Strength-Training Exercise in Dysphagia Rehabilitation: Principles, Procedures, and Directions for Future Research

Abstract

Dysphagia rehabilitation, historically, has focused a great deal on various compensations during swallowing to prevent aspiration and/or improve safety and efficiency. Exercise, in general, has been a part of the dysphagia rehabilitation landscape. However, heightened discussions in the field regarding best practices for exercise training, particularly strengthening, raise more questions than answers. The intent of this paper is to (1) explore the overriding principles of neuromuscular plasticity with regard to strength training, (2) evaluate how current exercise-training interventions in dysphagia rehabilitation correspond to these principles, and (3) postulate directions for future study of normal and disordered swallowing and determine how to incorporate these principles into dysphagia rehabilitation.

Differential effects of targeted tongue exercise and treadmill running on aging tongue muscle structure and contractile properties

“…Specific motor exercises that include the swallow and have been shown clinically to improve behavioral aspects of the swallow are the Mendelsohn Maneuver, the effortful swallow, and the Masako Maneuver (5,8,62). However, motor exercises that do not include a swallow such as progressive resistance tongue exercise with the Iowa Oral Pressure Instrument, expiratory muscle strength training, and the Shaker Head Lift have also led to improvements in strength and swallowing function (5,8,53,62,65,79). Therefore, we included aspects of learning and specificity in our study to further investigate their effects on the tongue musculature.…”

“…Current clinical treatments for oropharyngeal dysphagia have targeted the tongue with the goal of strengthening associated musculature (5,38,58,63,89). Targeted tongue exercises, such as progressive resistance tongue exercise, have been shown to increase tongue forces and have been associated with improved swallowing function (29,58).…”

Management of Dysphagia Following Traumatic Brain Injury

“…However, the principles of neural plasticity to swallowing rehabilitation may blur the line between this traditional divide. [76] Irrespective of this, supportive evidence for these management strategies is limited and has not necessarily provided recommendations on how best to prescribe and apply them [77].…”

O efeito da eletroestimulação neuromuscular na contração da musculatura supra-hióidea durante a deglutição de indivíduos com disfagia

“…After the data found in this study, the authors have questioned if the electrical stimulation of the muscle fibers type I, through application of FES current with a lower frequency, could result in greater gains in relation to the therapeutic efficiency. This questioning is due to the fact that the muscle fibers type I are more resistant to fatigue 26 and patients in this study were at the beginning of the rehabilitation process, at which usually the muscle condition is more weakness 4 .…”

“…The muscle fibers of type II are responsible for the "explosion" of muscle contraction and the strength gain, but more susceptible to fatigue 26 . After the data found in this study, the authors have questioned if the electrical stimulation of the muscle fibers type I, through application of FES current with a lower frequency, could result in greater gains in relation to the therapeutic efficiency.…”