Article

OBJECTIVE: To investigate functional and physiological changes in swallowing
performance of adults with chronic dysphagia after an exercise-based dysphagia
therapy. DESIGN: Intervention study: before-after trial with 3-month follow-up
evaluation. SETTING: Outpatient clinic within a tertiary care academic health
science center. PARTICIPANTS: Adults (N=9) with chronic (>12 mo) dysphagia after
unsuccessful prior therapies. Subjects were identified from among patients
referred to an outpatient dysphagia clinic. Subjects had dysphagia secondary to
prior treatment for head/neck cancer or from neurologic injury. All subjects
demonstrated clinical and fluoroscopic evidence of oropharyngeal dysphagia. No
subject withdrew during the course of this study. INTERVENTIONS: All subjects
completed 3 weeks of an intensive, exercise-based dysphagia therapy. Therapy was
conducted daily for 1h/d, with additional activities completed by subjects each
night between therapy sessions. MAIN OUTCOME MEASURES: Primary outcomes were
clinical and functional change in swallowing performance with maintenance at 3
months after intervention. Secondary, exploratory outcomes included physiological
change in swallow performance measured by hyolaryngeal elevation, lingual-palatal
and pharyngeal manometric pressure, and surface electromyographic amplitude.
RESULTS: Clinical and functional swallowing performances improved significantly
and were maintained at the 3-month follow-up examination. Subject perspective
(visual analog scale) on functional swallowing also improved. Four of 7 subjects
who were initially feeding tube dependent progressed to total oral intake after 3
weeks of intervention. Physiological indices demonstrated increased swallowing
effort after intervention. CONCLUSIONS: Significant clinical and functional
improvement in swallowing performance followed a time-limited (3 wk)
exercise-based intervention in a sample of subjects with chronic dysphagia.
Physiological changes after therapy implicate improved neuromuscular functioning
within the swallow mechanism.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS