Exercise-Based Approaches to Dysphagia Rehabilitation

Abstract

Rehabilitative techniques for dysphagia (swallowing impairment) increasingly employ exercise modeled on methods used to train muscles in sports medicine. Three techniques in particular show promise for improving muscle strength and function related to swallowing: the Shaker exercise, expiratory muscle strength training, and tongue pressure resistance training. All three techniques invoke principles of task specificity, muscular load, resistance, and intensity, and aim to achieve functional changes in swallowing through changes in muscle physiology derived from strength or endurance training. To date, studies of treatment benefit arising from these techniques involve small sample sizes; this is particularly true of randomized studies with controls receiving standard treatment or experiencing spontaneous recovery. Nevertheless, a review of the available literature shows that improvement of penetration-aspiration is a common finding for individuals with dysphagia receiving one of these three treatment approaches. Although hypothesized as an expected outcome of swallow muscle strength training, improvements in post-swallow residues are noted to be uncommon as an outcome of these exercise-based approaches. The available evidence suggests that exercise-based approaches to swallowing rehabilitation do succeed in changing muscle strength and function, but generalization to true swallowing tasks may be somewhat limited.

Effect of Dysphagia Rehabilitation Using Kinesiology Taping on Oropharyngeal Muscle Hypertrophy in Post-Stroke Patients: A Double Blind Randomized Placebo-Controlled Trial

“…Exercise-based dysphagia rehabilitation (EBDR) has been commonly used in clinical practice for the past three decades by multidisciplinary approach of specialized professionals including rehabilitation physicians, speech-language therapists, and occupational therapists [18,19]. In the past few years, many researchers have reported various methods of EBDR, such as shaker exercise (head lift exercise) [4,20], tongue strengthening exercise [12,21,22], expiratory muscle strengthening training [23,24], effortful swallowing [25,26], chin tuck against resistance exercise [27,28], forehead against resistance [29], chin-to-chest exercise [28,30], Mendelsohn [31,32], jaw opening exercise [33,34], proprioceptive neuromuscular facilitation technique [35], head extension swallowing exercise [36,37], swallowing against laryngeal restriction [38,39], and swallow exercise aid exercise [40,41] to improve swallowing function.…”

Efficacy of a novel swallowing exercise program for chronic dysphagia in long-term head and neck cancer survivors

“…29 Typically, repetitive exercises are used based on methods applied in sports medicine. [30][31][32][33] The exercises should be built on all principles (ie, specificity, individuality, and overload) that adhere to strength or endurance training. 29,30,[32][33][34][35] Swallowing is considered a submaximal muscular activity.…”

“…[30][31][32][33] The exercises should be built on all principles (ie, specificity, individuality, and overload) that adhere to strength or endurance training. 29,30,[32][33][34][35] Swallowing is considered a submaximal muscular activity. This means that the muscular strength generated to successfully complete the swallowing act is less than the so-called 1repetition maximum (1RM; ie, the maximal force that can be generated by the swallowing muscles in a single repetition).…”

Transcutaneous electrical stimulation as a resistance force in lingual exercise: A preliminary proof‐of‐concept study

“…Differences in methodology, including sample size (small vs. large), age of participants (young vs. old), participants' swallowing function (dysphagia vs. normal swallowing), outcome measures (swallow pressure vs. swallow kinematics vs. functional measures) along with the utilised strength training instrument and exercise paradigm may explain the disparity in the findings among different studies. However, it should be noted that according to the specificity principle of motor learning, the training should mirror the original motor act to make a difference in motor behaviour 35 . Therefore, embedding swallowing trials into the TES‐based exercise paradigm may facilitate the transfer effect of maximum lingual pressure to lingual pressure during swallowing.…”