/p>v> We end with this article the publication of studies on dysphagia carried out by renowned specialists and published by in Workshop Series| Vol. 72 under the title of “The steps to living well with dysphagia”.Exercise-Based Strategies for Dysphagia Rehabilitation
Author: Catriona M. Steele
Only in the last 15 years, publications on dysphagia explored the possibility that some intervention variants for the condition could have rehabilitative potential, that is, to achieve permanent changes in the physiology of swallowing. The rehabilitation techniques for dysphagia they characteristically resort to repetition exercises, which were designed based on methods used in sports medicine.
Three techniques, in particular, show promise for increasing muscle strength and performance associated with swallowing: shaker exercisehe respiratory muscle strength training (EFMR) and the strength training for tongue pressurehe. All three techniques evoke the principles of task specificity, muscle load, endurance, and intensity, and aim to achieve functional changes in swallowing from muscle physiology resulting from weight (strength) or resistance training. Repeated practice over a period of 6 to 8 weeks appears to determine changes in swallowing physiology, just as such regimens induce changes in limb muscle strength.
For example, him shaker exercise It is a head lifting technique that is practiced in a supine position, and that seeks to specifically exercise the suprahyoid muscles. Gravity is a constant source of resistance, and the exercise is performed with both isometric (sustained) and isokinetic (short repetitions) techniques. biomechanics of the suprahyoid muscles to promote a greater opening of the EES and decrease the pressures in it. The results of a recent clinical study suggest that by practicing this exercise improvements are achieved in terms of penetration-aspiration (entry of foreign material into the airway).
He EFMR is a second strategy that is based on exercises for the rehabilitation of dysphagia, originally developed for patients with respiratory distress and voice disorders. Patients forcefully exhale through a device that provides graduated resistance to expiratory airflow.
This exercise appears to force the suprahyoid muscles to function. Improvement was detected in individuals with Parkinson’s disease in relation to penetration-aspiration, as well as hyoid bone excursion measures after 4 weeks of EFMR. Perhaps the best-studied variant of exercise training for dysphagia is resistance training for the tongue, which is based on evidence that the maximum pressure between the tongue and palate declines with normal aging.
Robbins et al. successfully demonstrated that an 8-week program of repeated resistance-training exercises for tongue pressure improves tongue strength, both in healthy older adults and in survivors of cerebrovascular events with dysphagia. As with the Shaker exercise and the EFMR, thrust-draw scores improve with tongue-press strength training.
A recent work in the area of strength training for tongue pressure explored the idea that control of the liquid bolus during swallowing requires the ability to precisely modulate the pressures between the tongue and palate, rather than an increase in force.
Yeates et al. developed a modification of the Robbins protocol, in which the target zone for practice includes different pressure targets, ranging from 20% to 90% of the patient’s maximum values. Patients with dysphagia with different evolution times showed improvement in tongue strength parameters with this technique, however, the longer weakness of the tongue requires a longer course of treatment, as illustrated by the case of an individual who required 90 sessions. of practice to reach the normative values (Figure 1).
This strategy generates swallowing results similar to those of the Robbins protocol, specifically, the improvement of the penetration-aspiration scale scores after stimulation with liquids of watery consistency. Improvements in post-swallow pharyngeal residue have not yet been consistently demonstrated.
Debris retention in the pharynx after the implementation of the three intervention strategies for dysphagia that are based on exercise (Shaker exercises, EFMR and strength training for tongue pressure) suggests that the field still does not identify therapeutic tasks with sufficient specificity to allow the expulsion process of the pharyngeal bolus.
In conclusion, exercise-based interventions require a careful design, which pays attention to the selection of targets and the specificity, load, intensity and duration of treatment. So far there is preliminary evidence that in neurogenic dysphagia it is possible to reduce penetration-aspiration thanks to interventions that are based on exercise.