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For years, dysphagia therapies have been focused on helping patients to learn to swallow safely while rarely helping these patients to actually strengthen and improve their swallowing techniques. For instance, compensatory maneuvers, such as tilting the head or body positioning when swallowing are often encouraged by SLPs and other healthcare professionals.1
While these techniques may help to avoid choking complications, more recent approaches to dysphagia therapies follow a comprehensive plan of care that, as indicated by these study results, may actually help to improve swallowing function. Specific exercises involving the tongue, lips, jaw, and the swallowing process itself, have proven to be beneficial in enhancing swallowing function and quality of life for dysphagia patients.2
The following is a synopsis and sampling of study findings, including research involving neurological (post-stroke), tissue (cancer) and trauma related causes of dysphagia, relative to applied exercise therapies.
1. Exercise Therapy for Post-Stroke Patients
The detrimental effects of dysphagia on stroke patients are a typical and well-documented occurrence. Recent research indicates that the severity of these swallowing disorders may be limited or even reversed with exercise therapy applications.
To examine the effects of lingual exercise on swallowing recovery post-stroke, patients between the ages of 51 to 90 in a dysphagia clinic and tertiary care center were subjected to an eight-week isometric lingual exercise program, during which they compressed an air-filled bulb between the tongue and hard palette.
For measurement purposes, isometric and swallowing lingual pressures, bolus flow parameters, diet, and a dysphagia-specific quality of life questionnaire were collected and analyzed. The study findings indicated that lingual exercise enables acute and chronic dysphagic stroke patients to increase lingual strength with associated improvements in swallowing pressures, airway protection, and lingual volume.3
2. Preoperative Swallowing Exercises For Cancer Patients
Dysphagia is commonly associated with head and neck cancer treatment. While traditional dysphagia management strategies focus on post-treatment therapy, this study evaluated the utility of pretreatment swallowing exercises in improving post-treatment swallowing quality of life (QOL).
The study included 37 patients who underwent primary radiation or combined chemoradiation treatment for newly diagnosed hypopharyngeal, laryngeal, or oropharyngeal primary tumors. Of the 37 patients, 25 underwent swallowing exercises beginning two weeks prior to the start of radiation. The M.D. Anderson Dysphagia Inventory (MDADI) was administered for an average of 14 months after treatment to assess the success of the protocol. Analysis of QOL scores related to gender, primary site, stage, and race were obtained.
The 25 patients who performed pretreatment swallowing exercises showed improvement in the overall MDADI score compared to the control population who underwent post-treatment therapy. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved quality of life.
This study suggests that the implementation of pretreatment swallowing education and exercise may improve dysphagia-specific QOL indicators in head and neck cancer patients undergoing radiation and/or chemoradiation therapy.4
3. Exercise Therapies For Dysphagia Patients With Structural Damage
Range of motion exercises for the jaw, lips, oral tongue, tongue base, upper airway closure, and laryngeal elevation are useful for patients who have structural or tissue damage. Resistance exercises that strengthen this musculature have proven effective in helping dysphagia patients improve their swallowing techniques and abilities.
To verify the effectiveness of these resistance exercises, video endoscopy can be used to view vocal fold closure associated with swallowing. Intraoral tongue array sensors provide visual biofeedback during tongue-strengthening exercises. Once the results are measured and analyzed, treatments can be modified as necessary for maximum effectiveness.5
Dysphagia Patients Benefit From Exercise Therapies
Collectively, these studies are indicative of how SLPs and other health care professionals are progressively seeking appropriate exercise methods to enhance swallowing abilities and overall quality of life for dysphagia patients. If you feel any of your dysphagia patients may benefit from exercise therapy, specific techniques may be explored based on the specific needs and goals of each patient.
- Normal and abnormal swallowing, imaging in diagnosis and therapy. Bronwyn Jones; 2002 Second Edition; Springer.
- Dysphagia therapy. (Jose Vega, M.D., Ph.D., 2009; About Stroke.)
- The effects of lingual exercise on swallowing recovery poststroke. (Robbins JA, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ., 2006; 11.002)
- Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. (Brian Daniel Kulbersh MD*, Eben L. Rosenthal MD, Benjamin M. McGrew MD, Ryan D. Duncan MD, Nancy L. McColloch CCC-SLP, William R. Carroll MD, J S. Magnuson MD, The Laryngoscope; 2009; 116; 883-886)
- Evaluation and management of oropharyngeal dysphagia. Joy E. Gaziano, MA, CCC-SLP. 2002; 400-409.