Abstract
Suprahyoid muscle activation and tongue pressure force play a critical role for swallowing function. In addition, dysphagia limit is one of most important factors indicating swallowing efficiency. The purpose of this study was to compare the effects of 8-week training sessions of three different exercises including chin tuck against resistance (CTAR), Shaker exercises and chin tuck exercise with theraband on suprahyoid muscle activity, anterior tongue pressure and dysphagia limit in healthy subjects. Thirty-six healthy volunteers aged between 18 and 40 years who scored below 3 points from Turkish version of Eating Assessment Tool (T-EAT-10) were included in the study, and all participants were divided into three groups randomly. Maximal suprahyoid muscle activations and dysphagia limit of participants were assessed by superficial electromyography. CTAR and chin tuck exercise with theraband increased the maximum suprahyoid muscle activation (p1 = 0.004, p2 = 0.018), whereas Shaker exercise did not increase maximal suprahyoid muscle activation (p = 0.507) after exercise training. CTAR and chin tuck exercise with theraband increased tongue pressure (p1 = 0.045, p2 = 0.041), while Shaker exercise did not increase anterior tongue pressure (p = 0.248). There was no statistically significant difference in dysphagia limits in three groups between before and after exercise training (p > 0.05). As a result, although CTAR seems to be the most effective exercise in most parameters, chin tuck exercise with theraband can also be used as an alternative to CTAR to improve suprahyoid muscle activity and tongue pressure.
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References
Macht M, White SD, Moss M. Swallowing dysfunction after critical illness. Chest. 2014;146(6):1681–9. https://doi.org/10.1378/chest.14-1133.
Molfenter SM, Steele CM. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2011;26(1):67–74. https://doi.org/10.1007/s00455-010-9309-x.
Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(5):1314–21.
Yoon WL, Khoo JK, Rickard Liow SJ. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. 2014;29(2):243–8. https://doi.org/10.1007/s00455-013-9502-9.
Sze WP, Yoon WL, Escoffier N, Rickard Liow SJ. Evaluating the training effects of two swallowing rehabilitation therapies using surface electromyography—chin tuck against resistance (CTAR) exercise and the Shaker exercise. Dysphagia. 2016;31(2):195–205. https://doi.org/10.1007/s00455-015-9678-2.
Page PA, Lamberth J, Abadie B, Boling R, Collins R, Linton R. Posterior rotator cuff strengthening using theraband(r) in a functional diagonal pattern in collegiate baseball pitchers. J Athl Train. 1993;28(4):346–54.
Demir N, Serel Arslan S, Inal O, Karaduman AA. Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia. 2016;31(5):644–9. https://doi.org/10.1007/s00455-016-9723-9.
Yoshida M, Groher ME, Crary MA, Mann GC, Akagawa Y. Comparison of surface electromyographic (sEMG) activity of submental muscles between the head lift and tongue press exercises as a therapeutic exercise for pharyngeal dysphagia. Gerodontology. 2007;24(2):111–6. https://doi.org/10.1111/j.1741-2358.2007.00164.x.
Ertekin C, Aydogdu I, Yuceyar N. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J Neurol Neurosurg Psychiatry. 1996;61(5):491–6. https://doi.org/10.1136/jnnp.61.5.491.
Hewitt A, Hind J, Kays S, Nicosia M, Doyle J, Tompkins W, Gangnon R, Robbins J. Standardized instrument for lingual pressure measurement. Dysphagia. 2008;23(1):16–25. https://doi.org/10.1007/s00455-007-9089-0.
Stierwalt JA, Youmans SR. Tongue measures in individuals with normal and impaired swallowing. Am J Speech Lang Pathol. 2007;16(2):148–56. https://doi.org/10.1044/1058-0360(2007/019).
Watts CR. Measurement of hyolaryngeal muscle activation using surface electromyography for comparison of two rehabilitative dysphagia exercises. Arch Phys Med Rehabil. 2013;94(12):2542–8. https://doi.org/10.1016/j.apmr.2013.04.013.
Gao J, Zhang HJ (2017) Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med 53(3):426–432. https://doi.org/10.23736/S1973-9087.16.04346-X
Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and maintaining isometric and isokinetic goals of the Shaker exercise. Dysphagia. 2005;20(2):133–8. https://doi.org/10.1007/s00455-005-0004-2.
Huelke DF, Nusholtz GS. Cervical spine biomechanics: a review of the literature. J Orthop Res. 1986;4(2):232–45. https://doi.org/10.1002/jor.1100040212.
Falla DL, Jull GA, Hodges PW (2004) Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976) 29(19):2108–2114
Mayoux-Benhamou MA, Revel M, Vallee C, Roudier R, Barbet JP, Bargy F. Longus colli has a postural function on cervical curvature. Surg Radiol Anat. 1994;16(4):367–71.
Koskimies K, Sutinen P, Aalto H, Starck J, Toppila E, Hirvonen T, Kaksonen R, Ishizaki H, Alaranta H, Pyykko I. Postural stability, neck proprioception and tension neck. Acta Otolaryngol Suppl. 1997;529:95–7.
Santuz A, Akay T, Mayer WP, Wells TL, Schroll A, Arampatzis A. Modular organization of murine locomotor pattern in the presence and absence of sensory feedback from muscle spindles. J Physiol. 2019. https://doi.org/10.1113/JP277515.
Herzog W, ter Keurs HE. Force–length relation of in-vivo human rectus femoris muscles. Pflugers Arch. 1988;411(6):642–7.
ter Keurs HE, Iwazumi T, Pollack GH. The sarcomere length–tension relation in skeletal muscle. J Gen Physiol. 1978;72(4):565–92. https://doi.org/10.1085/jgp.72.4.565.
Ertekin C, Aydogdu I, Yuceyar N, Tarlaci S, Kiylioglu N, Pehlivan M, Celebi G. Electrodiagnostic methods for neurogenic dysphagia. Electroencephalogr Clin Neurophysiol. 1998;109(4):331–40.
Belo LR, Gomes NA, Coriolano M, de Souza ES, Moura DA, Asano AG, Lins OG. The relationship between limit of dysphagia and average volume per swallow in patients with Parkinson’s disease. Dysphagia. 2014;29(4):419–24. https://doi.org/10.1007/s00455-013-9512-7.
Buchholz DW, Bosma JF, Donner MW. Adaptation, compensation, and decompensation of the pharyngeal swallow. Gastrointest Radiol. 1985;10(3):235–9.
Selcuk B, Uysal H, Aydogdu I, Akyuz M, Ertekin C. Effect of temperature on electrophysiological parameters of swallowing. J Rehabil Res Dev. 2007;44(3):373–80.
Ertekin C, Kiylioglu N, Tarlaci S, Keskin A, Aydogdu I. Effect of mucosal anaesthesia on oropharyngeal swallowing. Neurogastroenterol Motil. 2000;12(6):567–72.
Ertekin C, Keskin A, Kiylioglu N, Kirazli Y, On AY, Tarlaci S, Aydogdu I. The effect of head and neck positions on oropharyngeal swallowing: a clinical and electrophysiologic study. Arch Phys Med Rehabil. 2001;82(9):1255–60.
Oh JC, Kwon JS. Effects of resistive jaw-opening exercise with elastic bands on suprahyoid muscle activation in normal subjects. Folia Phoniatr Logop. 2018;70(3–4):101–8. https://doi.org/10.1159/000491082.
Oh JC. A pilot study of the head extension swallowing exercise: new method for strengthening swallowing-related muscle activity. Dysphagia. 2016;31(5):680–6. https://doi.org/10.1007/s00455-016-9732-8.
Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res. 2008;51(4):828–35. https://doi.org/10.1044/1092-4388(2008/060).
Pearson WG Jr, Langmore SE, Yu LB, Zumwalt AC. Structural analysis of muscles elevating the hyolaryngeal complex. Dysphagia. 2012;27(4):445–51. https://doi.org/10.1007/s00455-011-9392-7.
Wakabayashi H, Matsushima M, Momosaki R, Yoshida S, Mutai R, Yodoshi T, Murayama S, Hayashi T, Horiguchi R, Ichikawa H. The effects of resistance training of swallowing muscles on dysphagia in older people: a cluster, randomized, controlled trial. Nutrition. 2018;48:111–6. https://doi.org/10.1016/j.nut.2017.11.009.
Pearson WG Jr, Hindson DF, Langmore SE, Zumwalt AC. Evaluating swallowing muscles essential for hyolaryngeal elevation by using muscle functional magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2013;85(3):735–40. https://doi.org/10.1016/j.ijrobp.2012.07.2370.
Castell JA, Castell DO, Schultz AR, Georgeson S. Effect of head position on the dynamics of the upper esophageal sphincter and pharynx. Dysphagia. 1993;8(1):1–6.
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Kılınç, H.E., Arslan, S.S., Demir, N. et al. The Effects of Different Exercise Trainings on Suprahyoid Muscle Activation, Tongue Pressure Force and Dysphagia Limit in Healthy Subjects. Dysphagia 35, 717–724 (2020). https://doi.org/10.1007/s00455-019-10079-w
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DOI: https://doi.org/10.1007/s00455-019-10079-w