An intensive swallowing exercise protocol for improving swallowing physiology in older adults with radiographically confirmed dysphagia

Matina Balou, Erica G Herzberg, David Kamelhar, Sonja M Molfenter, Matina Balou, Erica G Herzberg, David Kamelhar, Sonja M Molfenter

Abstract

Purpose: The aim of this study was to investigate improvements in swallowing function and physiology in a series of healthy older adults with radiographically confirmed dysphagia, following completion of an exercise-based swallowing intervention.

Patients and methods: Nine otherwise healthy older adults (six females, mean age =75.3, SD =5.3) had confirmed impairments in swallowing safety and/or efficiency on a modified barium swallow study. Each participant completed an 8-week swallowing treatment protocol including effortful swallows, Mendelsohn maneuvers, tongue-hold swallows, supraglottic swallows, Shaker exercises and effortful pitch glides. Treatment sessions were conducted once per week with additional daily home practice. Penetration-Aspiration Scale and the Modified Barium Swallowing Impairment Profile (MBSImP) were scored in a blind and randomized fashion to examine changes to swallowing function and physiology from baseline to post-treatment.

Results: There were significant improvements in swallowing physiology as represented by improved oral and pharyngeal composite scores of the MBSImP. Specific components to demonstrate statistical improvement included initiation of the pharyngeal swallow, laryngeal elevation and pharyngeal residue. There was a nonsignificant reduction in median PAS scores.

Conclusion: Swallowing physiology can be improved using this standardized high-intensity exercise protocol in healthy adults with evidence of dysphagia. Future research is needed to examine the individual potential of each exercise in isolation and to determine ideal dose and frequency. Studies on various etiological groups are warranted.

Keywords: deglutition; dysphagia; exercise; modified barium swallow; presbyphagia; rehabilitation.

Conflict of interest statement

Disclosure SMM receives grant funding from the NIH NIDCD R21DC015067. MB and DK receive salary from NYU School of Medicine, EH from NYU Rusk and SMM from NYU Steinhardt. The authors report no other conflicts of interest in this work.

References

    1. Madhavan A, Lagorio LA, Crary MA, Dahl WJ, Carnaby GD. Prevalence of and risk factors for dysphagia in the community Dwelling elderly: a systematic review. J Nutr Health Aging. 2016;20(8):806–815.
    1. He W, Goodkind D, Kowal P. International population reports, P95/16-1. US Census Bureau; 2016. International Population Reports: An Aging World 2015.
    1. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81(2):929–969.
    1. Ertekin C, Aydogdu I. Neurophysiology of swallowing. Clin Neurophysiol. 2003;114(12):2226–2244.
    1. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–146.
    1. White GN, O’Rourke F, Ong BS, Cordato DJ, Chan DK. Dysphagia: causes, assessment, treatment, and management. Geriatrics. 2008;63(5):15–20.
    1. Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia. 1994;9(1):7–11.
    1. Holas MA, Depippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol. 1994;51(10):1051–1053.
    1. Chen PH, Golub JS, Hapner ER, Johns MM. Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia. 2009;24(1):1–6.
    1. Altman KW, Yu G, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch Otolaryngol Head Neck Surg. 2010;136(8):784–789.
    1. Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483–1489.
    1. Nagai H, Russell JA, Jackson MA, Connor NP. Effect of aging on tongue protrusion forces in rats. Dysphagia. 2008;23(2):116–121.
    1. Ota F, Connor NP, Konopacki R. Alterations in contractile properties of tongue muscles in old rats. Ann Otol Rhinol Laryngol. 2005;114(10):799–803.
    1. Butler SG, Stuart A, Leng X, et al. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011;66A(4):452–458.
    1. Feng X, Todd T, Lintzenich CR, et al. Aging-related geniohyoid muscle atrophy is related to aspiration status in healthy older adults. J Gerontol A Biol Sci Med Sci. 2013;68(7):853–860.
    1. Molfenter SM, Amin MR, Branski RC, et al. Age-related changes in pharyngeal lumen size: a retrospective MRI analysis. Dysphagia. 2015;30(3):321–327.
    1. Aminpour S, Leonard R, Fuller SC, Belafsky PC. Pharyngeal wall differences between normal younger and older adults. Ear, Nose Throat J. 2011;90(4):E1–E5.
    1. Langmore SE, Pisegna JM. Efficacy of exercises to rehabilitate dysphagia: a critique of the literature. Int J Speech Lang Pathol. 2015;17(3):222–229.
    1. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–98.
    1. Martin-Harris B, Logemann JA, McMahon S, Schleicher M, Sandidge J. Clinical utility of the modified barium swallow. Dysphagia. 2000;15(3):136–141.
    1. Hazelwood RJ, Armeson KE, Hill EG, Bonilha HS, Martin-Harris B. Identification of swallowing tasks from a modified barium swallow study that optimize the detection of physiological impairment. J Speech Lang Hear Res. 2017;60(7):1855–1863.
    1. Robbins J, Butler SG, Daniels SK, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51(1):S276.
    1. Pisegna JM, Kaneoka A, Pearson WG, Kumar S, Langmore SE. Effects of non-invasive brain stimulation on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials. Clin Neurophysiol. 2016;127(1):956–968.
    1. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22(3):251–265.
    1. Lazarus C, Logemann JA, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck. 1993;15(5):419–424.
    1. Hammer MJ, Jones CA, Mielens JD, Kim CH, McCulloch TM. Evaluating the tongue-hold maneuver using high-resolution manometry and electromyography. Dysphagia. 2014;29(5):564–570.
    1. Martin BJ, Logemann JA, Shaker R, Dodds WJ. Normal laryngeal valving patterns during three breath-hold maneuvers: a pilot investigation. Dysphagia. 1993;8(1):11–20.
    1. Shaker R, Kern M, Bardan E, et al. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol. 1997;272(6 Pt 1):G1518–G1522.
    1. Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol. 1991;260(3 Pt 1):G450–G456.
    1. Miloro KV, Pearson WG, Langmore SE. Effortful pitch glide: a potential new exercise evaluated by dynamic MRI. J Speech Lang Hear Res. 2014;57(4):1243–1250.
    1. Martin-Harris B, Brodsky MB, Michel Y, et al. MBS measurement tool for swallow impairment – MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.
    1. Steele CM, Grace-Martin K. Reflections on clinical and statistical use of the Penetration-Aspiration scale. Dysphagia. 2017;32(5):601–616.
    1. Robbins J. Guest editorial: the current state of clinical geriatric dysphagia research. Journal of Rehabilitation Research and Development. 2002;39(4):ix.
    1. Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116(11):858–865.
    1. Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;300(6726):721–722.
    1. Yang EJ, Kim MH, Lim JY, Paik NJ. Oropharyngeal dysphagia in a community-based elderly cohort: the Korean longitudinal study on health and aging. J Korean Med Sci. 2013;28(10):1534–1539.
    1. Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly. Drugs Aging. 2005;22(2):115–130.
    1. Stephen JR, Taves DH, Smith RC, Martin RE. Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia. 2005;20(4):266–272.
    1. Martin-Harris B, Brodsky MB, Michel Y, Lee FS, Walters B. Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res. 2007;50(3):585–594.
    1. Pearson WG, Hindson DF, Langmore SE, Zumwalt AC. Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2013;85(3):735–740.

Source: PubMed

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