Neuromuscular Treatments for Speech and Swallowing

Abstract

Despite the proliferation of oral motor therapies, much controversy exists regarding the application and benefit of neuromuscular treatments (NMTs) such as strength training for alleviating dysarthria and/or dysphagia. Not only is limited empirical support available to validate the use of NMTs, but clinicians may also lack the foundational information needed to judge the theoretical soundness of unstudied treatment strategies. This tutorial reviews the theoretical foundations for several NMTs, including active exercises, passive exercises, and physical modalities. It highlights how these techniques have been used to address neuromuscular impairments in the limb musculature and explores potential applications to the speech and swallowing musculature. Key issues discussed in relation to active exercise are the selection of treatment targets (e.g., strength, endurance, power, range of motion), specificity of training, progression, and recovery. Factors influencing the potential effectiveness of passive exercises and physical modalities are presented, along with discussion of additional issues contributing to the controversy surrounding oral motor therapies.

Management of Dysphagia Following Traumatic Brain Injury

“…The use of oral motor exercises, such as range of movement and strength exercises as a treatment for dysphagia is controversial [91]. A systematic review of oral motor exercises and sensory motor interventions found 'insufficient evidence to draw any conclusions on the value of these interventions in dysphagia treatment' [92] and that further studies are required to determine their efficacy.…”

“…Identifying exactly why (at a neurological level) oropharyngeal movements are impaired can be difficult. For example, there is very little, if any, data on what constitutes normal tone in the swallowing musculature [91], and abnormal oropharyngeal muscle tone is difficult to identify. Additionally 'the effects of hypotonia…may be difficult to distinguish perceptually from those of weakness.'…”

“…Additionally 'the effects of hypotonia…may be difficult to distinguish perceptually from those of weakness.' [91] Thus, if the exact nature of the neuromuscular presentation is unknown, recommending specific oral motor exercises can be very difficult, if not impossible. Strengthening exercises for patients who display hypertonia or rigidity are contraindicated as it may increase tone, discomfort and further reduce the range of movement [91,101].…”

“…[91] Thus, if the exact nature of the neuromuscular presentation is unknown, recommending specific oral motor exercises can be very difficult, if not impossible. Strengthening exercises for patients who display hypertonia or rigidity are contraindicated as it may increase tone, discomfort and further reduce the range of movement [91,101]. Thus, without an accurate identification of the nature of the problem use of oral motor exercises as a form of treatment is not prudent.…”

The effectiveness of moxibustion on dysphagia after stroke; A Case Series

“…Despite the proliferation of oral motor therapies (Lin et al, 2003), much controversy exists regarding the application and benefit of neuromuscular treatments such as strength training for alleviating dysphagia (Clark. 2003).…”