Swallow Exercise Research Articles

The Effectiveness of a Combination of Swallowing Exercises with Benson Relaxation and Aromatherapy on the Swallowing Ability of Stroke Patients

Stroke patients with dysphagia require proper initial screening so as not to cause severe complications. More optimal efforts are needed to improve swallowing ability to avoid complications. Swallowing exercises combined with Benson Relaxation and Aromatherapy are expected to provide better results in increasing the swallowing ability score of stroke patients with dysphagia. This study aims to determine the effect of the combination of Swallowing Exercise with Benson Relaxation and Aromatherapy on the swallowing ability of stroke patients. This type of research is a quasi-experimental pre and post-test. Researchers intervened in two groups of respondents. One group intervened with a combination of swallowing exercises with Benson relaxation, and one group combined swallowing exercises with aromatherapy. The sampling technique was consecutive sampling. The number of samples was 44 people: 20 people in Intervention Group I and 25 in Intervention Group II. Statistical analysis used a dependent t-test (paired t-test) to test the difference in the average score of swallowing ability before and after the intervention and an independent t-test to test the difference in the average score after the intervention in intervention groups I and II. This research showed a significant difference in the average score of swallowing ability before and after the intervention in the intervention group I and II, and there is no difference in the average score of swallowing ability after the intervention in the intervention group I and II. Swallowing exercise combined with Benson relaxation and aromatherapy can improve the swallowing ability score of dysphagia patients due to stroke.

Early interceptive treatment of a skeletal open bite using a vertical holding appliance in combination with myofunctional therapy, and a smile-clenching-swallow exercise: a case report with a 3-year follow-up

Abstract This case report aimed to describe the effectiveness of myofunctional therapy involving a vertical holding appliance and a smile–clenching–swallow exercise for vertical control, in a growing patient who presented with a high-angle facial pattern. A 10-year-old girl sought treatment for a skeletal open bite. Early interception aimed to reduce the divergent skeletal growth pattern. The patient was asked to perform a smile–clenching–swallow exercise by pushing the tongue dorsum against a palatal resin pad on a transpalatal arch. The action exerted an upward force on the maxillary first molars, which reinforced the effects of myofunctional therapy. This interaction between the tongue and resin pad resulted in positive feedback, and a constant intrusive force delivered to the molars and balanced co-operation from the orofacial musculature. The initial vertical skeletal discrepancy was successfully resolved within 3 months. The subsequent fixed appliance treatment was straightforward. After 3 years of follow-up, the treatment outcome was stable.

Rehabilitation Interventions in Head and Neck Cancer: A Review

<h3>Objective(s)</h3> To investigate the evidence and quality of rehabilitation interventions on functional outcomes in head and neck cancer (HNC). <h3>Data Sources</h3> PubMed, EMBASE, and CINAHL electronic databases were searched for "head and neck neoplasms" and "rehabilitation" limited to English language and human studies from 5/1/2017 - 7/22/2020. Additional interventional studies from 1/1/1990 - 4/30/2017 were sourced from our previously published scoping review (Parke et al. 2019). <h3>Study Selection</h3> Included studies were interventional trials with majority HNC population and rehabilitation-specific interventions and outcomes. Exclusion criteria included surgical, dental, economic, or smoking interventions. Studies were screened for inclusion by two independent authors. Sixty-nine of 1176 studies retrieved met inclusion criteria. <h3>Data Extraction</h3> Pairs of authors independently extracted data and evaluated study quality with the PEDro tool. <h3>Data Synthesis</h3> Studies were organized by intervention category, population, setting, timing, and study quality. The largest intervention categories included jaw exercise (13 studies), swallow exercise (11), and whole body exercise (13). Most interventions occurred in the outpatient setting for oropharyngeal cancer. Timing was predominantly post-treatment in the restorative Dietz category (51). Median study sample size was 50 (range 15 to 399). Median study quality was 5 with no studies of excellent quality. Major limitations included lack of therapist blinding (97%), lack of concealed allocation (64%), lack of intention to treat analysis (59%), and high participant drop out (58%). <h3>Conclusions</h3> Most interventional trials in HNC rehabilitation are focused on restorative exercise for the jaw, swallow, or the whole body. Most studies have substantial methodological weaknesses. Higher quality interventional studies in HNC rehabilitation are needed. <h3>Author(s) Disclosures</h3> None.

Adherence to Swallow Exercises during (Chemo)Radiotherapy for Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> Patients undergoing curative (chemo)radiotherapy ((C)RT) for head and neck cancer (HNC) who experience or are at risk of developing dysphagia are often provided with pre-treatment swallow exercises (SE), in line with consensus opinion for best practice. Evidence of SE efficacy is limited, with adherence cited as a confounding factor. We evaluated SE adherence in our patient group with the aim of proposing opportunities for improvement. <h3>Materials/Methods</h3> A 16 item questionnaire was developed with input from patients, speech and language therapists (SLTs) and oncologists, including quantitative and qualitative questions covering demographics, patient reported swallow function, understanding of and confidence with SE, frequency of completion, and resources that could improve adherence. The questionnaire was offered in paper or electronic format (Civica Software) to patients who completed (C)RT over a 3-month period. All patients had received swallow exercises as per our standard protocol with advice to complete them 7-10 times per day, supported by a written leaflet and regular SLT review during treatment. <h3>Results</h3> Of 39 patients who completed (C)RT, 90% (n=35) completed the questionnaire; 51% (n=18) treated with primary (C)RT and 46% (n=16) post-operative (C)RT. Swallowing difficulties were reported by 31% (n=11) pre-(C) RT, rising to 71% (n=25) at end of treatment. Almost all (94%, n=33) stated they understood the rationale for SE. Frequency of completion was variable (Table 1). Treatment toxicities were reported as barriers to adherence by 51% (n=18). Over a third of patients (37%, n=13) felt only somewhat, slightly or not at all confident they were completing SE correctly. Regarding resources that would improve adherence, a leaflet with written instructions and pictures or diagrams was selected most frequently (46%, n=16), a website/app with videos was also popular (29%, n=10). 80% (n=28) planned to continue SE after treatment. 83% (n=29) rated their overall experience of SE and advice as either good or very good. <h3>Conclusion</h3> A questionnaire offers a simple way to obtain a snapshot view of current experience, and our high response rate suggests results are reliable. Our findings suggest that our current recommendation of SE completion 7-10 times per day is not achievable for most patients; a change in recommendation to 3-5 times per day is supported by recent evidence and encourages self-efficacy. At least a third of patients lacked confidence in completing SE, and we are focusing on this by developing new pictorial, online and video resources. Our survey indicated high overall satisfaction with our current service despite variable adherence. Future work will evaluate the impact of service improvements on patient outcomes.

Changes in Cardiac Function During a Swallow Exercise Program in Patients with Coronary Artery Disease.

Research regarding risks of swallow treatment suggests that patients with coronary artery disease (CAD) experience changes in heart rate/rhythm when completing the supraglottic swallow and super-supraglottic swallow. The current study evaluated cardiac function during multiple swallowing exercises in patients with dysphagia and CAD. Eligible patients had CAD and confirmed pharyngeal dysphagia from VFS and sufficient cognitive ability to follow direction. The protocol included an a priori concealed randomized order of seven swallowing exercises (supraglottic swallow, super-supraglottic swallow, Mendelsohn and Masako maneuvers, effortful swallow with and without breath hold, and jaw opening exercise). Objective measures of heart rate/rhythm, oxygen saturation, and blood pressure were compared before vs after the overall session and each exercise using the Wilcoxon signed-rank test, and McNemar's and Cochran's Q tests with alpha at 0.05 and power at 0.80. Participants were 20 adults (15 male), aged 28-88 (median 76.5years). 90% were intubated during their hospital stay (44% > 1 intubation) and 20% suffered post-op stroke. Severe dysphagia, marked by NPO status, occurred in 30% of patients. Sessions were 26min long (mean; SD = 2.29). With few exceptions, objective measures were stable pre vs post overall and after each exercise. Potential vulnerability was noted with increased heart rate after the super-supraglottic swallow and increased arrhythmias after the effortful swallow (p < 0.05 for both). The order that swallowing exercises were completed did not significantly impact cardiovascular function. Telemetry and pulse oximetry proved to be feasible tools to monitor for subtle changes in cardiovascular function during completion of swallowing exercises.

Chin tuck against resistance exercise with feedback to improve swallowing, eating and drinking in frail older people admitted to hospital with pneumonia: protocol for a feasibility randomised controlled study

BackgroundSwallowing difficulties (dysphagia) and community-acquired pneumonia are common in frail older people and maybe addressed through targeted training of the anterior neck musculature that affects the swallow. We have developed a swallowing exercise rehabilitation intervention (CTAR-SwiFt) by adapting a previously established swallowing exercise to ensure patient safety and ease of execution in the frail elderly population. The CTAR-SwiFt intervention consists of a feedback-enabled exercise ball that can be squeezed under the chin, with real-time feedback provided via a mobile application. The aim of this study is to evaluate the feasibility of assessing the effectiveness of the CTAR-SwiFt intervention in reducing dysphagia and community-acquired pneumonia, prior to a larger-scale multi-centre randomised controlled trial.MethodsWe will recruit 60 medically stable patients over the age of 75 years who have been admitted with a diagnosis of pneumonia to the acute frailty wards at two participating hospitals in the UK. Study participants will be randomised into one of three groups: standard care, low intensity (once daily) CTAR-SwiFt exercise or high intensity (twice daily) CTAR-SwiFt exercises. The intervention period will last for 12 weeks, the final follow-up assessment will be conducted at 24 weeks. We will assess the feasibility outcomes, including rates of participant recruitment and retention, compliance with the exercise regime and adverse incidents. Additionally, we will assess the usability and acceptability of the intervention device and the performance of different clinical outcome measures (e.g. chin tuck strength, Functional Oral Intake Scale, SWAL-QOL, EQ-5D and swallow speed). A sub-sample of study participants will complete videofluoroscopic assessments of swallowing function before and after the intervention to evaluate the physiological changes (e.g. bolus flow rates, laryngeal elevation, base-of-tongue retraction).ConclusionsBy improving the ability to swallow, using our chin tuck exercise intervention, in frail older patients admitted to hospital with pneumonia, it is anticipated that patients’ oral intake will improve. It is suggested that this will further impact clinical, patient and healthcare economic outcomes, i.e. reduce the need for supplemental feeding, improve patient satisfaction with oral intake and swallowing-related quality of life, decrease the occurrence of chest infections and reduce hospital admissions and related healthcare costs.Trial registrationISRCTN, ISRCTN12813363. Registered on 20 January 2020

Possible Rehabilitation Procedures to Treat Sarcopenic Dysphagia.

Sarcopenic dysphagia requires the presence of both dysphagia and generalized sarcopenia. The causes of dysphagia, except for sarcopenia, are excluded. The treatment for sarcopenic dysphagia includes resistance training along with nutritional support; however, whether rehabilitation procedures are useful remains unclear. In this narrative review, we present possible rehabilitation procedures as a resistance training for managing sarcopenic dysphagia, including Shaker exercise, Mendelsohn maneuver, tongue-hold swallow exercise, jaw-opening exercise, swallow resistance exercise, lingual exercise, expiratory muscle strength training, neuromuscular electrical stimulation, and repetitive peripheral magnetic stimulation. We hope that some procedures mentioned in this article or new methods will be effective to treat sarcopenic dysphagia.

Bridge Swallowing Exercise for Gastroesophageal Reflux Disease Symptoms: A Pilot Study.

ABSTRACTObjectives:We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought to evaluate whether the bridge swallowing exercise could improve gastroesophageal reflux disease (GERD) symptoms and gastroscopy findings.Methods:Seventeen subjects with scores of 8 points or higher on the Frequency Scale for Symptoms of GERD (FSSG) questionnaire participated in the study. The exercise of dry swallowing in the bridge posture lasted 4 weeks and was performed ten times per day. FSSG scores were compared before and after exercise. Three of the 17 participants underwent upper gastrointestinal endoscopy. The modified Los Angeles classification of reflux esophagitis was used for objective assessment before and after exercise.Results:No participants dropped out of this study. FSSG scores improved significantly after exercise (from median [range] 16 [13–21] points before exercise to 5 [4–10] points after exercise, P <0.001). Upper gastrointestinal endoscopy showed improvement in the modified Los Angeles classification grade in one participant.Conclusions:The bridge swallowing exercise significantly improves FSSG scores. This exercise can be performed easily and safely without adverse events. Further multicenter prospective studies are needed to validate that the bridge swallowing exercise is effective in improving GERD.

Improved Swallow Outcomes with Early Intervention using Combined Swallow Therapy in Advanced Oropharyngeal Carcinoma.

AbstractObjectiveTo evaluate the impact of early intervention using combined swallow therapy, consisting of traditional swallow exercises and transcutaneous neuromuscular electrical stimulation, on patients with advanced oropharyngeal squamous cell carcinoma.MethodsA cohort study of 60 prospectively enrolled patients was performed. Thirty patients with advanced oropharyngeal squamous cell carcinoma starting combined swallow therapy two weeks after surgery that continued throughout chemoradiotherapy were compared with a matched cohort of 30 patients starting combined swallow therapy after cancer treatment completion. Gastrostomy tube status, modified barium swallow, and Functional Oral Intake Scale scores were assessed before and after therapy.ResultsBoth cohorts demonstrated a statistically significant improvement in Functional Oral Intake Scale scores. All patients in the early intervention cohort discontinued gastrostomy tube use, compared with one-third in the control cohort, with greater improvements in Functional Oral Intake Scale scores. The tongue base was the site of greatest improvement in the early intervention group.ConclusionEarly initiation of combined swallow therapy may optimise swallow outcomes in patients with advanced oropharyngeal squamous cell carcinoma.

Prospective Validation of the Use It or Lose It Paradigm: Secondary Analysis of Sub-Acute Dietary Outcomes by Eat and Exercise Status During Oropharyngeal Radiotherapy

<h3>Purpose/Objective(s)</h3> The investigators' 2013 use it or lose it study suggested functional benefit of two pharyngeal activities during head and neck radiotherapy (RT) – maintenance of oral intake (EAT) and swallowing exercise. EAT and EXERCISE independently associated with better odds of resuming a regular diet in long term survivorship and shorter duration of gastrostomy (FT) dependence. The prior work is limited by the retrospective nature of the dataset and historically far higher FT utilization. Our aim was to validate the previous work in a contemporary cohort of oropharyngeal cancer (OPC) survivors treated with RT using prospectively acquired validated outcome measures. <h3>Materials/Methods</h3> Endpoints included subacute diet after RT per the performance status scale for head and neck cancer (PSS-HN; solid food diet coded as ≥60 and no FT) and length of FT-dependence in days. Primary independent variables included oral intake (PO) at the end of RT (nothing per oral/NPO; partial PO; full PO) and swallow exercise adherence. Multiple linear regression and logistic regression models were analyzed adjusting for tumor location, baseline diet, chemotherapy and N and T stage. <h3>Results</h3> Analysis included 595 patients treated with primary radiotherapy (RT; 19% 111) /chemoradiation (CRT; 73% 434) or primary TORS + CRT (8% 50) for OPC (base of tongue/glossopharyngeal sulcus [46% 276]; tonsil [44% 263]; other [9% 56]). At the end of RT 9% of patients were NPO (55), 19% partial PO (115), 71% full PO (425). Statistically significant (<i>P</i> < 0.05) covariates for EAT and/or EXERCISE included tumor location, chemotherapy, N and T stage. Fifty-seven percent of patients (340) reported adherence to swallow exercises. Overall, 66% (394) of patients returned to a solid diet by 3-6 months. In adjusted models, EAT and EXERCISE during RT were independently, significantly (<i>P</i> < 0.01) associated with sub-acute diet recovery and FT duration. Patients who maintained full PO during RT were 2.5 times more likely to eat a solid diet by 3-6 months (OR 2.5, 95% CI: 1.3, 5) when compared to those who were NPO during treatment. Patients who exercised were 2.9 times more likely to return to a solid diet (OR 2.9, 95% CI: 1.8, 4.4) relative to those who did not. Thirty-eight percent of patients received a FT (231) and the median duration of tube dependence was 89 days (IQR: 28-142). EAT was independently associated with FT duration (<i>P</i> < 0.001, Coefficient, -123.6, 95% CI: -148.7, -98.4), while EXERCISE was not (<i>P</i> = .73). <h3>Conclusion</h3> These prospective registry data validate prior work that indicate independent benefit of EAT and swallowing EXERCISE adherence during RT on subacute functional outcomes. Patients who maintained full PO and/or exercise were more likely to eat solid foods by 3-6 months after treatment, while patients who EAT during treatment expectedly have the shortest feeding tube dependence.

Effects of Effortful Swallowing Exercise with Progressive Anterior Tongue Press Using Iowa Oral Performance Instrument (IOPI) on the Strength of Swallowing-Related Muscles in the Elderly: A Preliminary Study.

The purpose of this study was to confirm the effect of effortful swallowing (ES) exercise programs applied to increase the swallowing-related muscle strength in the elderly. In this study, 20 healthy elderly people (76.65 ± 5.87years; 10 women and 10 men) participated and exercised for 7weeks. The experimental group performed ES exercise combined with external resistance using Iowa Oral Performance Instrument (IOPI), and the control group performed pure ES without external resistance. The exercises were performed for 20min a day, 2days a week for 7weeks in both groups. ES was repeated 60 times in weeks 1 and 2, 80 times in week 3 and 4, and 120 times in weeks 5-7. In the experimental group, the isometric and swallowing tongue pressures at week 8 were significantly improved compared to baseline. At week 8, the anterior and swallowing tongue pressures and anterior tongue endurance were significantly higher than those of the control group. In the control group, no significant change in tongue pressure-related variables was observed after 7weeks of exercise. ES exercise combined with IOPI resistance for 7weeks tended to increase the suprahyoid muscle activation level without statistical significance. For clinical application of this exercise protocol, further studies including more elderly people and patients with dysphagia are required.

Effect of Tongue-Hold Swallow on Pharyngeal Contractile Properties in Healthy Individuals

Tongue-hold swallow (THS) is a swallow exercise in which an individual swallows saliva while holding the anterior portion of the tongue between the front teeth. The effect of THS on pharyngeal contractile vigor is still unclear. The purpose of this study was to quantify THS using high-resolution manometry with a contractile integral analysis. Twenty-two healthy participants performed three different saliva swallow tasks: normal swallow, weak THS (in which the tongue was protruded 1 cm outside the upper incisors), and strong THS (in which the tongue was protruded 2 cm outside the upper incisors). The participants repeated each task twice randomly. Pharyngeal and upper esophageal sphincter metrics, including the pharyngeal contractile integral, were analyzed. Both weak and strong THS enhanced the velopharyngeal contractile integral and peak pressure compared with normal swallow (P < 0.01). THS also prolonged mesopharyngeal contraction (P < 0.01). Holding the tongue anteriorly during swallow requires significant biomechanical changes to pharyngeal contractile properties at the superior and middle pharyngeal constrictor levels; thus, it may serve as a resistance exercise for the muscles that are involved in bolus propulsion.

The effects of swallowing exercise and non-nutritive sucking exercise on oral feeding readiness in preterm infants: A randomized controlled trial

IntroductionPreterm infants demonstrate problems with pharyngeal swallowing in addition to sucking problems. Oral motor intervention and nonnutritive sucking (NNS) were introduced for promoting oral feeding skills in preterm infants. NNS cannot cover all the components of oral feeding. In another hand, the swallowing exercise (SE) can accelerate the attainment of independent oral feeding in the preterm infants. The current study sought to examine if a combined program of NNS and SE compared with a program that only involves NNS would be more effective on oral feeding readiness of premature infants. Material and methodsThis randomized controlled trial was conducted in a neonatal intensive care unit (NICU). 45 preterm infants were recruited in three groups. In the group I, infants were provided with NNS twice a day. The group II received a program that involved 15 min of NNS and 15 min of SE, daily. Both interventions were provided 10 days during two consecutive weeks. The group III, control group, just received the routine NICU care. All infants were assessed by functional oral feeding outcome measures including postmenstrual age (PMA) at the start of oral feeding, PMA at full oral feeding, transition time (days from start to full oral feeding), PMA at discharge time and also the infant's dependency on tube-feeding at discharge time after interventions. Also, all infants were assessed via Preterm Oral Feeding Readiness Scale (POFRAS) before and after intervention. ResultsNo significant differences were observed in the PMA mean at start of oral-feeding (P = 0.29), full oral-feeding (P = 0.13), discharge time (P = 0.45) and the mean of transition time (P = 0.14). Compared to the control group, more infants in the group II were discharged without tube-feeding (P = 0.01). The mean of POFRAS was significantly higher in both groups I and II compared to the group III (P = 0.02 and P = 0.01, respectively). This score was, however, not statistically different between the groups I and II (P = 0.98). ConclusionsBoth studied interventions were superior to routine NICU care in enhancing the oral feeding readiness of preterm infants based on the POFRAS score. The studied combined program of NNS and SE, and not NNS program, could significantly increase the number of discharged infants without tube-feeding compared to control group.

Surface Electromyographic Biofeedback and the Effortful Swallow Exercise for Stroke-Related Dysphagia and in Healthy Ageing

Dysphagia is common after stroke, leading to adverse outcome. The Effortful Swallow (ES) is recommended to improve swallowing but it is not known if dysphagic patients can increase muscle activity during the exercise or if age affects performance. Providing surface electromyographic (sEMG) biofeedback during dysphagia therapy may enhance exercise completion, but this has not been investigated and the technique’s acceptability to patients is not known. Aims: To determine if age or post-stroke dysphagia affect the ability to increase submental muscle activity during the ES, if sEMG biofeedback improves ES performance and if sEMG is an acceptable addition to therapy. In a Phase I study submental sEMG amplitudes were measured from 15 people with dysphagia < 3 months post-stroke and 85 healthy participants aged 18–89 years during swallowing (NS) and when they performed the ES with and without sEMG biofeedback. Participant feedback was collected via questionnaire. Measurements were compared with repeated measures ANOVA and age effects were examined with linear regression. Both groups produced significantly greater muscle activity for the ES than NS (p < 0.001) and significantly increased activity with biofeedback (p < 0.001) with no effect of age. Participant feedback about sEMG was very positive; over 98% would be happy to use it regularly. The ES is a physiologically beneficial dysphagia exercise, increasing muscle activity during swallowing. sEMG biofeedback further enhances performance and is considered an acceptable technique by patients. These findings support the potential application of sEMG biofeedback and the ES in dysphagia therapy in stroke, justifying further investigation of patient outcome.

MRI Assessment of Swallow Muscle Activation with the Swallow Exercise Aid and with Conventional Exercises in Healthy Volunteers: An Explorative Biomechanical Study.

Swallowing muscle strength exercises are effective in restoring swallowing function. In order to perform the exercises with progressive load, the swallow exercise aid (SEA) was developed. Precise knowledge on which muscles are activated with swallowing exercises, especially with the SEA, is lacking. This knowledge would aid in optimizing the training program to target the relevant swallowing muscles, if necessary. Three healthy volunteers performed the three SEA exercises (chin tuck against resistance, jaw opening against resistance and effortful swallow) and three conventional exercises [conventional effortful swallow (cES), Shaker and Masako] in supine position inside an MRI scanner. Fast muscle functional MRI scans (generating quantitative T2-maps) were made immediately before and after the exercises. Median T2 values at rest and after exercise were compared to identify activated muscles. After the three SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles showed significant T2 value increase. After the Shaker, the lateral pterygoid muscles did not show such an increase, but the three other muscle groups did. The cES and Masako caused no significant increase in any of these muscle groups. During conventional (Shaker) exercises, the suprahyoid, infrahyoid, and sternocleidomastoid muscles are activated. During the SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles are activated. The findings of this explorative study further support the potential of the SEA to improve swallowing rehabilitation.

AGE-RELATED FUNCTIONAL RESERVE DECLINE IS NOT SEEN IN PHARYNGEAL SWALLOWING PRESSURES

Age-related decline in functional reserve has been described in tongue strength: tongue pressure during swallowing does not change with age, but maximal-effort isometric tongue pressure decreases with age. Healthy persons show a slight increase in pharyngeal swallowing pressure with age, but it is unknown if there is a similar decline in functional reserve. Fifty-six healthy adults (n=38 60 years) underwent pharyngeal high-resolution manometry during effortful and normal-effort thin liquid swallows. Repeated measures ANOVAs were performed on maximum pressures, pharyngeal contractile integral (PCI), pharyngeal pressure gradients, and upper esophageal sphincter minimum pressures. We hypothesized that older individuals would generate a less-robust pressure increase with effortful swallowing than younger individuals. Maximum pressures, PCI, and gradients increase during effortful swallowing (p<0.001), but there was no interaction effect with age, suggesting a lack of age-related functional reserve decline. Older individuals had greater UES minimum pressures than younger individuals in the effortful swallowing task (p=0.03), which may stem from reduced muscular compliance in this area. These findings do not align with those reported in tongue pressures, suggesting that muscle properties and pressure generation may be fundamentally different between the pharynx and the oral tongue. Alternatively, the effortful swallowing task may not elicit maximum contractility of the pharyngeal musculature. The preserved ability to increase pharyngeal pressure during effortful swallowing may support the use of the effortful swallow exercise in older adults with swallowing disorders.

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.

The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program.

Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes. Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes. At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups. Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.

Combining different treatment philosophies and techniques to reach the desired treatment goal using butterfly system: Customizing orthodontic treatment

This case report describes the orthodontic treatment of an 18-year-old male patient who presented with straight profile, tongue thrust habit, proclined upper incisors, generalized spacing in the upper and lower arches, Katz Class II premolar relation unilaterally, and Class II canine relation unilaterally with increased overjet and overbite. A butterfly system was used for the treatment combined with frictionless biomechanics in the initial stage of the treatment followed by continuous arch mechanics in the later part of the treatment. A tongued crib was used to stop the tongue thrust habit along with one elastic swallow exercise. Micro-implant anchorage was used unilaterally in the upper arch for retraction of the entire segment and correction of the unilateral Class II canine and premolar relationship. To avoid a dished-in profile, a nonextraction treatment was executed. Final correction of distally tipped canines was achieved using conventional Begg's uprighting auxiliaries in the vertical slots of the butterfly system in the finishing stage. The case was finished using bite-settling elastics. The total treatment time was 1 year and 2 months. Esthetic and functional goals were achieved satisfactorily with proper selection of biomechanics.

Swallowing Exercises: Will They Really Help Head and Neck Cancer Patients?

Purpose:The work was a comparative study, the aim of which is to evaluate the impact of swallowing exercises on swallowing problems among head and neck cancer patients (HNCPs) after CRT.Methods:The sample of 60 HNCPs was equally divided into control and study groups. The investigators met all patients 3 times (before, during and after CRT); swallowing ability was assessed using the Sydney Swallowing Questionnaire (SSQ). The University of Texas, MD Anderson Cancer Center Swallowing Exercise Protocol was explained and demonstrated by the investigators to the study group. All tools used were translated into Arabic. Data analyses were carried out using the statistical package for social sciences (SPSS), program version 20.Results:Most of the patients from both groups experienced mild dysphagia during the 1st visit. By the 3rd visit, severe dysphagia (to thin and thick liquids, and soft and hard food) was higher in the control group (73.3%) compared to the study group (26.7%). By the third visit there was statistically significant difference between both groups in swallowing thin liquids (p = 0.01), as well as thick liquids (p = 0.01). At the 1st visit, there was no significant difference regarding swallowing soft food (p = 0.24), hard food (p = 0.17), dry food (p = 0.89) and swallowing Saliva (p = 0.28). While by the 3rd visit, there was significant difference between control and study groups in all parameters.Conclusions:Adequate prevention and treatment of dysphagia, with use of swallowing programs, is essential to plan a complete therapeutic programme.