Research: the CTAR exercise, the JOAR exercise, the Shaker Exercise and PhagiaFlex
These research articles discuss how these exercises improved swallow function, improved laryngeal or hyolaryngeal elvevation (HLE), and improved UES opening, which is stretching the esophagus to open more.
Below are the abstracts of some of the research on CTAR, JOAR/CTC, Shaker Exercise, and the PhagiaFlex Dysphagia Exercise Device. The first five studies used PhagiaFlex Devices (ISO CTAR Devices) in the research study.
Chin tuck against resistance exercise for dysphagia rehabilitation: A systematic review
Abstract
Background: Chin tuck against resistance (CTAR) exercise has been recently reported to be a new therapeutic exercise method that can help improve swallowing function in patients with dysphagia. However, due to the differences in exercise protocols, methods and the tools used across studies of CTAR exercise, an overall systematic review of these studies is necessary.
Objective: The present study investigated the exercise protocols, methods and tools used in various studies of CTAR exercise and summarised their findings.
Methods: We searched for studies related to CTAR exercise using electronic databases and selected nine articles for review. The articles were categorised on the basis of four criteria: study design and quality, training protocol, outcome measures and clinical effect.
Results: Four articles reported that CTAR exercise not only helped activate the suprahyoid muscle in healthy adults, but also activated the sternocleidomastoid muscle less than Shaker exercise. In addition, five articles reported that CTAR exercise was effective in improving swallowing function and oral diet stage in the pharyngeal phase, including reduction of airway aspiration in patients with dysphagia after stroke.
Conclusions: CTAR exercise more selectively activates the suprahyoid muscle and is an effective therapeutic exercise for improving swallowing function in patients with dysphagia. Because it is less strenuous than Shaker exercise, it requires less physical burden and effort, allowing greater compliance.
Efficacy of modified chin tuck against resistance exercise using hand‐free device for dysphagia in stroke survivors: A randomised controlled trial
Abstract
Background: Chin tuck against resistance exercise was recently reported as a novel method for improving the swallowing function of patients with post‐stroke dysphagia. However, as this exercise involves holding and fixing the device using the hand, physically weak patients may find it difficult to perform it. Objectives: This study aimed to investigate the effect of modified chin tuck against resistance (mCTAR) exercise on patients with post‐stroke dysphagia. Methods: In total, 30 patients with dysphagia were recruited in this study. They were randomly assigned to either the experimental or control group. The experimental group performed mCTAR exercise and received traditional dysphagia treatment, whereas the control group received only traditional dysphagia treatment. mCTAR exercise involved isometric and isotonic exercises. Aspiration and oral diet were eval‐ uated using penetration‐aspiration scale (PAS) and functional oral intake scale (FOIS), respectively. Moreover, the rate of nasogastric tube removal was analysed. Results: Compared with the control group, the experimental group showed statistically significant improvement in PAS and FOIS (P < 0.001, both). The rates of na‐ sogastric tube removal were 25% and 15% in the experimental and control groups, respectively. Conclusion: This study demonstrated that mCTAR exercise can reduce aspiration and improve dietary levels in patients with post‐stroke dysphagia. Therefore, mCTAR exercise is expected to be beneficial for physically vulnerable patients with dysphagia who have limited hand strength and range of motion.
Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: A randomized pilot study.
Abstract
BACKGROUND: Recently, chin tuck against resistance exercise (CTAR) has been reported as a remedial treatment for pharyngeal dysphagia. However, the clinical evidence of the effect is still lacking.
OBJECTIVE: This study investigated the effect of CTAR on the swallowing function in patients with dysphagia following subacute stroke.
METHODS: The patients were randomly assigned to an experimental (n = 11) or a control group (n = 11). The experimental group performed CTAR using the CTAR device. The control group received only conventional dysphagia treatment. Both groups received training on five days a week, for four weeks. The swallowing function was measured using functional dysphagia scale (FDS) and penetration-aspiration scale (PAS), based on a videofluoroscopic swallowing study (VFSS).
RESULTS: The experimental group showed more improvements in the oral cavity, laryngeal elevation/epiglottic closure, residue in valleculae, and residue in pyriform sinuses of FDS and PAS compared to the control group (p < 0.05, all).
CONCLUSIONS: This study demonstrated that CTAR is effective in improving the pharyngeal swallowing function in patients with dysphagia after stroke. Therefore, we recommend CTAR as a new remedial training alternative to HLE.
Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases
This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands. (JKDS 2018;8: 121-125)
Keywords: Dysphagia, Hand-free chin-tuck-resistance exercise, Stroke, Swallowing, Suprahyoid muscle
Effects of chin tuck against resistance exercise on post-stroke dysphagia rehabilitation: A systematic review and meta-analysis
Background: Chin tuck against resistance (CTAR) exercise was introduced to substitute for the commonly used Shaker exercise for dysphagia rehabilitation. The effects of CTAR exercise in stroke survivors needs to be validated.
Objective: To investigate the effects of Chin tuck against resistance (CTAR) exercise on the swallowing function and psychological condition in stroke survivors compared to no exercise intervention and the Shaker exercise.
Materials and methods: The Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL and four Chinese databases were searched for randomized controlled trails (RCTs) and quasi-RCTs from inception to February 2022.
Results: After screened and assessed the methodological quality of the studies, nine studies with 548 stroke survivors were included in the systematic review. 8 studies were included in the meta-analysis using RevMan 5.4 software. The mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated. The results revealed that CTAR exercise is effective in improving swallowing safety (MD, −1.43; 95% CI, −1.81 to −1.06; P < 0.0001) and oral intake ability (SMD, −1.82; 95% CI, −3.28 to −0.35; P = 0.01) compared with no exercise intervention, CTAR exercise is superior to Shaker exercise in improving swallowing safety (MD, −0.49; 95% CI, −0.83 to −0.16; P = 0.004). The psychological condition in CTAR group is significant better than the control group (MD, −5.72; 95% CI, −7.39 to −4.05; P < 0.00001) and Shaker group (MD, −2.20; 95% CI, −3.77 to −0.64; P = 0.006).
Conclusions: Our findings support CTAR exercise as a superior therapeutic exercise for post-stroke dysphagia rehabilitation than Shaker exercise. More high-qualities RCTs from larger multicenter are needed to analysis the effects of CTAR exercise in patients with different type and phase of stroke and explore the optimal training dose.
Effect of Chin Tuck against Resistance Exercise in Citizens with Oropharyngeal Dysphagia-A Randomised Controlled Study
Abstract
Oropharyngeal dysphagia (OD) impacts the safety and efficacy of the swallowing function. The aim was to uncover the effect of chin tuck against resistance (CTAR) exercises compared to standard care in relation to the swallowing function in citizens with OD. Ninety-two citizens (46% male, median age 78 years (IQR 71, 84)) with OD confirmed by the Volume-Viscosity Swallow Test and/or Minimal Eating Observation Form version II were randomised to standard care with the addition of CTAR daily for six weeks or standard care only. The participants were included from seven Danish municipalities from March 2019 to October 2020. A nonsignificant effect on dysphagia of CTAR training combined with standard care versus standard care alone was documented. Both CTAR training combined with standard care and standard care alone had a significant effect on the swallowing function in citizens with OD, with the best effect in the group receiving CTAR training combined with standard care. A significant effect compared to baseline was observed in all participants (p = 0.03) after 12 weeks. Participants in both groups had a significant reduction in problems with manipulating food in the mouth (p = 0.005), swallowing (p = 0.005), and chewing (p = 0.03) but an increased appetite (p = 0.01). The reported quality of life scored with DHI-DK was significantly improved in both groups.
Keywords: dysphagia; eating difficulties; oropharyngeal; swallowing difficulties; swallowing disorder; training.
Comparison of three different types of exercises for selective contractions of supra- and infrahyoid muscles
Abstract
Several exercise methods, such as the Shaker exercise, tongue press exercise, chin tuck against resistance (CTAR) exercise, and submandibular push exercise, have been introduced to strengthen the muscles involved in swallowing. In this study, we compared the effectiveness of the CTAR, submandibular push, and Shaker exercises for the induction of selective supra- and infrahyoid muscle contractions using surface electromyography (EMG). This study is a prospective non-randomized controlled study. Twenty-five healthy subjects and 20 patients experiencing swallowing difficulty were enrolled. During the three different types of exercises, the root mean square (RMS) values of the sternocleidomastoid (SCM), suprahyoid (anterior belly of the digastric and mylohyoid muscles), and infrahyoid (sternothyroid and thyrohyoid muscles) muscles were analyzed using surface EMG. Differences in the activity of swallowing muscles among the three different exercises were analyzed using one-way repeated measured analysis of variance. In terms of both the maximum and mean RMS values of the suprahyoid muscle, the submandibular push exercise showed a larger RMS value than the CTAR and Shaker exercises in healthy subjects (p < 0.05). In terms of both the maximum and mean RMS values of the suprahyoid muscle, the Shaker exercise and submandibular push exercise showed a larger RMS value than the CTAR exercise in patients with swallowing difficulty (p < 0.05). The submandibular push exercise may be effective as a swallowing muscle exercise owing to its superiority in inducing selective contractions of the supra- and infrahyoid muscles. The CTAR and Shaker exercises are also effective in this regard.
Effects of Craniocervical Flexion on Suprahyoid and Sternocleidomastoid Muscle Activation in Different Exercises
Abstract
This study aims to investigate the effects of craniocervical flexion (CCF) on the activation of suprahyoid and sternocleidomastoid (SCM) muscles in Shaker and Resistant Jaw Opening (RJO) exercises, and to compare the effects of these two exercises on the same muscles with the Chin Tuck Against Resistance (CTAR) exercise. The study recruited a total of 37 healthy participants (20 female and 17 male, mean age: 27.45 ± 7.32 years). All participants received craniocervical flexion training with the biofeedback pressure unit (Stabilizer™, Chattanooga Group Inc. USA). Shaker, Shaker with CCF, RJO, RJO with CCF and CTAR exercises were performed and surface electromyographic (sEMG) activations of the suprahyoid and SCM muscles were recorded. In addition, the maximum sEMG activations of suprahyoid and SCM muscles were recorded for the normalization procedure. CCF increased the effect of Shaker exercise on the suprahyoid muscle activation (p < 0.001); but this effect was not seen in RJO exercise (p > 0.05). Suprahyoid muscle activation was lower in Shaker exercise compared to RJO and CTAR exercises (p < 0.016). SCM muscle activation was greater in CTAR exercise compared to Shaker and RJO exercises (p < 0.016). The addition of CCF to the Shaker and RJOE exercises did not affect the ranking among the three exercises for both the suprahyoid and SCM muscles. The result of this study suggest that integration of CCF movement to the Shaker exercise would have a greater therapeutic effect. In addition, RJO exercise can be included in the rehabilitation program as an alternate to CTAR exercise.
Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction.
Abstract
BACKGROUND: The incidence of stroke is high in China. The dysphagia caused by cerebral infarction (CI), seriously affects patients' life quality, and even endangers patients' lives. It is necessary to explore how to improve dysphagia caused by CI.
AIM: To compare the effects of rehabilitation training on dysphagia and psychological state after CI between Shaker exercise and chin tuck against resistance (CTAR) exercise.
DESIGN: Control study. Blind.
SETTING: Inpatients.
POPULATION: A total of 90 patients with dysphagia after CI were divided into CTAR group, Shaker group and control group by random digit table (each group with 30 patients).
METHODS: Video fluoroscopic swallowing study (VFSS) and Self-Rating Depression Scale (SDS) were performed on all patients before intervention. VFSS was evaluated based on Penetration-Aspiration Scale. All patients received routine treatments including internal medicine, traditional rehabilitation training and routine nursing. The patients in control group only receive the routine treatments. Besides the routine treatments, the patients in CTAR group also received CTAR exercise, and the patients in Shaker group also received Shaker exercise. VFSS was performed again on all patients, respectively, 2, 4, and 6 weeks after exercise. SDS was performed again on all patients 6 weeks after exercise.
RESULTS: There were no statistical differences amongst the three groups in VFSS and SDS before intervention (P>0.05). After intervention, all patients had various degrees of improvement for dysphagia in the three groups, especially between 2 and 4 weeks in CTAR and Shaker groups. The total effective rate was significantly higher in CTAR group (86.67%) and Shaker group (76.67%) than in control group (43.33%) (all P<0.05). The scores of SDS was significantly lower in CTAR group than in Shaker group and control group 6 weeks after intervention (all P<0.05).
CONCLUSIONS: For the patients with dysphagia after CI, CTAR exercise can significantly relieve depression and has the similar effect on improving swallowing function as compared with Shaker group.
CLINICAL REHABILITATION IMPACT: This study suggests that in conscious patients CTAR exercises have greater impact on CI-related depression than Shaker exercises.
Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography--Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise.
Abstract
In this study, the efficacy of two dysphagia interventions, the Chin Tuck against Resistance (CTAR) and Shaker exercises, were evaluated based on two principles in exercise science-muscle-specificity and training intensity. Both exercises were developed to strengthen the suprahyoid muscles, whose contractions facilitate the opening of the upper esophageal sphincter, thereby improving bolus transfer. Thirty-nine healthy adults performed two trials of both exercises in counter-balanced order. Surface electromyography (sEMG) recordings were simultaneously collected from suprahyoid muscle group and sternocleidomastoid muscle during the exercises. Converging results using sEMG amplitude analyses suggested that the CTAR was more specific in targeting the suprahyoid muscles than the Shaker exercise. Fatigue analyses on sEMG signals further indicated that the suprahyoid muscle group were equally or significantly fatigued (depending on metric), when participants carried out CTAR compared to the Shaker exercise. Importantly, unlike during Shaker exercise, the sternocleidomastoid muscles were significantly less activated and fatigued during CTAR. Lowering the chin against resistance is therefore sufficiently specific and intense to fatigue the suprahyoid muscles.
KEYWORDS:
Deglutition disorders; Esophageal sphincter, upper; Muscle fatigue; Sternocleidomastoid muscle; Submental muscles; Swallowing intervention
Effects of Strengthening Exercises on Swallowing Musculature and Function in Senior Healthy Subjects: a Prospective Effectiveness and Feasibility Study.
Abstract
Head and neck cancer (HNC) patients may develop dysphagia due to muscle atrophy and fibrosis following chemoradiotherapy. Strengthening of the swallowing muscles through therapeutic exercise is potentially effective for improving swallowing function. We hypothesize that a customized Swallow Exercise Aid (SEA), developed for isometric and isokinetic strengthening exercises (against resistance), can help to functionally strengthen the suprahyoid musculature, which in turn can improve swallowing function. An effectiveness/feasibility study was carried out with ten senior healthy volunteers, who performed exercises 3 times per day for 6 weeks. Exercises included chin tuck against resistance (CTAR), jaw opening against resistance (JOAR), and effortful swallow exercises with the SEA. Multidimensional assessment consisted of measurements of maximum chin tuck and jaw opening strength, maximum tongue strength/endurance, suprahyoid muscle volume, hyoid bone displacement, swallowing transport times, occurrence of laryngeal penetration/aspiration and/or contrast residue, maximum mouth opening, feasibility/compliance (questionnaires), and subjective swallowing complaints (SWAL-QOL). After 6-weeks exercise, mean chin tuck strength, jaw opening strength, anterior tongue strength, suprahyoid muscle volume, and maximum mouth opening significantly increased (p < .05). Feasibility and compliance (median 86 %, range 48-100 %) of the SEA exercises were good. This prospective effectiveness/feasibility study on the effects of CTAR/JOAR isometric and isokinetic strengthening exercises on swallowing musculature and function shows that senior healthy subjects are able to significantly increase swallowing muscle strength and volume after a 6-week training period. These positive results warrant further investigation of effectiveness and feasibility of these SEA exercises in HNC patients with dysphagia.
Treatment and evaluation of dysphagia rehabilitation especially on suprahyoid muscles as jaw-opening muscles☆
Summary
In our aging society, the number of patients with dysphagia, which is associated with disease and aging, is rapidly increasing. The swallowing reflex is a complex process that involves coordinated contractions of swallowing muscles. Many researchers have reported that age-related changes, such as frailty and sarcopenia, affect swallowing muscles and contribute to the decline in the swallowing function. Thus, simple, non-invasive evaluation methods and exercises for swallowing muscles in elderly patients with dysphagia are important.
Anterior–superior hyolaryngeal elevation during swallowing results from contractions of the suprahyoid muscle, which plays a primary role in opening the upper esophageal sphincter, along with relaxation of the cricopharyngeal muscle and laryngeal closure. Thus, many researchers have studied methods for evaluating and augmenting suprahyoid muscles. On the other hand, some researchers have reported on dysphagia rehabilitation focused on jaw-opening actions, because hyolaryngeal elevation muscles correspond with jaw-opening muscles. In this study, we describe a new dysphagia evaluation method and an exercise that focuses on suprahyoid muscles with application of jaw-opening actions.
Abbreviations: SH, suprahyoid; sEMG, surface electromyography; 320-ADCT, 320-row area detector computed tomography; JOF, jaw-opening force; JOE, jaw-opening exercise; JOFT, jaw-opening force test; JOR, jaw-opening against resistance
Keywords: Dysphagia, Suprahyoid muscle, Swallowing, Hyoid, Jaw-opening, Aging
Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise.
Abstract
For patients with dysphagia resulting from upper esophageal sphincter dysfunction, strengthening the suprahyoid muscles through therapeutic exercise has proved effective in restoring oral feeding. The aim of this study was to compare the maximum and mean surface electromyography (sEMG) activity of the suprahyoid muscles during the Chin Tuck Against Resistance (CTAR) exercise and the Shaker exercise for both isokinetic and isometric tasks. During the CTAR exercises, the participant is seated while tucking the chin to compress an inflatable rubber ball, whereas during the Shaker exercise, the participant is lay supine while lifting the head to look at the feet. Forty healthy participants (20 males, 20 females) aged 21-39 years completed all four tasks in counterbalanced order, with measures of resting activation taken prior to each exercise. Although subjective feedback suggested that the sitting position for CTAR is less strenuous than the supine position for Shaker, the results of separate analyses showed significantly greater maximum sEMG values during the CTAR isokinetic and isometric exercises than during the equivalent Shaker exercises, and significantly greater mean sEMG values were observed for the CTAR isometric exercise than for the Shaker isometric exercise. Clinical trials are now needed, but the CTAR exercises appear effective in exercising the suprahyoid muscles, and they could achieve therapeutic effects comparable to those of Shaker exercises, with the potential for greater compliance by patients.
Effects of 2 Resistive Exercises on Electrophysiological Measures of Submandibular Muscle Activity.
Abstract
OBJECTIVE: To compare the electrophysiological activity in submandibular hyolaryngeal muscles during performance of 2 exercises that incorporate resistance against muscular contraction.
DESIGN: Within-subject repeated-measures design.
SETTING: Academic research laboratory.
PARTICIPANTS: Healthy, young adult women (N=26; mean age, 24.1y) without a history of dysphagia, cervical spine conditions, neurologic disease, or head/neck cancer.
INTERVENTIONS: Participants performed 2 isometric exercises requiring contraction against resistance to the submandibular hyolaryngeal muscles: one requiring jaw opening against a semirigid brace (chin-to-chest [CtC] exercise) and one requiring a chin tuck against an air-inflated rubber ball (chin tuck against resistance [CTAR] exercise). Measures of electrophysiology using surface electromyography (sEMG) were obtained during exercise performance.
MAIN OUTCOME MEASURES: Microvolts as measured from sEMG electrode sensors placed on the skin surface above the hyolaryngeal muscles (surface of skin above geniohyoid, mylohyoid, and anterior digastric). Dependent variables included peak contraction amplitude (in μV) and mean contraction amplitude (in μV) across 10 seconds of sustained contraction.
RESULTS: Significant effects of exercise on peak and mean contraction amplitudes were present when both exercises were compared with baseline sEMG activity. (P<.001 for both). Normalized values of peak contraction amplitude and mean contraction amplitude during performance of CtC were not significantly different compared with CTAR.
CONCLUSIONS: This study provides supporting evidence for the influence of 2 published exercises on motor unit recruitment in the submandibular hyolaryngeal muscles, both of which have been previously proposed as rehabilitative modalities. Theoretical and clinical implications are discussed.
Measurement of hyolaryngeal muscle activation using surface electromyography for comparison of two rehabilitative dysphagia exercises.
Abstract
OBJECTIVE: To investigate the effects of a resistance-based chin-to-chest (CtC) exercise on measures of hyolaryngeal muscle activation compared with a head-lift exercise.
DESIGN: Within-subject, repeated-measures design.
SETTING: Academic research laboratory.
PARTICIPANTS: Healthy young women (N=20) without a history of dysphagia, cervical spine conditions, neurologic disease, or head/neck cancer (mean age, 22.5y).
INTERVENTIONS: All participants performed an isometric jaw-opening exercise against resistance (CtC) and an isometric head-lift exercise, both targeting activation in the hyolaryngeal (suprahyoid) muscles. The CtC exercise required jaw opening into a chin brace secured againstthe upper torso for a duration of 10 seconds. The isometric head-lift exercise required lifting and holding the head from a supine position for 10 seconds. The degree to which each exercise activated the suprahyoid muscles was measured using surface electromyography (sEMG).
MAIN OUTCOME MEASURES: Microvolts as measured from sEMG sensors placed on the skin surface above the hyolaryngeal muscles (surface of skin above geniohyoid, mylohyoid, and anterior digastric). Dependent variables included the peak microvolts during 10 seconds of sustained contraction and the difference in microvolts from rest to peak contraction for each exercise.
RESULTS: Activation in the hyolaryngeal musculature as measured via sEMG was significantly greater when participants performed the CtC exercise compared with the head-lift exercise. Measures of peak microvolts during contraction were significantly greater for CtC (t=10.72, P<.001) compared with the head-lift exercise, and difference measures in microvolts calculated between rest and contraction for each exercise revealed a 2-fold increase in hyolaryngeal muscular activation for CtC (t=8.27, P<.001).
CONCLUSIONS: The isometric CtC exercise resulted in greater activation of the hyolaryngeal muscles compared with an isometric head-lift exercise. Results support the need for further investigations to determine whether the CtC exercise has a positive effect as a rehabilitative exercise for clinical populations with dysphagia secondary to upper esophageal sphincter dysfunction where hyolaryngeal excursion is a physiological impairment.
Jaw-opening exercise for insufficient opening of upper esophageal sphincter
Objective: To investigate the effects of the jaw-opening exercise on decreased upper esophageal sphincter (UES) opening while swallowing.
Design: Intervention study: before-after trial with 4-week follow-up evaluation.
Setting: A university school of dentistry dental hospital.
Participants: Patients with dysphagia (N=8; 7 men, 1 woman; average age ± SD, 70.5±11.3y; age range, 54-86y).
Interventions: All patients performed a jaw-opening exercise to strengthen the suprahyoid muscles. The exercise involved opening the jaw to its maximum and maintaining this position for 10 seconds. Each exercise set consisted of 5 repetitions, and 2 sets were carried out daily for 4 weeks. The effectiveness of the exercise was evaluated by a videofluorographic swallowing study (VFSS).
Main outcome measures: Hyoid elevation, UES opening, pharynx passage time, and pharyngeal residue after swallowing at preexercise and postexercise were compared by VFSS.
Results: Compared with before starting the exercise, significant improvements were observed in the extent of upward movement of the hyoid bone (P<.05), the amount of UES opening (P<.05), and the time for pharynx passage (P<.05) 4 weeks after initiating the exercise. Pharyngeal residue decreased in some subjects, and no increases were noted in any subjects.
Conclusions: The jaw-opening exercise is an effective treatment for dysphagia caused by dysfunction of hyoid elevation and UES opening.
Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening
Abstract
Background & aims: We evaluated the effect of a novel rehabilitative exercise on restoration of deglutition in a group of patients with deglutitive failure caused by abnormal upper esophageal sphincter (UES) opening manifested by postswallow residue and aspiration necessitating percutaneous tube feeding.
Methods: We studied a total of 27 patients by videofluoroscopy and functional assessment of swallowing scores before and after 6 weeks of a head-raising exercise program. Seven of 27 patients, assigned randomly, participated in a sham exercise before entering the tested exercise program. Eleven of 27 were randomized to the real exercise program.
Results: Although there was no change in swallow function and biomechanics after the sham exercise, following 6 weeks of real exercise, all 11 patients exhibited a significant improvement in their UES opening, anterior laryngeal excursion (P < 0.01), as well as resolution of postdeglutitive aspiration and were able to resume oral feeding. Similar results were found when the 7 patients in the sham group were crossed over to the real exercise group. Comparison of before and after exercise values for anteroposterior UES opening (P < 0.01) and laryngeal anterior excursion (P < 0.05), as well as functional outcome assessment of swallowing (P < 0.05) in the entire group of 27 patients also showed significant improvement. Etiology and duration of dysphagia did not affect the outcome.
Conclusions: The proposed suprahyoid muscle strengthening exercise program is effective in restoring oral feeding in some patients with deglutitive failure because of abnormal UES opening.