Shaker Exercise Research Articles

Effects of Biofeedback Training with Shaker Exercise on the Suprahyoid muscle Activity of Stroke with Swallowing Disorder

Effects of Biofeedback Training with Shaker Exercise on the Suprahyoid muscle Activity of Stroke with Swallowing Disorder

An intensive swallowing exercise protocol for improving swallowing physiology in older adults with radiographically confirmed dysphagia.

PurposeThe aim of this study was to investigate improvements in swallowing function and physiology in a series of healthy older adults with radiographically confirmed dysphagia, following completion of an exercise-based swallowing intervention.Patients and methodsNine otherwise healthy older adults (six females, mean age =75.3, SD =5.3) had confirmed impairments in swallowing safety and/or efficiency on a modified barium swallow study. Each participant completed an 8-week swallowing treatment protocol including effortful swallows, Mendelsohn maneuvers, tongue-hold swallows, supraglottic swallows, Shaker exercises and effortful pitch glides. Treatment sessions were conducted once per week with additional daily home practice. Penetration–Aspiration Scale and the Modified Barium Swallowing Impairment Profile (MBSImP) were scored in a blind and randomized fashion to examine changes to swallowing function and physiology from baseline to post-treatment.ResultsThere were significant improvements in swallowing physiology as represented by improved oral and pharyngeal composite scores of the MBSImP. Specific components to demonstrate statistical improvement included initiation of the pharyngeal swallow, laryngeal elevation and pharyngeal residue. There was a nonsignificant reduction in median PAS scores.ConclusionSwallowing physiology can be improved using this standardized high-intensity exercise protocol in healthy adults with evidence of dysphagia. Future research is needed to examine the individual potential of each exercise in isolation and to determine ideal dose and frequency. Studies on various etiological groups are warranted.

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 Proprioceptive Neuromuscular Facilitation Neck Flexion Exercise and the Shaker Exercise on the Activities of the Suprahyoid Muscles in Chronic Stroke Patients with Dysphagia

PURPOSE: The purpose of this study is to examine the effect of proprioceptive neuromuscular facilitation (PNF) neck flexion exercise and the Shaker exercises on the activity of the suprahyoid muscles in chronic stroke patients with dysphagia and to show what exercise methods are effective for swallowing rehabilitation. METHODS: This study was conducted at F hospital in Daegu from August 2014 to February 2017 with 60 participants who understood the purpose of the study and desired to participate. The 60 participants were randomly divided into an experimental group (PNF neck flexion exercise) (n=30) and a control group (Shaker exercise) (n=30). PNF neck flexion exercise was performed in the experimental group and the Shaker exercise was performed in the control group for 30 minutes, 5 times a week for 6 weeks. The activity of the suprahyoid muscles was measured before and after treatment. RESULTS: Both the experimental group and the control group showed a statistically significant change in the activity of the suprahyoid muscles before and after the treatment. The changes were also statistically significant when compared by group. CONCLUSION: In conclusion, PNF neck flexion exercise should be used in addition to Shaker exercise when rehabilitating a patient with a swallowing disability.

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

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.

Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia.

Dysphagia after stroke can cause a variety of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. In the present study, we aimed to investigate the effects of Shaker exercise on aspiration and oral diet level in stroke survivors with dysphagia. Participants were randomly assigned to an experimental group (n = 16) or a control group (n = 16). Participants in the experimental group performed Shaker exercise and conventional dysphagia therapy, whereas those in the control group performed only conventional dysphagia therapy. All participants performed training 5 days a week for 4 weeks. Degree of aspiration was assessed using the Penetration-Aspiration Scale (PAS) based on videofluoroscopic swallowing study, while oral diet level was assessed using the Functional Oral Intake Scale (FOIS). The experimental group showed greater improvement on both the PAS (p < 0.05) and FOIS (p < 0.05) compared with the control group. The results of this study suggest that Shaker exercise is a effective exercise for recovery of swallowing function in stroke survivors with dysphagia.

Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study.

[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.

Effect of Modified Shaker Exercise on the Amplitude and Duration of Swallowing Sounds: Evidence from Cervical Auscultation.

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.

Comparison of Chin Tuck Against Resistance and Shaker Exercise on Suprahyoid and Sternocleidomastoid Muscle Activity in Stroke Older Patients with Dysphagia

저항성 고개 숙이기 운동과 shaker 운동은 목뿔위근의 강화를 사용되는 중재법이다. 이전의 연구들에서는 삼킴 장애가 있는 환자들 대상으로 두 운동을 비교하지 않았다. 본 연구는 삼킴장애를 가진 뇌졸중 노인 환자에게 저항성 고개 숙이기 운동과 shaker 운동이 목뿔위근, 목빗근에 미치는 효과를 알아보고자 하였다. 10명의 삼킴 장애가 있는 뇌졸중 노인...

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.

Shaker Exercise Rehabilitation in Head and Neck Cancer and Stroke Patients with Dysphagia - A Pilot Study

Background: Dysphagia is a common sequela post (chemo) radiotherapy ([C]RT) for head and neck cancer (HNC) and after stroke. The Shaker maneuver is a promising rehabilitative exercise for improvement of swallowing function by means of strengthening neck musculature. This pilot study primarily aimed to evaluate the feasibility of the Shaker exercise and, secondarily, to evaluate its impact on dysphagia and health-related quality of life in patients with radiation-induced or stroke-related dysphagia. Method: A prospective pilot study incorporating six patients treated with (C)RT for HNC and four patients post stroke. Compliance to the training was documented in an exercise diary. Outcome measures included videoradiography (VRG), fiberendoscopic evaluation of swallowing (FEES) and patient-reported outcomes including the European Organisation of Research and Treatment for Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and Head and Neck 35 Module (H&N35) and M.D. Anderson Dysphagia Inventory (MDADI). Patients underwent Shaker training for eight weeks. Assessment was performed pre and post training with an additional followup at three months post training for patient-reported outcomes. Results: Nine out of ten patients were able to perform the Shaker exercise. Patients reported improved scores in all domains of the MDADI and improvements in the EORTC Social eating post-training which remained or improved further at the three month follow-up. Similar results were not reflected by the objective measurements VRG and FEES, which demonstrated diverging results. Conclusion: The intensified and extended Shaker exercise program was easy to learn and possible to perform. Improvements were reflected in the patient-reported outcomes but instrumental assessment showed diverging results and missing data making conclusions difficult to draw. To assess the actual effect of the Shaker exercise on dysphagia, randomised controlled studies are needed with a larger number of patients in more homogenous groups.

Significant preservation of swallowing function in chemoradiotherapy for advanced head and neck cancer by prophylactic swallowing exercise.

Dysphagia is a serious complication of chemoradiotherapy (CRT) in patients with head and neck cancer. Approximately 20% to 30% of patients who have dysphagia require feeding tubes. The purpose of this study was to evaluate the impact of prophylactic swallowing exercises on swallowing function. Fifty-one patients with advanced oropharyngeal, hypopharyngeal, and laryngeal cancers were included in this study. Twenty-one patients performed the Shaker exercise and 30 practiced traditional Mendelsohn maneuvers (control group). Before and after treatment, videofluoroscopy and swallowing motion were analyzed to establish movement of the hyoid bone, larynx, and aspiration scores. Average movement of the hyoid bone, thyrohyoid shortening, and upper esophageal sphincter opening were significantly better maintained in the Shaker group. Aspiration score of the Shaker exercise was significantly lower than control group. Feeding tube rates for the Shaker and control groups were 14% and 40% (p < .05). Shaker exercises as a prophylactic exercise contributed to preservation of swallowing function in patients with head and neck cancer.

Effects of neck exercises on swallowing function of patients with stroke.

[Purpose] This study examined the effects of neck exercises using PNF on the swallowing function of stroke patients with dysphasia. [Subjects and Methods] A total of 26 study subjects were selected and randomly divided into an experimental group of 13 subjects, who received the PNF-based short neck flexion exercises, and a control group of 13 subjects, who received the Shaker exercise. [Results] The experimental group showed statistically significant improvements in premature bolus loss, residue in the valleculae, laryngeal elevation, epiglottic closure, residue in the pyriform sinuses, and coating of the pharyngeal wall after swallowing, and improvements in pharyngeal transit time, and aspiration on both the new VFSS scale and the ASHA NOMS scale. [Conclusion] PNF-based short neck flexion exercises appear to be effective at improving swallowing function of stroke patients with dysphagia.

Dysphagia Management in Acute and Sub-acute Stroke.

Swallowing dysfunction is common after stroke. More than 50% of the 665 thousand stroke survivors will experience dysphagia acutely of which approximately 80 thousand will experience persistent dysphagia at 6 months. The physiologic impairments that result in post-stroke dysphagia are varied. This review focuses primarily on well-established dysphagia treatments in the context of the physiologic impairments they treat. Traditional dysphagia therapies including volume and texture modifications, strategies such as chin tuck, head tilt, head turn, effortful swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver and exercises such as the Shaker exercise and Masako (tongue hold) maneuver are discussed. Other more recent treatment interventions are discussed in the context of the evidence available.

Therapeutic effect of oral rehabilitation method combined with Shaker exercise on dysphagia in patients with cerebral infarction

Objective To evaluate the effect of oral rehabilitation method combined with Shaker exercise on the swallowing function and the quality of life in the patients with dysphagia caused by cerebral infarction. Methods A total of 120 patients with swallowing disorder caused by cerebral infarction were randomly divided into conventional treatment group (n=30), oral rehabilitation method group (n=30), Shaker exercise group (n=30) and comprehensive therapy group (n=30). The patients in the conventional treatment group were treated with conventional treatment, while the patients in oral rehabilitation method group received oral rehabilitation method treatment in addition. The Shaker exercise group accepted Shaker exercise and conventional treatment, while the comprehensive therapy group accepted oral rehabilitation method in addition. All patients were assessed with video fluoroscopic swallowing study (VFSS) and swallowing-related quality of life (SWAL-QOL), before treatment and 4-week after treatment. Results Before treatment there was no significant difference among the four groups in VFSS and SWAL-QOL scores (P>0.05). After 4-week treatment the swallowing function showed different degrees of improvement. The difference of VFSS score in the conventional treatment group was not statistically significant before treatment and 4-week after treatment (P=0.38), but it was statistically significant among the other three groups(P<0.01). After 4-week treatment there was significant difference among the four groups in VFSS score (P<0.01), and the comprehensive therapy group curative effect was significantly better than that of the other groups. The total effective rate was 96.67% in the comprehensive therapy group, 26.67% in the conventional treatment group, 66.67% in the oral rehabilitation method group, and 70.00% in the Shaker exercise group. the SWAL-QOL score in the comprehensive therapy group was higher than that of the other three groups. The average SWAL-QOL score was 187.30±10.68 in the comprehensive therapy group, (140.10±16.62) in the conventional treatment group, (161.47±24.53) in the oral rehabilitation method group, and(163.97±23.91) in the Shaker exercise group. Conclusion Application of oral rehabilitation method combined with Shaker exercise in the patients with swallowing disorder caused by cerebral infarction could effectively improve the degree of swallowing disorder and the quality of life. Key words: Dysphagia; Oral rehabilitation method; Shake exercise; Quality of life; Elder

Comparison of muscle activity between two adult groups according to the number of Shaker exercise

The purpose of this study was to investigate the muscle activity of the suprahyoid and infrahyoid muscles according to the number of Shaker exercise. The 19 experimental subjects were recruited and randomly assigned to the two experimental groups. The 1st experimental group performed Shaker exercise once a day, and 2nd experimental group performed Shaker exercise three times a day for 6 weeks. Shaker exercise consists of isometric and isotonic contraction movement, enhancing the strength of suprahyoid muscle and increasing the opening of UES. After performing Shaker exercise for 6 weeks, the muscle activity of experimental groups was measured and analysed by surface electromyography. As a result, muscle activity of the suprahyoid and infrahyoid muscles showed significant improvement in both groups (P < 0·05). Comparing muscle activity of both groups, there was no significant difference. This means the Shaker exercise shows similar exercise effects on suprahyoid muscle which is the primary target muscle irrespective of the number of Shaker exercise. The activity of the infrahyoid muscle, which takes a supportive role, also showed significant difference between the two groups. In the results of a follow-up test after 4 weeks, muscle activity was higher than the initial status and the value of the EMG activity was statistically significant (P < 0·05). These results by EMG study may suggest that Shaker exercise performed once a day, like performing three times a day, has enough exercise effect and there is similar effect on the suprahyoid muscle between the 2 groups. In addition, the exercise effect lasts for 4 weeks after completing exercise.

Effect of Neck Position on Muscle Fatigue during Shaker Exercise

Objective: The aim of this study is to find the influence on muscle fatigue by changing an angle of neck while Shaker exercise. Background: Shaker exercise is commonly applied to dysphagia patients for strengthen suprahyoid muscle(SHM) and relaxing upper esophageal sphincter. Method: Experiments were conducted by measuring muscle fatigue with surface electromyography(SEMG) in case of neck 15° and 50° flexion, in addition to original method. For the study 30 undergraduate students were participated as subjects. Muscle fatigue was measured with variations of median frequency(MF) and median frequency slope(MFS) by attaching SEMG to 3 muscles. At the same time, perceived exertion was measured by using Borgs rating of perceived exertion(RPE). Results: A MF was increased when low angle in SHM, both male and female. It means that muscle fatigue was significantly decreased(p<.05). RPE was significantly increased when low angle(p<.01). Perceived exertion explained 15.2% of the variation of MF in SHM. And regression equation was, MF in SHM = 59.918 + (4,910 * RPE). Conclusion: The outcome shows that it is possible to use the efficient method which makes muscle fatigue decrease by reducing the angle of neck flexion. Application: The results might contribute to develop the effective Shaker exercise method.

섭식훈련이 연하치료를 받는 뇌졸중 환자의 삼킴기능에 미치는 영향

Purpose : This study was conducted for the purpose of finding out of effects Eating training on patients with swallowing disorder caused by stroke to their swallowing functions. Method : 29 subjects were selected and the divided into two groups. Group 1 is consist of 14 patients under eating training group and Group 2 is consist of 15 patients each group has five times per week. 30 minuted per time covering 12-week period. Selected patients can swallow them selves without aspiration and basically eating trainings involve Thermal Tactile Stimulation(TTS), Shaker exercise, tongue movements, laryngeal mobilization exercise. MASA(The Mann Assessment of Swallowing Ability)and VFSS(Videofluoroscopic Swallowing Study) was carried out to find out effects of training. And We use FDS(Functional Dysphagia Scale) for VFSS to more objective score. Result : Through the results of this study was increase in Eating performance skill actual eating training group than the practiceless group. Therefore, the actual eating training is to improve the swallowing function and It will be useful in clinical intervention for stroke patients. Conclusion : Through the results of this study was increase in Eating performance skill actual eating training group than the practice less group. Therefore, the actual eating training is to improve the swallowing function and It will be useful in clinical intervention for stroke patients.

Chin Tuck Against Resistance (CTAR): New Method for Enhancing Suprahyoid Muscle Activity Using a Shaker-type Exercise

For patients with dysphagia resulting from upper esophageal sphincter dysfunction, strengthening the suprahyoid muscles through therapeutic exercise has proved effective in restoring oral feeding. The aim of this study was to compare the maximum and mean surface electromyography (sEMG) activity of the suprahyoid muscles during the Chin Tuck Against Resistance (CTAR) exercise and the Shaker exercise for both isokinetic and isometric tasks. During the CTAR exercises, the participant is seated while tucking the chin to compress an inflatable rubber ball, whereas during the Shaker exercise, the participant is lay supine while lifting the head to look at the feet. Forty healthy participants (20 males, 20 females) aged 21-39years completed all four tasks in counterbalanced order, with measures of resting activation taken prior to each exercise. Although subjective feedback suggested that the sitting position for CTAR is less strenuous than the supine position for Shaker, the results of separate analyses showed significantly greater maximum sEMG values during the CTAR isokinetic and isometric exercises than during the equivalent Shaker exercises, and significantly greater mean sEMG values were observed for the CTAR isometric exercise than for the Shaker isometric exercise. Clinical trials are now needed, but the CTAR exercises appear effective in exercising the suprahyoid muscles, and they could achieve therapeutic effects comparable to those of Shaker exercises, with the potential for greater compliance by patients.

Neuogenic and oropharyngeal dysphagia

Oropharyngeal dysphagia (OD) is a swallowing disorder caused by congenital abnormalities and structural damage and disease‐associated damage of the oral cavity, pharynx, and upper esophageal sphincter. Patients with OD lack the protective mechanisms necessary for effective swallowing, exhibiting difficulty controlling food in the mouth and initiating a swallow, leading to choking, coughing, and nasal regurgitation. OD is a major risk factor for malnutrition, dehydration, and aspiration pneumonia. The following on OD includes commentaries on the application of simulation of oropharyngeal transient receptor potential vanilloid 1 (TRPV1) and maneuvers like the Shaker exercise to improve the safety and efficacy of swallow in OD patients; the prevalence of esophageal pathologies in OD patients and the need to evaluate the esophagus, esophagogastric junction, and stomach; and strategies for clinical screening to detect OD and aspiration among high‐risk patients and to improve oral health care, maintain nutrition and hydration, and prevent aspiration pneumonia.