What is the role of exercise in the treatment of dysphagia?

parvin

Fawad

@sarkarsatarupa Exercises are used to increase muscle tone and augment pharyngeal swallow. Two types of exercise can be recommended to patients with dysphagia: indirect (eg, exercises to strengthen swallowing muscles) and direct (eg, exercises to be performed while swallowing).

Exercise techniques are geared especially toward range of motion (ROM), coordination, and the strengthening of muscles of the jaw, lips, cheek, tongue, soft palate, and vocal cords. Exercises designed to facilitate oral motor strength, ROM, and coordination usually are performed 5-10 times per day.

Biofeedback techniques are used to reeducate muscles affected in facial palsy and disorders of articulation. Such techniques include electromyographic feedback, with surface electrodes placed over the anterior neck. Visual feedback is obtained through a videofluoroscopic swallowing study (VFSS) while experimentation with head positions and swallowing maneuvers is conducted.

Lips
Lip exercises can facilitate the patient's ability to prevent food or liquid from leaking out of the oral cavity. Tongue exercises are used to facilitate manipulation of the bolus and its propulsion through the oral cavity or to facilitate retraction of the tongue base. Passive ROM and active-assistive ROM exercise concepts also can be applied in this technique. Tongue-holding maneuvers facilitate compensatory anterior movement of the posterior pharyngeal wall.

Head lift
Head-lift exercises increase anterior movement of the hyolaryngeal complex and opening of the upper esophageal sphincter. Patients lie flat and are instructed to keep their shoulders on the floor as they raise their head high enough to see their toes, maintaining this position for 1 minute. They repeat this activity 3 times, followed by 30 consecutive repetitions of the same action. Patients should perform this exercise 3 times per day for several weeks.

A study by Choi et al indicated that combining head-lift exercises with conventional dysphagia therapy is more effective than conventional dysphagia therapy alone in the treatment of poststroke dysphagia. Greater improvement in degree of aspiration (evaluated using the Penetration-Aspiration Scale) and oral diet level (assessed via the Functional Oral Intake Scale) was seen in the head-lift group than in the patients who received only conventional treatment.

Other
Jaw exercises help to facilitate the rotatory movements of mastication. Respiratory exercises (eg, resistive straw sucking, coughing, incentive spirometer) are recommended to improve respiratory strength. Vocal cord adduction exercises can promote strengthening of weak vocal cords.