Exercise Science Principles Strengthen Swallowing Rehabilitation

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Exercise Science Principles Strengthen Swallowing Rehabilitation

http://www.sciencedaily.com/releases/2007/04/070430155724.htm

Just thinking about swallowing makes it harder to do. Head and neck

cancer, a stroke, brain tumor, brain injury or even a tracheostomy

tube and mechanical ventilation needed to sustain life can make it

impossible. Dysphagia, or swallowing problems, can also result from

aging and accompanying loss of muscle strength.

Dr. Lori Burkhead, MCG speech-language pathologist and clinical

research scientist, works with White to improve his

swallowing. (Credit: Medical College of Georgia)Ads by Google

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" We swallow a thousand times or more per day, just our own saliva,

without even thinking about it, " says Dr. Lori Burkhead, speech-

language pathologist and clinical research scientist at the Medical

College of Georgia Department of Otolaryngology -- Head and Neck

Surgery. " We swallow in our sleep. Babies do it in utero. It is

something we do without giving it much thought, but it's actually a

very complex act that involves an intricate coordination between the

brain, muscles and respiratory system. "

An estimated 18 million Americans have difficulty with this routine

function that, at worst, can lead to aspiration pneumonia,

malnutrition, dehydration and death.

Evidence suggests that the same exercise science principles that

strengthen bodies can help restore this fundamental function using

mouth and throat muscles. Because swallowing muscles are not easy to

access, applying the usual principles of exercise is more

difficult. " Physical therapists can put a weight in someone's hand

and exercise them or they can give patients external assistance and

get them to complete a movement, " says Dr. Burkhead. " I can't put

weights on throat muscles for strengthening and I can't get at those

muscles to help patients finish the movements they cannot do on

their own. "

Theories about the amount of resistance needed to strengthen a

muscle, the number of repetitions and specificity of exercise along

with technology such as biofeedback may help speech-language

pathologists put more science and success into helping patients

regain the ability to swallow, according to a review article

authored by Dr. Burkhead for the scientific journal Dysphagia.

" At present, there remain more questions than answers regarding how

to most effectively and efficiently approach dysphagia

rehabilitation, " Dr. Burkhead and her co-authors write.

Historically, research has focused on compensatory maneuvers such as

changing body position or modifying the amount or consistency of

food and liquid. Compensation is important, but the problem still

remains unless it is addressed through rehabilitation efforts, they

say.

Although exercise principles used in physical rehabilitation and

sports training have been gaining attention in dysphagia

rehabilitation, Dr. Burkhead proposes more emphasis on these

theories and more studies to learn to optimize these principles.

Dr. Burkhead asserts that many of the treatment techniques used in

physical rehabilitation or athletic training are applicable and

beneficial in dysphagia rehabilitation. " Physical therapists won't

just tell a stroke patient to get up and walk; they first work on

strengthening muscles of interest and discrete movements until

patients can stand and take a few steps. They start with the

components of a movement and then ultimately train the movement of

interest, which in this case would be walking. The same thing goes

for swallowing therapy. We can start with tongue movement or lip

closure, but then we must be very conscious of moving toward task-

specific exercise and working our patients at more challenging

levels of intensity, which is something that our field is now

starting to pay more attention to, " says Dr. Burkhead.

There also is heightened interest in using tools such as

neuromuscular electrical stimulation and biofeedback to boost the

effects of exercise. She already routinely incorporates

biofeedback. " It provides concrete information for the therapist as

well as the patient and empowers them to take a more active role in

their recovery. We frequently ask patients to swallow with greater

emphasis or to swallow in unusual ways as part of their exercise

regimen. Biofeedback helps them know if they are doing it correctly

and with the right amount of intensity. "

Computer-aided biofeedback provides patients a graphic

representation on a computer screen of what their muscles are doing.

The therapist can challenge patients to reach for higher and higher

goals, which challenges the muscles more and more. " This helps the

patient understand what they are doing right and to do more of it, "

she says. " This empowers patients and helps them not only judge but

then modify their own performance. "

Dr Burkhead also is developing a strengthening technique that

incorporates a creative way to access hard-to-reach muscles. Her

technique incorporates the use of the Therabite® device, developed

by Atos Medical in Sweden, to improve mouth opening. The device

holds the jaw in position while the patient places his tongue at the

roof of the mouth and swallows. The rationale is based on exercise

principles known to work in other parts of the body. Her studies in

healthy patients have shown that swallowing in this unusual position

significantly increases activation of the swallowing muscles.

Despite advances in this field, many questions remain about how to

best help patients resume safe swallowing. " We use the evidence

available to us along with what we know about how the body works to

design treatment plans that target the problems as best we can. Many

patients have improved with traditional therapy techniques, but I

think that more research will lead to better therapy and greater

outcomes in a shorter amount of time. "

Co-authors include researchers at the University of Florida and

Malcom Randall Veterans Affairs Medical Center in Gainesville.