Exercise

Recent and some previous dysphagia literature emphasizes the use of exercise physiology. Researchers such Lazarus et. al, Robbins et.al, Burkhead et. al and Clark have published the need for incorporating exercise physiology into dysphagia therapy. They emphasize the need to understand the muscles involved in the swallowing mechanism, understand their function so that you can exercise those muscles in the manner in which they function for the swallow.

Many approaches are showing great strides in therapy using a food, swallowing based approach.   Using the food as resistance along with changes to the way the person is swallowing can be one of the best approaches to changing the swallowing mechanism.

When considering exercise for your patient, it’s so important to think about the principles of neuroplasticity:

  • Use it or lose it
  • Use it and improve it
  • Experience specific
  • Repetition
  • Intensity
  • Time
  • Salience
  • Age
  • Transference
  • Interference

So basically, when you work with patients with dysphagia and consider those principles of neuroplasticity, what you do matters.

Not so sure about all of these principles?  Download your Neuroplasticity Cheat Sheet here.

What else should you consider when looking at exercises for your patient?

  1.   Not all patients need to “strengthen their swallow.”   Some patients need to work on timing of the swallow, or require compensatory strategies, such as many of our patients with head and neck cancer.
  2. Evidence-based exercises.   How many times do you see patients with exercises that have absolutely no evidence to support them?  No, we shouldn’t shame these SLPs into oblivion, but shouldn’t we do our due diligence in crushing these non-EBP exercises into non-existence??
  3. Consider exercise principles.

Exercise principles:

  • Individuality
  • Trainability
  • Specificity
  • Progression
  • Overload
  • Variety
  • Rest
  • Adaptation
  • Recovery
  • Reversibility
  • Maintenance
  • Ceiling

Download your Exercise Principles Cheat Sheet here.

Exercise should incorporate:

  • Resistance
  • Speed
  • Repetition
  • Intensity
  • Load
  • Pacing
  • Fatigue
  • Target strength, timing and coordination

 The best way to work and improve the swallowing function is to swallow. Not only simply swallow, but push the swallow beyond it’s normal capacity. One way to incorporate increasing the load of the swallow is to use the effortful swallow, the masako or the Mendelsohn maneuver. The Shaker is a great load-resistant exercise to increase opening of the UES. These exercises have been researched and shown to be effective. Logemann credits the research that has been established for the Shaker exercise and the lingual strengthening exercises from Robbins to increase lingual strength, with overall strengthening of the swallow.

 

References:

Logemann, J.A. (2005). The Role of Exercise Programs for Dysphagia Patients. Dysphagia. 20: 139-140.

Clark, H.M. (2005). Therapeutic exercise in dysphagic manamgent: Philosophies, practices and challenges. Perspectives in Swallowing and Swallowing Disorders, 24-27.

 Robbins, J.A, Butler, S.G, Daniels S.K., Diez Gross, R., Langmore, S., Lazarus C.L., et al (2008). Swallowing adn dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language and Hearing Research, 51: S276-S300.

Burkhead, L.M., Sapienza, C.M., Rosenbek, J.C. (2007). Strength-training exercise in dysphagia rehabilitation: Principles, procedures and directions for future research. Dysphagia, 22:251-265.

Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12: 400-415.

Robbins, J.A., Gangnon, R.E., Theis, S.M., Kays, S.A., Hewitt, A.L. and Hind, J.A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatric Society, 52, 1483-1489.

Lazarus, C., Logemann, J.A., Huang, C.F., and Rademaker, A.W. (2003). Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatrice et Logopaedica, 55, 199-205.

Crary, M. A., Carnaby, G. D., LaGorio, L. A., & Carvajal, P. J. (2012). Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program. Archives of physical medicine and rehabilitation93(7), 1173-1178.

Burkhead, L. M. (2009). Applications of exercise science in dysphagia rehabilitation. Perspectives on Swallowing and Swallowing Disorders (Dysphagia)18(2), 43-48

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