Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening

Shaker, Reza; Easterling, Caryn; Kern, Mark; Nitschke, Terilynn; Massey, Benson T.; Daniels, Stephanie K.; Grande, Barbara; Kazandjian, Marta; Dikeman, Karen

doi:10.1053/gast.2002.32999

Cited by 408 publications

(298 citation statements)

References 16 publications

Supporting

Mentioning

279

Contrasting

Unclassified

Order By: Relevance

“…The Shaker exercise is a simple isotonic/isometric head-raising exercise that has been shown to increase the anteroposterior deglutitive opening diameter and cross-sectional area of the UES [1,2]. The original design of the Shaker exercise was based on patient tolerance and reported fatigue and consisted of three isometric repetitions of 1-min sustained head raisings with 1-min rest periods.…”

Section: Discussionmentioning

confidence: 99%

Section: Exercise Protocolmentioning

confidence: 99%

“…The UES is normally in a state of tonic contraction that prevents air passage from the pharynx into the esophagus. Sphincteric relaxation and distensibility also contribute to UES opening.The Shaker exercise is a simple isotonic/isometric head-raising exercise that has been shown to increase the anteroposterior deglutitive opening diameter and cross-sectional area of the UES [1,2]. This exercise consists of three isometric repetitions of 1-min sustained head raisings with the patient in the supine position, alternating with 1-min rest periods.…”

mentioning

confidence: 99%

“…Before and after completing 6 weeks of the exercise, the subjects were instructed to perform the isometric portion of the Shaker exercise while surface EMG electrodes were placed as described above. Direction was given to each participant to perform the isometric or sustained portion of the two-part exercise [1,2].For the Shaker exercise trials, the subjects were placed flat on an examining table in a supine position and asked to raise only their head off the table, flexing the neck to look at their feet. The intent of the exercise was to have the subject look at their feet while keeping their shoulders flat on the table with the thoracic muscles relaxed.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

et al. 2008

Self Cite

View full text Add to dashboard Cite

Recent studies suggest that the Shaker exercise induces fatigue in the upper esophageal sphincter (UES) opening muscles and sternocleidomastoid (SCM), with the SCMs fatiguing earliest. The aim of this study was to measure fatigue induced by the isometric portion of the Shaker exercise by measuring the rate of change in the median frequency (MF rate) of the power spectral density (PSD) function, which is interpreted as proportional to the rate of fatigue, from surface electromyography (EMG) of suprahyoid (SHM), infrahyoid (IHM), and SCM. EMG data compared fatigue-related changes from 20-, 40-, and 60-s isometric hold durations of the Shaker exercise. We found that fatigue-related changes were manifested during the 20-s hold. The findings confirm that the SCM fatigues initially and as fast as or faster than the SHM and IHM. In addition, upon completion of the exercise protocol, the SCM had a decreased MF rate, implying improved fatigue resistance, while the SHM and IHM showed increased MF rates, implying that these muscles increased their fatiguing effort. We conclude that the Shaker exercise initially leads to increased fatigue resistance of the SCM, after which the exercise loads the less fatigue-resistant Correspondence to: Jacqueline Wertsch, wertschj@mcw.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript SHM and IHM, potentiating the therapeutic effect of the Shaker exercise regimen with continued exercise performance. KeywordsDysphagia; Electromyography; Exercise; Muscle fatigue; Power spectral density; Surface EMG; Therapeutic exercise; Shaker exercise; UES opening; Deglutition; Deglutition disordersSwallowing is a complicated process that involves many neck muscles, including the suprahyoid muscle group. During swallowing, this group of muscles, which includes the mylohyoid, geniohyoid, and digastric muscles, contracts and acts as a traction force that contributes to the anteroposterior deglutitive opening of the upper esophageal sphincter (UES), allowing food to pass into the esophagus. The UES is normally in a state of tonic contraction that prevents air passage from the pharynx into the esophagus. Sphincteric relaxation and distensibility also contribute to UES opening.The Shaker exercise is a simple isotonic/isometric head-raising exercise that has been shown to increase the anteroposterior deglutitive opening diameter and cross-sectional area of the UES [1,2]. This exercise consists of three isometric repetitions of 1-min sustained head raisings with the patient in the supine position, alternating with 1-min rest periods. Participants are instructed to raise their head high and forward enough to be able to observe their toes without raising their shoulders off the ground. The three sustained head raisings are followed by a second portion of the exercise that includes 30 consecutive, nonsustained, repetitive head raisings in the same supine position.In prior work, surface EMG (sEMG) studies have been used to evaluate specific muscle activation patterns...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Exercise Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

et al. 2008

Self Cite

View full text Add to dashboard Cite

show abstract

“…They obtained an average GUSS scoring of two. PEG was done in all the four patients along with Shaker's exercise [31,32] to improve opening of the cricopharyngeal sphincter. There were two patients with traumatic brain injury who showed global aphasia with aspiration.…”

Section: Resultsmentioning

confidence: 99%

Oropharyngeal Dysphagia: Neurogenic Etiology and Manifestation

Sebastian

Nair

Thomas

et al. 2014

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

To determine the type, severity and manifestation of dysphagia in patients with neurogenic etiology. Clinical documentation was done on the different etiologies, its manifestation, assessment findings and management strategies taken for patients with neurogenic oropharyngeal dysphagia who were referred for assessment and management of dysphagia over a period of three months in a tertiary care teaching hospital. Flexible endoscopic examination was done in all the patients. The severity of dysphagia in these patients were graded based on Gugging Swallowing Screen (GUSS). A total of 53 patients with neurogenic oropharyngeal dysphagia were evaluated by an otolaryngologist and a speech language pathologist over a period of three months. The grading of severity based on GUSS for these patients were done. There were 30 patients with recurrent laryngeal nerve injury due to various etiologies, one patient with Neurofibroma-vestibular schwanoma who underwent surgical excision, 16 patients with stroke, two patients with traumatic brain injury, two patients with Parkinsonism and two patients with myasthenia gravis. The manifestation of dysphagia was mainly in the form of prolonged masticatory time, oral transit time, and increased number of swallows required for each bolus, cricopharyngeal spasms and aspiration. Among the dysphagia patients with neurogenic etiology, dysphagia is manifested with a gradual onset and is found to have a progressive course in degenerative disorders. Morbidity and mortality may be reduced with early identification and management of neurogenic dysphagia.

show abstract

Interventions for dysphagia and nutritional support in acute and subacute stroke

Geeganage

Beavan

Ellender

et al. 2012

Cochrane Database of Systematic Reviews

204

243

View full text Add to dashboard Cite

Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening

Cited by 408 publications

References 16 publications

Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design

Oropharyngeal Dysphagia: Neurogenic Etiology and Manifestation

Interventions for dysphagia and nutritional support in acute and subacute stroke

Contact Info

Product

Resources

About