I saw a tweet about this new Swallowing Exercise Aid yesterday. I was extremely curious and decided to check out the article.
We’ve had some new research come out on the Chin Tuck Against Resistance (CTAR) and Jaw Opening Against Resistance (JOAR) as well as Isometric Progress Resistive Oropharyngeal Therapy (IPRO). The common theme here is resistance.
Kraaijenga, SAC, et al. Effects of Strengthening Exercises on Swallowing Musculature and Function in Senior Healthy Subjects: A Prospective Effectiveness and Feasibility Study. Dysphagia (2015) DOI: 10.1007/s00455-015-9611-8.
This article looked at using a Swallowing Exercise Aid (SEA) in connection with 3 exercises (CTAR, JOAR and effortful swallow with resistance.)
Ten healthy senior males with a median age of 60 were used in the study. Inclusion criteria included absence of dysphagia or history of dysphagia.
Exercises were completed 3x/day for 6 weeks including CTAR, JOAR and effortful swallow with resistance (swallowing with the mandible down and mouth closed). The SEA device used was the Therabite Jaw Mobilization device with a Therabite Active Band. The SEA device was used as resistance for all 3 exercises.
Both CTAR and JOAR were completed isokinetically and isometrically. For the isokinetic portion, each was completed 30 times with a 1 second muscle contraction. For the isometric portion, each person was to complete static completion of the exercise for 60 seconds 3 times with a 60 second rest period between hold. After an additional 60 second break, the person swallowed 10 consecutively using an effortful swallow while pushing the mandible down against the SEA and keeping the mouth closed. Each exercise session was approximated to last 15 minutes.
Each participant was given written instructions on completion of the exercise. They were sent 3 daily texts as reminders and used tally sheets to record exercise logs. Participants were advised to stop exercises if they experienced pain or distress.
Outcomes were recorded prior to and 2 days after the 6 week exercise period. Outcomes were measured by used of a dynamometer, the Iowa Oral Performance Instrument (IOPI), MRI and Videofluoroscopic Swallow Study (VFSS). Outcomes measured included:
- Maximum chin tuck and jaw opening strength.
- Maximum tongue strength and endurance
- Suprahyoid mass (Anterior Bell of the Digastric, Mylohyoid, Geniohyoid)
- Hyoid bone displacement
Outcomes measured following 6 weeks of exercise indicated a significant increase in all of the above along with increased mouth opening and no pain. Compliance with the program was reported at 86%.
This program has huge implications for our patients with head and neck cancer. I’m excited to see where this study may lead.