak microvolts during 10 seconds of sustained contraction and the difference in microvolts from rest to peak contraction for each exercise. ResultsActivation in the hyolaryngeal musculature as measured via sEMG was significantly greater when participants performed the CtC exercise compared with the head-lift exercise. Measures of peak microvolts during contraction were significantly greater for CtC (t=10.72, P<.001) compared with the head-lift exercise, and difference measures in microvolts calculated between rest and contraction for each exercise revealed a 2-fold increase in hyolaryngeal muscular activation for CtC (t=8.27, P<.001). ConclusionsThe isometric CtC exercise resulted in greater activation of the hyolaryngeal muscles compared with an isometric head-lift exercise. Results support the need for further investigations to determine whether the CtC exercise has a positive effect as a rehabilitative exercise for clinical populations with dysphagia secondary to upper esophageal sphincter dysfunction where hyolaryngeal excursion is a physiological impairment.

Effects of the head lift exercise on the swallow function: a systematic review

Ageing is associated with modifications in upper oesophageal sphincter function that may be deleterious to deglutition. The head lift exercise (Shaker exercise) is a head-raising work out aiming to improve the opening of this segment, and ultimately to reduce aspiration. We aimed to review critically the evidence on the effects of this structured intervention programme and to identify gaps to be filled by future research. We identified published reports addressing the effect of this exercise in increasing the anteroposterior diameter and cross-sectional area of the deglutitive upper oesophageal sphincter opening or dysphagic symptoms. Nine methodologically heterogeneous studies were included in the review, and the reported effects of the head lift exercise were an increase in the anterior excursion of the larynx and in the anteroposterior diameter of the upper oesophageal sphincter opening, and the elimination of dysphagic symptoms. Further studies including control groups and accounting for potential confounders are needed for a sound assessment of the effectiveness of this technique. The data on the functional results are, however, promising for dysphagia interventions.

Comparison of surface electromyographic (sEMG) activity of submental muscles between the head lift and tongue press exercises as a therapeutic exercise for pharyngeal dysphagia

The present study compared surface electromyographic (sEMG) activity obtained from the submental muscle group for a tongue press and a head lift exercise as potential therapeutic exercises for dysphagic elderly. Fifty-three healthy volunteers with a mean age of 35.3 participated in this study. Subjects were required to perform an isometric task, pressing their tongue against the hard palate, and an isotonic task requiring sustained lingual force against the hard palate. Pressure sensors were used to measure the amount of lingual pressure against the hard palate. Submental sEMG data from these tasks were compared with those obtained from the isometric and isotonic aspects of a head lift exercise. No sEMG differences were identified between the isometric tongue press task and head lift exercise. Isotonic tongue press exercises resulted in significantly higher maximum and mean sEMG values compared with the isotonic head lift exercise (p < 0.05). The submental sEMG activity from the tongue press exercise was equal (isometric) to, or greater (isotonic) than comparable muscle activation obtained during the head lift exercise. The tongue press exercise may be less strenuous than the head lift exercise while achieving the same therapeutic effect.

Electrophysiologic validation of deglutitive ues opening head lift exercise

Electrophysiologic validation of deglutitive ues opening head lift exercise