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Muscle Strengthening Approaches to Dysphagia Rehabilitation

  • Swallowing Disorders (Ruth E Martin, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of review

This review defines the concept of muscle strength, presents currently used muscle strengthening approaches for treatment of dysphagia, and discusses research findings in this context. We also emphasize the importance of understanding mechanisms of muscular change to allow refinement of existing strengthening methods, improved treatment approaches, optimal treatment doses, and maintenance programs grounded in scientific evidence.

Recent findings

Approaches to rehabilitation of dysphagia (swallowing disorders) have traditionally involved compensatory maneuvers to improve safety and efficiency of the swallow. Beyond compensation for deficits, recent rehabilitative methods include muscle strengthening techniques that vary in targeted swallowing-related muscles targeted and specifics of the regimen.

Summary

Given the inherent plasticity of skeletal muscles, including muscles active during swallowing, exercise may have a key role in dysphagia rehabilitation as these treatments are optimized in ongoing research. We conclude that multisite randomized controlled trials are needed to clearly establish efficacy of these regimens and to allow individualization of treatment programs.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients: structured abstract. [Online]. Available: http://archive.ahrq.gov/clinic/tp/dysphtp.htm. Accessed 16 Aug 2016.

  2. Grimby G, Aniansson A, Hedberg M, Henning GB, Grangård U, Kvist H. Training can improve muscle strength and endurance in 78- to 84-yr-old men. J Appl Physiol. 1992;73(6):2517–23.

    CAS  PubMed  Google Scholar 

  3. Connor NP, Russell JA, Wang H, Jackson MA, Mann L, Kluender K. Effect of tongue exercise on protrusive force and muscle fiber area in aging rats. J. Speech Lang. Hear. Res. 2009;52(3):732–44.

    Article  PubMed  Google Scholar 

  4. Stathopoulos E, Felson Duchan J. History and principles of exercise-based therapy: how they inform our current treatment. Semin Speech Lang. 2006;27(4):227–35.

    Article  PubMed  Google Scholar 

  5. Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003;12(4):400–15.

    Article  PubMed  Google Scholar 

  6. Enoka RM. Muscle strength and its development. New perspectives. Sports Med. 1988;6(3):146–68.

    Article  CAS  PubMed  Google Scholar 

  7. Atha J. Strengthening muscle. Exerc Sport Sci Rev. 1981;9:1–73.

    Article  CAS  PubMed  Google Scholar 

  8. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263(22):3029–34.

    Article  CAS  PubMed  Google Scholar 

  9. Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG, Evans WJ. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol. 1988;64(3):1038–44.

    CAS  PubMed  Google Scholar 

  10. Tracy BL, Ivey FM, Hurlbut D, Martel GF, Lemmer JT, Siegel EL, Metter EJ, Fozard JL, Fleg JL, Hurley BF. Muscle quality. II. Effects of strength training in 65- to 75-yr-old men and women. J Appl Physiol. 1999;86(1):195–201.

    CAS  PubMed  Google Scholar 

  11. Montero-Fernández N, Serra-Rexach JA. Role of exercise on sarcopenia in the elderly. Eur J Phys Rehabil Med. 2013;49(1):131–43.

    PubMed  Google Scholar 

  12. Huxley H, Hanson J. Changes in the cross-striations of muscle during contraction and stretch and their structural interpretation. Nature. 1954;173(4412):973–6.

    Article  CAS  PubMed  Google Scholar 

  13. Skeletal muscle structure, function, and plasticity: 9780781775939: Medicine & Health Science Books @ Amazon.com. [Online]. Available: https://www.amazon.com/Skeletal-Muscle-Structure-Function-Plasticity/dp/0781775930. Accessed 06 Aug 2016.

  14. Schiaffino S, Reggiani C. Fiber types in mammalian skeletal muscles. Physiol Rev. 2011;91(4):1447–531.

    Article  CAS  PubMed  Google Scholar 

  15. Stewart M. Muscle structure and function—an explanation. Equine Vet J. 1976;8(1):17–9.

    Article  CAS  PubMed  Google Scholar 

  16. Huxley AF. The activation of striated muscle and its mechanical response. Proc R Soc Lond B Biol Sci. 1971;178(1050):1–27.

    Article  CAS  PubMed  Google Scholar 

  17. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22(3):251–65.

    Article  PubMed  Google Scholar 

  18. McLoon LK, Andrade F, editors. Craniofacial muscles. New York, NY: Springer New York; 2013.

    Google Scholar 

  19. Matsuo K, Palmer JB. Coordination of mastication, swallowing and breathing. Jpn Dent Sci Rev. 2009;45(1):31–40.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Roden DF, Altman KW. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin N Am. 2013;46(6):965–87.

    Article  Google Scholar 

  21. Connor NP, Ota F, Nagai H, Russell JA, Leverson G. Differences in age-related alterations in muscle contraction properties in rat tongue and hindlimb. J. Speech Lang. Hear. Res. 2008;51(4):818–27.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Adams V, Mathisen B, Baines S, Lazarus C, Callister R. Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with elderly adults. Disabil Rehabil. 2015;37(5):389–95.

    Article  PubMed  Google Scholar 

  23. • Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, Robbins J. Effects of device-facilitated isometric progressive resistance oropharyngeal therapy on swallowing and health-related outcomes in older adults with dysphagia. J Am Geriatr Soc. 2016;64(2):417–24. This paper reports preliminary results from an intensive lingual strengthening program for older adults with dysphagia, the Swallow STRONG program. Following an 8-week progressive strengthening regimen, patients showed improvements in a variety of swallowing-related outcome measures.

    Article  PubMed  Google Scholar 

  24. Jones CA, Knigge MA, McCulloch TM. Speech pathologist practice patterns for evaluation and management of suspected cricopharyngeal dysfunction. Dysphagia. 2014;29(3):332–9.

  25. Kristmundsdottir F, Mahon M, Froes MM, Cumming WJ. Histomorphometric and histopathological study of the human cricopharyngeus muscle: in health and in motor neuron disease. Neuropathol Appl Neurobiol. 1990;16(6):461–75.

  26. •• Stokely SL, Peladeau-Pigeon M, Leigh C, Molfenter SM, Steele CM. The relationship between pharyngeal constriction and post-swallow residue. Dysphagia. 2015;30(3):349–56. Results of this study revealed that measurements of pharyngeal area at rest in both healthy young adults and patients with neurogenic dysphagia were significantly larger in those with postswallow residue in either the valleculae or pyriform sinus. This supports the use of pharyngeal area as a surrogate measure of pharyngeal strength.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jang HJ, Leigh JH, Seo HG, Han TR, Oh BM. Effortful swallow enhances vertical hyolaryngeal movement and prolongs duration after maximal excursion. J Oral Rehabil. 2015;42(10):765–73.

    Article  CAS  PubMed  Google Scholar 

  28. Folland JP, Williams AG. The adaptations to strength training: morphological and neurological contributions to increased strength. Sports Med. 2007;37(2):145–68.

    Article  PubMed  Google Scholar 

  29. Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports Med. 2006;36(2):133–49.

    Article  PubMed  Google Scholar 

  30. Lever TE, Cox KT, Holbert D, Shahrier M, Hough M, Kelley-Salamon K. The effect of an effortful swallow on the normal adult esophagus. Dysphagia. 2007;22(4):312–25.

    Article  PubMed  Google Scholar 

  31. Huckabee M-L, Steele CM. An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressure during effortful swallow. Arch Phys Med Rehabil. 2006;87(8):1067–72.

    Article  PubMed  Google Scholar 

  32. Pavlath GK, Thaloor D, Rando TA, Cheong M, English AW, Zheng B. Heterogeneity among muscle precursor cells in adult skeletal muscles with differing regenerative capacities. Dev Dyn. 1998;212(4):495–508.

    Article  CAS  PubMed  Google Scholar 

  33. Buchner DM, De Lateur BJ. The importance of skeletal muscle strength to physical function in older adults. Ann Behav Med. 1991;13(3):91–8.

    Google Scholar 

  34. Park J-W, Oh J-C, Lee HJ, Park S-J, Yoon T-S, Kwon BS. Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dysphagia. 2009;24(3):296–301.

    Article  PubMed  Google Scholar 

  35. Delorme TL, Watkins AL. Technics of progressive resistance exercise. Arch Phys Med Rehabil. 1948;29(5):263–73.

    CAS  PubMed  Google Scholar 

  36. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, Nieman DC, Swain DP, American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.

    Article  PubMed  Google Scholar 

  37. Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am Journal Speech Lang Pathol. 1996;5.

  38. Etty Griffin LY. Neuromuscular training and injury prevention in sports. Clin Orthop Relat Res. 2003;(409):53–60.

  39. Rutherford OM, Greig CA, Sargeant AJ, Jones DA. Strength training and power output: transference effects in the human quadriceps muscle. J Sports Sci. 1986;4(2):101–7.

    Article  CAS  PubMed  Google Scholar 

  40. Hutcheson KA, Bhayani MK, Beadle BM, Gold KA, Shinn EH, Lai SY, Lewin J. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1127–34.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. ‘Pharyngocise’: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):210–9.

    Article  PubMed  Google Scholar 

  42. Mortensen HR, Jensen K, Aksglæde K, Lambertsen K, Eriksen E, Grau C. Prophylactic swallowing exercises in head and neck cancer radiotherapy. Dysphagia. 2015;30(3):304–14.

    Article  CAS  PubMed  Google Scholar 

  43. Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82(12):1661–5.

    Article  CAS  PubMed  Google Scholar 

  44. Hammer MJ, Jones CA, Jones CA, Mielens JD, Kim CH, McCulloch TM. Evaluating the tongue-hold maneuver using high-resolution manometry and electromyography. Dysphagia. 2014;29(5):564–70.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Phys. 1991;260(3 Pt 1):G450–6.

    CAS  Google Scholar 

  46. Bülow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia. 2001;16(3):190–5.

    Article  PubMed  Google Scholar 

  47. Bülow M, Olsson R, Ekberg O. Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction. Dysphagia. 2002;17(3):197–201.

  48. Lazarus C, Logemann JA, Song CW, Rademaker AW, Kahrilas PJ. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002;54(4):171–6.

  49. Fukuoka T, Ono T, Hori K, Tamine K, Nozaki S, Shimada K, Yamamoto N, Fukuda Y, Domen K. Effect of the effortful swallow and the Mendelsohn maneuver on tongue pressure production against the hard palate. Dysphagia. 2013;28(4):539–47.

    Article  PubMed  Google Scholar 

  50. Hoffman MR, Mielens JD, Ciucci MR, Jones CA, Jiang JJ, McCulloch TM. High-resolution manometry of pharyngeal swallow pressure events associated with effortful swallow and the Mendelsohn maneuver. Dysphagia. 2012;27(3):418–26.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Huckabee M-L, Butler SG, Barclay M, Jit S. Submental surface electromyographic measurement and pharyngeal pressures during normal and effortful swallowing. Arch Phys Med Rehabil. 2005;86(11):2144–9.

    Article  PubMed  Google Scholar 

  52. Lenius K, Stierwalt J, LaPointe LL, Bourgeois M, Carnaby G, Crary M. Effects of lingual effort on swallow pressures following radiation treatment. J Speech Lang Hear Res. 2015;58(3):687–97.

    Article  PubMed  Google Scholar 

  53. Park J-W, Kim Y, Oh J-C, Lee H-J. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia. 2012;27(4):521–7.

    Article  PubMed  Google Scholar 

  54. Clark HM, Shelton N. Training effects of the effortful swallow under three exercise conditions. Dysphagia. 2014;29(5):553–63.

    Article  PubMed  Google Scholar 

  55. Doeltgen SH, Macrae P, Huckabee M-L. Pharyngeal pressure generation during tongue-hold swallows across age groups. Am J Speech Lang Pathol. 2011;20(2):124–30.

    Article  PubMed  Google Scholar 

  56. Bodén K, Hallgren A, Witt Hedström H. Effects of three different swallow maneuvers analyzed by videomanometry. Acta Radiol. 2006;47(7):628–33.

    Article  PubMed  Google Scholar 

  57. McCullough GH, Kim Y. Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke. Dysphagia. 2013;28(4):511–9.

    Article  PubMed  Google Scholar 

  58. McCullough GH, Kamarunas E, Mann GC, Schmidley JW, Robbins JA, Crary MA. Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil. 2012;19(3):234–43.

    Article  PubMed  PubMed Central  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. Shaker R, Kern M, Bardan E, Taylor A, Stewart ET, Hoffmann RG, Arndorfer RC, Hofmann C, Bonnevier J. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Phys. 1997;272(6 Pt 1):G1518–22.

    CAS  Google Scholar 

  61. Woo H-S, Won S-Y, Chang K-Y. Comparison of muscle activity between two adult groups according to the number of shaker exercise. J Oral Rehabil. 2014;41(6):409–15.

    Article  PubMed  Google Scholar 

  62. Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and maintaining isometric and isokinetic goals of the shaker exercise. Dysphagia. 20(2):133–138.

  63. 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.

    Article  PubMed  Google Scholar 

  64. Mishra A, Rajappa A, Tipton E, Malandraki GA. The recline exercise: comparisons with the head lift exercise in healthy adults. Dysphagia. 2015;30(6):730–7.

    Article  PubMed  Google Scholar 

  65. Hamlet S, Mathog R, Fleming S, Jones L, Muz J. Modification of compensatory swallowing in a supraglottic laryngectomy patient. Head Neck. 1990;12(2):131–6.

    Article  CAS  PubMed  Google Scholar 

  66. Logemann JA. Evaluation and treatment of swallowing disorders. San Diego, CA: College-Hill Press; 1983.

    Google Scholar 

  67. Mendelsohn MS, Martin RE. Airway protection during breath-holding. Ann. Otol. Rhinol. Laryngol. 1993;102(12):941–4.

    Article  CAS  PubMed  Google Scholar 

  68. Bülow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers. Dysphagia. 1999;14(2):67–72.

    Article  PubMed  Google Scholar 

  69. Ohmae Y, Logemann JA, Kaiser P, Hanson DG, Kahrilas PJ. Effects of two breath-holding maneuvers on oropharyngeal swallow. Ann Otol Rhinol Laryngol. 1996;105(2):123–31.

    Article  CAS  PubMed  Google Scholar 

  70. Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19(6):535–40.

    Article  CAS  PubMed  Google Scholar 

  71. Kasahara T, Hanayama K, Kodama M, Aono K, Masakado Y. The efficacy of supraglottic swallow as an indirect swallowing exercise by analysis of hyoid bone movement. Tokai J Exp Clin Med. 2009;34(3):72–5.

    PubMed  Google Scholar 

  72. Fujiwara S, Ono T, Minagi Y, Fujiu-Kurachi M, Hori K, Maeda Y, Boroumand S, Nitschke I, Ursula V, Bohlender J. Effect of supraglottic and super-supraglottic swallows on tongue pressure production against hard palate. Dysphagia. 2014:1–8

  73. Imada M, Kagaya H, Ishiguro Y, Kato M, Inamoto Y, Tanaka T, Shibata S, Saitoh E. Effect of visual biofeedback to acquire supraglottic swallow in healthy individuals: a randomized-controlled trial. Int J Rehabil Res. 2016;39(2):181–4.

    Article  PubMed  Google Scholar 

  74. Chaudhuri G, Hildner CD, Brady S, Hutchins B, Aliga N, Abadilla E. Cardiovascular effects of the supraglottic and super-supraglottic swallowing maneuvers in stroke patients with dysphagia. Dysphagia. 2002;17(1):19–23.

    Article  PubMed  Google Scholar 

  75. Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007;35(5):562–90.

    Article  PubMed  Google Scholar 

  76. Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001;46(5):466–74.

    CAS  PubMed  Google Scholar 

  77. Huckabee M-L, Doeltgen S. Emerging modalities in dysphagia rehabilitation: neuromuscular electrical stimulation. N Z Med J. 2007;120(1263):U2744.

    PubMed  Google Scholar 

  78. Braid V, Barber M, Mitchell SL, Martin BJ, Granat M, Stott DJ. Randomised controlled trial of electrical stimulation of the quadriceps after proximal femoral fracture. Aging Clin Exp Res. 2008;20(1):62–6.

    Article  PubMed  Google Scholar 

  79. Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 award winner. Eur J Phys Rehabil Med. 2008;44(2):159–67.

    CAS  PubMed  Google Scholar 

  80. Lowe DA, Alway SE. Animal models for inducing muscle hypertrophy: are they relevant for clinical applications in humans? J Orthop Sports Phys Ther. 2002;32(2):36–43.

    Article  PubMed  Google Scholar 

  81. Connor NP, Russell JA, Jackson MA, Kletzien H, Wang H, Schaser AJ, Leverson GE, Zealear DL. Tongue muscle plasticity following hypoglossal nerve stimulation in aged rats. Muscle Nerve. 2013;47(2):230–40.

    Article  PubMed  Google Scholar 

  82. Nosaka K, Newton M, Sacco P. Responses of human elbow flexor muscles to electrically stimulated forced lengthening exercise. Acta Physiol Scand. 2002;174(2):137–45.

    Article  CAS  PubMed  Google Scholar 

  83. McDonough P, Behnke BJ, Kindig CA, Poole DC. Rat muscle microvascular PO2 kinetics during the exercise off-transient. Exp Physiol. 2001;86(3):349–56.

    Article  CAS  PubMed  Google Scholar 

  84. Morrow NG, Kraus WE, Moore JW, Williams RS, Swain JL. Increased expression of fibroblast growth factors in a rabbit skeletal muscle model of exercise conditioning. J Clin Invest. 1990;85(6):1816–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Clark H, Lazarus C, Arvedson J, Schooling T, Frymark T. Evidence-based systematic review: effects of neuromuscular electrical stimulation on swallowing and neural activation. Am J Speech Lang Pathol. 2009;18(4):361–75.

    Article  PubMed  Google Scholar 

  86. Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Ann. Otol. Rhinol. Laryngol. 2007;116(1):36–44.

    Article  PubMed  Google Scholar 

  87. Bogaardt H, van Dam D, Wever NM, Bruggeman CE, Koops J, Fokkens WJ. Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis. Ann. Otol. Rhinol. Laryngol. 2009;118(4):241–6.

    Article  PubMed  Google Scholar 

  88. Carnaby-Mann GD, Crary MA. Adjunctive neuromuscular electrical stimulation for treatment-refractory dysphagia. Ann. Otol. Rhinol. Laryngol. 2008;117(4):279–87.

    Article  PubMed  Google Scholar 

  89. Lim K-B, Lee H-J, Lim S-S, Choi Y-I. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial. J Rehabil Med. 2009;41(3):174–8.

    Article  PubMed  Google Scholar 

  90. Oh B-M, Kim D-Y, Paik N-J. Recovery of swallowing function is accompanied by the expansion of the cortical map. Int J Neurosci. 2007;117(9):1215–27.

    Article  PubMed  Google Scholar 

  91. Bhatt AD, Goodwin N, Cash E, Bhatt G, Silverman CL, Spanos WJ, Bumpous JM, Potts K, Redman R, Allison WA, Dunlap NE. Impact of transcutaneous neuromuscular electrical stimulation on dysphagia in patients with head and neck cancer treated with definitive chemoradiation. Head Neck. 2015;37(7):1051–6.

    Article  PubMed  Google Scholar 

  92. Li L, Li Y, Huang R, Yin J, Shen Y, Shi J. The value of adding transcutaneous neuromuscular electrical stimulation (VitalStim) to traditional therapy for post-stroke dysphagia: a randomized controlled trial. Eur J Phys Rehabil Med. 2015;51(1):71–8.

    CAS  PubMed  Google Scholar 

  93. Lee KW, Kim SB, Lee JH, Lee SJ, Ri JW, Park JG. The effect of early neuromuscular electrical stimulation therapy in acute/subacute ischemic stroke patients with dysphagia. Ann Rehabil Med. 2014;38(2):153–9.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Terré R, Mearin F. A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury. Eur J Neurol. 2015;22(4):687–e44.

    Article  PubMed  Google Scholar 

  95. Zhang M, Tao T, Zhang Z-B, Zhu X, Fan W-G, Pu L-J, Chu L, Yue S-W. Effectiveness of neuromuscular electrical stimulation on patients with dysphagia with medullary infarction. Arch Phys Med Rehabil. 2016;97(3):355–62.

    Article  PubMed  Google Scholar 

  96. Scarponi L, Mozzanica F, De Cristofaro V, Ginocchio D, Pizzorni N, Bottero A, Schindler A. Neuromuscular electrical stimulation for treatment-refractory chronic dysphagia in tube-fed patients: a prospective case series. Folia Phoniatr Logop. 2015;67(6):308–14.

    Article  PubMed  Google Scholar 

  97. Park J-S, Oh D-H, Hwang N-K, Lee J-H. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial. J Oral Rehabil. 2016;43(6):426–34.

    Article  PubMed  Google Scholar 

  98. Suiter DM, Leder SB, Ruark JL. Effects of neuromuscular electrical stimulation on submental muscle activity. Dysphagia. 2006;21(1):56–60.

    Article  PubMed  Google Scholar 

  99. Bülow M, Speyer R, Baijens L, Woisard V, Ekberg O. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia. 2008;23(3):302–9.

    Article  PubMed  Google Scholar 

  100. Kiger M, Brown CS, Watkins L. Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy. Dysphagia. 2006;21(4):243–53.

    Article  PubMed  Google Scholar 

  101. Lee HY, Hong JS, Lee KC, Shin Y-K, Cho S-R. Changes in hyolaryngeal movement and swallowing function after neuromuscular electrical stimulation in patients with dysphagia. Ann Rehabil Med. 2015;39(2):199–209.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Bath PM, Scutt P, Love J, Clavé P, Cohen D, Dziewas R, Iversen HK, Ledl C, Ragab S, Soda H, Warusevitane A, Woisard V, Hamdy S, Swallowing Treatment Using Pharyngeal Electrical Stimulation (STEPS) Trial Investigators. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke. 2016;47(6):1562–70.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Langmore SE, McCulloch TM, Krisciunas GP, Lazarus CL, Van Daele DJ, Pauloski BR, Rybin D, Doros G. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: a randomized clinical trial. Head Neck. 2016;38(Suppl 1):E1221–31.

    Article  PubMed  Google Scholar 

  104. Tsukano H, Taniguchi H, Hori K, Tsujimura T, Nakamura Y, Inoue M. Individual-dependent effects of pharyngeal electrical stimulation on swallowing in healthy humans. Physiol Behav. 2012;106(2):218–23.

    Article  CAS  PubMed  Google Scholar 

  105. Suntrup S, Teismann I, Wollbrink A, Winkels M, Warnecke T, Pantev C, Dziewas R. Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior—magnetoencephalographic evidence. NeuroImage. 2015;104:117–24.

    Article  PubMed  Google Scholar 

  106. Suntrup S, Marian T, Schröder JB, Suttrup I, Muhle P, Oelenberg S, Hamacher C, Minnerup J, Warnecke T, Dziewas R. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med. 2015;41(9):1629–37.

    Article  CAS  PubMed  Google Scholar 

  107. Restivo DA, Casabona A, Centonze D, Marchese-Ragona R, Maimone D, Pavone A. Pharyngeal electrical stimulation for dysphagia associated with multiple sclerosis: a pilot study. Brain Stimul. 2013;6(3):418–23.

    Article  PubMed  Google Scholar 

  108. Vasant DH, Michou E, O’Leary N, Vail A, Mistry S, Hamdy S, and Greater Manchester Stroke Research Network. Pharyngeal electrical stimulation in dysphagia poststroke: a prospective, randomized single-blinded interventional study. Neurorehabil Neural Repair. 2016.

  109. Lazarus CL, Logemann JA, Pauloski BR, Rademaker AW, Larson CR, Mittal BB, Pierce M. Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res. Aug. 2000;43(4):1011–23.

    Article  CAS  PubMed  Google Scholar 

  110. Steele CM, Cichero JAY. Physiological factors related to aspiration risk: a systematic review. Dysphagia. Jun. 2014;29(3):295–304.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, Lee N, Ho M, Ganz C, Smith B, Sanfilippo N. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Surg. May 2014;43(5):523–30.

    Article  CAS  PubMed  Google Scholar 

  112. Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, Robbins J. Effects of device-facilitated isometric progressive resistance oropharyngeal therapy on swallowing and health-related outcomes in older adults with dysphagia. J Am Geriatr Soc. 2016.

  113. •• Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, Wolkin T. A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016. This study compared the outcomes of two tongue resistance protocols, one that included a swallowing task and one that did not, in patients poststroke. Significant improvements were seen in tongue strength and postswallow vallecular residue with thin liquids regardless of treatment condition .

  114. Chiara T, Martin AD, Davenport PW, Bolser DC. Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough. Arch Phys Med Rehabil. 2006;87(4):468–73.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Pitts T, Bolser D, Rosenbek J, Troche M, Okun MS, Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest. 2009;135(5):1301–8.

    Article  PubMed  Google Scholar 

  116. Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, Romrell J, Pitts T, Wheeler-Hegland KM, Sapienza CM. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75(21):1912–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Plowman EK, Watts SA, Tabor L, Robison R, Gaziano J, Domer AS, Richter J, Vu T, Gooch C. Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve. 2016;54(1):48–53.

    Article  PubMed  PubMed Central  Google Scholar 

  118. Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. 2016.

  119. Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial. Arch Phys Med Rehabil. 2016;97(8):1345–51.

    Article  PubMed  Google Scholar 

  120. Crary MA, Carnaby GD, LaGorio LA, Carvajal PJ. Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program. Arch Phys Med Rehabil. 2012;93(7):1173–8.

    Article  PubMed  Google Scholar 

  121. Carnaby-Mann GD, Crary MA. McNeill dysphagia therapy program: a case-control study. Arch Phys Med Rehabil. 2010;91(5):743–9.

    Article  PubMed  Google Scholar 

  122. Lan Y, Ohkubo M, Berretin-Felix G, Sia I, Carnaby-Mann GD, Crary MA. Normalization of temporal aspects of swallowing physiology after the McNeill dysphagia therapy program. Ann Otol Rhinol Laryngol. 2012;121(8):525–32.

    PubMed  Google Scholar 

  123. Sia I, Carvajal P, Lacy AA, Carnaby GD, Crary MA. Hyoid and laryngeal excursion kinematics—magnitude, duration and velocity—changes following successful exercise-based dysphagia rehabilitation: MDTP. J Oral Rehabil. 2015;42(5):331–9.

    Article  CAS  PubMed  Google Scholar 

  124. • Schaser AJ, Ciucci MR, Connor NP. Cross-activation and detraining effects of tongue exercise in aged rats. Behav Brain Res. 2016;297:285–96. Results of this study showed that tongue exercise paired with a swallow was associated with increased tongue forces in young and old rats as well as an increase in neurotrophin levels in the brainstem hypoglossal nucleus that controls tongue musculature with exercise in old rats. Future work will need to examine carryover of these effects to improvements in swallowing function.

    Article  PubMed  Google Scholar 

  125. •• Kletzien H, Russell JA, Leverson GE, Connor NP. Differential effects of targeted tongue exercise and treadmill running on aging tongue muscle structure and contractile properties. J Appl Physiol. 2013;114(4):472–81. In this study of a group of rats at different ages, targeted tongue exercise was shown to result in an increased proportion of slowly contracting and fast-contracting fatigue-resistant isoforms which may have resulted in the observed decreased fatigue in the old targeted tongue exercise group.

    Article  PubMed  Google Scholar 

  126. • Swigert NB. What’s your value? Acute care wants to know: when hospital administrators look to cut costs, everything is on the table. SLPs can protect themselves by bolstering efficiency and proving their value. ASHA Leader. 2015;20(4):36. This article highlights recent changes to reimbursement models for acute care, including value-based purchasing, and emphasizes the importance of speech-language pathologists playing a role in helping hospitals achieve their overall quality goals that affect reimbursement levels. Several approaches are discussed, including developing programs, such as those that reduce the occurrence of pneumonia, that help the hospital reach its readmission target.

    Article  Google Scholar 

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Acknowledgments

This manuscript was prepared in the Geriatric Research Education and Clinical Center (GRECC) at the William S. Middleton Veteran Affairs Hospital in Madison, WI; GRECC manuscript #2017-001. The views and content expressed in this article are solely the responsibility of the authors and do not necessarily reflect the position, policy, or official views of the Department of Veteran Affairs or the U.S. government.

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Authors and Affiliations

  1. Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA

    Nicole Rogus-Pulia

  2. Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison GRECC (11G), Madison, WI, 53705, USA

    Nicole Rogus-Pulia

  3. Department of Communication Sciences and Disorders, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53705, USA

    Nadine P. Connor

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  1. Nicole Rogus-Pulia
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  2. Nadine P. Connor
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Correspondence to Nicole Rogus-Pulia.

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Nicole Rogus-Pulia reports personal fees from Medbridge as well as grants from the American Speech-Language-Hearing Foundation, the Wisconsin Alzheimer's Disease Research Center, and the Veterans Health Administration's Office of Geriatrics and Extended Care.

Nadine P. Connor reports grants from the National Institutes of Health.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Swallowing Disorders

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Rogus-Pulia, N., Connor, N.P. Muscle Strengthening Approaches to Dysphagia Rehabilitation. Curr Phys Med Rehabil Rep 4, 277–286 (2016). https://doi.org/10.1007/s40141-016-0136-3

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