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Update on Exercise-Based Rehabilitation Approaches for Neurogenic Dysphagia

  • Swallowing Disorders (M Gonzalez-Fernandez, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This article provides clinicians and researchers with a summary of recent research over the past 5 years for exercise-based rehabilitation for neurogenic dysphagia. Research that utilized rehabilitation paradigms in the neurogenic population is emphasized.

Recent Findings

Numerous studies utilizing exercise-based rehabilitation in both non-neurogenic and neurogenic populations provide positive findings following treatment. Recruitment criteria and outcome measures were variable across studies and generally focused on signs and symptoms of dysphagia rather than underlying swallowing impairment. Dosing regimens frequently varied across exercises and studies.

Summary

Recent research in exercise-based dysphagia rehabilitation has added valuable information to the field. The differences across studies regarding recruitment criteria, outcome measures, and dosing, however, make it difficult to synthesize results. Future research should focus on underlying swallowing impairment for recruitment criteria and outcome measures as well as developing optimal dosing and maintenance programs. Improvement in these areas would increase robustness of results and facilitate improved translation of research findings to clinical practice.

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References

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

  1. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed; 1998.

  2. Robbins J, Butler SG, Daniels SK, Gross RD, Langmore S, Lazarus CL, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hearing Res. 2008;51(1):S276–300. https://doi.org/10.1044/1092-4388(2008/021).

    Article  Google Scholar 

  3. Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53(9):1483–9. https://doi.org/10.1111/j.1532-5415.2005.53467.x.

    Article  PubMed  Google Scholar 

  4. Steele CM, Bailey GL, Polacco REC, Hori SF, Molfenter SM, Oshalla M, et al. Outcomes of tongue-pressure strength and accuracy training for dysphagia following acquired brain injury. Int J Speech Lang Pathol. 2013;15(5):492–502. https://doi.org/10.3109/17549507.2012.752864.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lazarus C, Logemann JA, Huang CF, Rademaker AW. Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatr Logop. 2003;55(4):199–205. https://doi.org/10.1159/000071019.

    Article  PubMed  Google Scholar 

  6. Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150–8. https://doi.org/10.1016/j.apmr.2006.11.002.

    Article  PubMed  Google Scholar 

  7. Oh JC. Effects of tongue strength training and detraining on tongue pressures in healthy adults. Dysphagia 2105 30(3):315–20. https://doi.org/10.1007/s00455-015-9601-x

  8. Yeates EM, Molfenter SM, Steele CM. Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: three case reports. Clin Interv Aging. 2008;3(4):735–47. https://doi.org/10.2147/cia.s3825.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, et al. A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016;31(3):452–61. https://doi.org/10.1007/s00455-016-9699-5.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Daniels SK, Huckabee ML, Gozdzikowska K. Dysphagia following stroke. 3rd ed. San Diego: Plural; 2019.

  11. Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, et al. 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. https://doi.org/10.1111/jgs.13933.

    Article  PubMed  Google Scholar 

  12. Van den Steen L, Vanderwegen J, Guns C, Elen R, De Bodt M, Van Nuffelen G. Tongue-strengthening exercises in healthy older adults: does exercise load matter? A randomized controlled trial Dysphagia. 2019;34(3):315–24. https://doi.org/10.1007/s00455-018-9940-5.

    Article  PubMed  Google Scholar 

  13. Yano J, Yamamoto-Shimizu S, Yokoyama T, Kumakura I, Hanayama K, Tsubahara A. Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults. Arch Oral Biol. 2019;98:238–42. https://doi.org/10.1016/j.archoralbio.2018.11.028.

    Article  PubMed  Google Scholar 

  14. • Szynkiewicz SH, Nobriga CV, O’Donoghue CR, Becerra BJ, LaForge G. Motor imagery practice and increased tongue strength: a case series feasibility report. J Speech Lang Hearing Res. 2019;62(6):1676–84. https://doi.org/10.1044/2019_JSLHR-S-18-0128. Novel rehabilitation program that could impact treatment if continued positive results.

    Article  Google Scholar 

  15. Namiki C, Hara K, Tohara H, Kobayashi K, Chantaramanee A, Nakagawa K, et al. Tongue-pressure resistance training improves tongue and suprahyoid muscle functions simultaneously. Clin Interv Aging. 2019;14:601–8. https://doi.org/10.2147/CIA.S194808.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Moon JH, Hahm SC, Won YS, Cho HY. The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial. Int J Rehabil Res. 2018;41(3):204–10. https://doi.org/10.1097/MRR.0000000000000282.

    Article  PubMed  Google Scholar 

  17. Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59–64. https://doi.org/10.1111/joor.12461.

    Article  CAS  PubMed  Google Scholar 

  18. Namasivayam-MacDonald AM, Burnett L, Nagy A, Waito AA, Steele CM. Effect of tongue strength training on mealtime function in long-term care. Am J Speech Lang Pathol. 2017;26(4):1213–24. https://doi.org/10.1044/2017_AJSLP-16-0186.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Lang Pathol. 1996;5(1):23–30. https://doi.org/10.1044/1058-0360.0501.23.

    Article  Google Scholar 

  20. 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. https://doi.org/10.1159/000063192.

    Article  PubMed  Google Scholar 

  21. Fujiu-Kurachi M, Fujiwara S, Tamine KI, Kondo J, Minagi Y, Maeda Y, et al. Tongue pressure generation during tongue-hold swallows in young healthy adults measured with different tongue positions. Dysphagia. 2014;29(1):17–24. https://doi.org/10.1007/s00455-013-9471-z.

    Article  PubMed  Google Scholar 

  22. Hammer MJ, 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. https://doi.org/10.1007/s00455-014-9545-6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Oh JC, Park JW, Cha TH, Woo HS, Kim DK. Exercise using tongue-holding swallow does not improve swallowing function in normal subjects. J Oral Rehabil. 2012;39(5):364–9. https://doi.org/10.1111/j.1365-2842.2011.02274.x.

    Article  PubMed  Google Scholar 

  24. Woo HS, Chang KY, Oh JC. The effect of eight-week tongue holding maneuver program on activation of swallowing related muscles. J Korean Soc Occup Ther. 2014;22(1):53–63. https://doi.org/10.14519/jksot.2014.22.1.05.

    Article  Google Scholar 

  25. Oh JC. Effects of tongue-hold swallows on suprahyoid muscle activation according to the relative tongue protrusion length: a preliminary study. Springerplus. 2016;5(1):1–5. https://doi.org/10.1186/s40064-016-2799-8.

    Article  CAS  Google Scholar 

  26. Fujiwara S, Fujiu-Kurachi M, Hori K, Maeda Y, Ono T. Tongue pressure production and submental surface electromyogram activities during tongue-hold swallow with different holding positions and tongue length. Dysphagia. 2018;33(4):403–13. https://doi.org/10.1007/s00455-017-9865-4.

    Article  PubMed  Google Scholar 

  27. Oh JC. Effects of tongue-hold swallows on suprahyoid muscle activation according to the relative tongue protrusion length in the elderly individuals. Dysphagia. 2019;34(3):382–90. https://doi.org/10.1007/s00455-018-9948-x.

    Article  PubMed  Google Scholar 

  28. Aihara K, Inamoto Y, Aoyagi Y, Shibata S, Kagaya H, Sato Y, et al. Effect of tongue-hold swallow on pharyngeal cavity: kinematic analysis using 320-row area detector CT. Jpn J Compr Rehabil Sci. 2020;11:35–42. https://doi.org/10.11336/jjcrs.11.35.

    Article  Google Scholar 

  29. Byeon H. Effect of the Masako maneuver and neuromuscular electrical stimulation on the improvement of swallowing function in patients with dysphagia caused by stroke. J Phys Ther Sci. 2016;28(7):2069–71. https://doi.org/10.1589/jpts.28.2069.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kumaresan A, Manoj Abraham M, Nayak CK. The effectiveness of Masako manoeuvre on post-stroke dysphagia. Int J Res Pharm Sci 2018:9(4):1457–9. https://pharmascope.org/ijrps/article/view/491

  31. Pouderoux P, Kahrilas PJ. Deglutitive tongue force modulation by volition, volume, and viscosity in humans. Gastroenterology. 1995;108(5):1418–26. https://doi.org/10.1016/0016-5085(95)90690-8.

    Article  CAS  PubMed  Google Scholar 

  32. Huckabee ML, 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. https://doi.org/10.1016/j.apmr.2006.04.019.

    Article  PubMed  Google Scholar 

  33. Bülow M, Olsson R, Ekberg O. Videomanometric analysis of suproglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia. 2001;16(3):190–5. https://doi.org/10.1007/s00455-001-0065-9.

    Article  PubMed  Google Scholar 

  34. Bülow M, Olsson R, Ekberg O. Videomanometric analysis of suproglottic swallow, effortful swallow, and chin tuck in healthy volunteers. Dysphagia. 1999;14(2):67–72. https://doi.org/10.1007/PL00009589.

    Article  PubMed  Google Scholar 

  35. 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. https://doi.org/10.1053/apmr.2001.28006.

    Article  CAS  PubMed  Google Scholar 

  36. • Molfenter SM, Hsu CY, Lu Y, Lazarus CL. Alterations to swallowing physiology as the result of effortful swallowing in healthy seniors. Dysphagia. 2018;33(3):380–8. https://doi.org/10.1007/s00455-017-9863-6. While this article evaluated immediate effects, it provides an excellent example of sufficient detail for replication.

    Article  PubMed  Google Scholar 

  37. 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. https://doi.org/10.1111/joor.12312.

    Article  CAS  PubMed  Google Scholar 

  38. Park T, Kim Y. Effects of tongue pressing effortful swallow in older healthy individuals. Arch Gerontol Geriatr. 2016;66:127–33. https://doi.org/10.1016/j.archger.2016.05.009.

    Article  PubMed  Google Scholar 

  39. Park JW, Hong HJ, Nam K. Comparison of three exercises on increasing tongue strength in healthy young adults. Arch Oral Biol. 2020;111:104636. https://doi.org/10.1016/j.archoralbio.2019.104636.

    Article  PubMed  Google Scholar 

  40. Park HS, Oh DH, Yoon T, Park JS. Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial. Int J Lang Commun Disord. 2019;54(3):479–84. https://doi.org/10.1111/1460-6984.12453.

    Article  PubMed  Google Scholar 

  41. Kim JH, Kim YA, Kim KS, Kim ST, Kim TS, Cho YS. Effect of the combination of Mendelsohn maneuver and effortful swallowing on aspiration in patients with dysphagia after stroke. J Phys Ther Sci. 2017;29(11):1967–9. https://doi.org/10.1589/jpts.29.1967.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kim H, Park JW, Nam K. Effortful swallow with resistive electrical stimulation training improves pharyngeal constriction in patients post-stroke with dysphagia. J Oral Rehabil. 2017;44(10):763–9. https://doi.org/10.1111/joor.12538.

    Article  CAS  PubMed  Google Scholar 

  43. Park JS, Oh DH, Hwang NK, Lee JH. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomized controlled trial. J Oral Rehabil. 2016;43(6):426–34. https://doi.org/10.1111/joor.12390.

    Article  PubMed  Google Scholar 

  44. Gosselink R, Kovacs L, Ketelaer P, Carton H, Decramer M. Respiratory muscle weakness and respiratory muscle training in severely disabled multiple sclerosis patients. Arch Phys Med Rehabil. 2000;81(6):747–51. https://doi.org/10.1016/s0003-9993(00)90105-9.

    Article  CAS  PubMed  Google Scholar 

  45. Wheeler KM, Chiara T, Sapienza CM. Surface electromyographic activity of the submental muscles during swallow and expiratory pressure threshold training tasks. Dysphagia. 2007;22(2):108–16. https://doi.org/10.1007/s00455-006-9061-4.

    Article  PubMed  Google Scholar 

  46. Laciuga H, Davenport PW, Sapienza C. The acute effects of a single session of expiratory muscle strength training on blood pressure, heart rate, and oxygen saturation in healthy adults. Front Physiol. 2012;3:48. https://doi.org/10.3389/fphys.2012.00048.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Saleem AF, Sapienza CM, Okun MS. Respiratory muscle strength training: treatment and response duration in a patient with early idiopathic Parkinson’s disease. NeuroRehabilitation 2005:20(4):323–33. https://www.ncbi.nlm.nih.gov/pubmed/16403998

  48. Silverman EP, Sapienza CM, Saleem A, Carmichael C, Davenport PW, Hoffman-Ruddy B, et al. Tutorial on maximum inspiratory and expiratory mouth pressures in individuals with idiopathic Parkinson disease (IPD) and the preliminary results of an expiratory muscle strength training program. NeuroRehabilitation. 2006;21(1):71–9. https://doi.org/10.3233/NRE-2006-21110.

    Article  PubMed  Google Scholar 

  49. 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. https://doi.org/10.1378/chest.08-1389.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75(21):1912–9. https://doi.org/10.1212/WNL.0b013e3181fef115.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Baker S, Davenport P, Sapienza C. Examination of strength training and detraining effects in expiratory muscles. J Speech Lang Hearing Res. 2005;48(6):1325–33. https://doi.org/10.1044/1092-4388(2005/092).

    Article  Google Scholar 

  52. Kim J, Davenport P, Sapienza C. Effect of expiratory muscle strength training on elderly cough function. Arch Gerontol Geriatr. 2009;48(3):361–6. https://doi.org/10.1016/j.archger.2008.03.006.

    Article  PubMed  Google Scholar 

  53. 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. https://doi.org/10.1016/j.apmr.2005.12.035.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Troche MS, Rosenbek JC, Okun MS, Sapienza CM. Detraining outcomes with expiratory muscle strength training in Parkinson disease. J Rehabil Res Dev. 2014;51(2):305–10. https://doi.org/10.1682/JRRD.2013.05.0101.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Hutcheson KA, Barrow MP, Plowman EK, Lai SY, Fuller CD, Barringer DA, et al. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: a case series. Laryngoscope. 2018;128(5):1044–51. https://doi.org/10.1002/lary.26845.

    Article  PubMed  Google Scholar 

  56. Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology. 2017;34(1):121–8. https://doi.org/10.1111/ger.12234.

    Article  PubMed  Google Scholar 

  57. 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. https://doi.org/10.1016/j.apmr.2016.03.027.

    Article  PubMed  Google Scholar 

  58. Moon JH, Jung JH, Won YS, Cho HY, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phys Ther Sci. 2017;29(4):609–12. https://doi.org/10.1589/jpts.29.609.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Eom MJ, Chang MY, Oh DH, Kim HD, Han NM, Park JS. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. NeuroRehabilitation. 2017;41(4):747–52. https://doi.org/10.3233/NRE-172192.

    Article  PubMed  Google Scholar 

  60. Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil. 2016;43(5):364–72. https://doi.org/10.1111/joor.12382.

    Article  CAS  PubMed  Google Scholar 

  61. Kuo YC, Chan J, Wu YP, Bernard JR, Liao YH. Effect of expiratory muscle strength training intervention on the maximum expiratory pressure and quality of life of patients with Parkinson disease. NeuroRehabilitation. 2017;41(1):219–26. https://doi.org/10.3233/NRE-171474.

    Article  PubMed  Google Scholar 

  62. • Plowman EK, Tabor-Gray L, Rosado KM, Vasilopoulos T, Robison R, Chapin JL, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis: results of a randomized, sham-controlled trial. Muscle Nerve. 2019;59(1):40–6. https://doi.org/10.1002/mus.26292. This article evaluates EMST in individuals with ALS and demonstrates preservation of swallowing function in the exercise group and worsening function in the control group.

    Article  PubMed  Google Scholar 

  63. Plowman EK, Watts SA, Tabor L, Robison R, Gaziano J, Domer AS, et al. Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve. 2016;54(1):48–53. https://doi.org/10.1002/mus.24990.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Tabor LC, Rosado KM, Robison R, Hegland K, Humbert IA, Plowman EK. Respiratory training in an individual with amyotrophic lateral sclerosis. Ann Clin Transl Neurol. 2016;3(10):819–23. https://doi.org/10.1002/acn3.342.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Mohannak N, Pattison G, Radich B, Hird K, Godecke E, Mastaglia F, et al. Exploring the efficacy of the expiratory muscle strength trainer to improve swallowing in inclusion body myositis: a pilot study. Neuromuscul Disord. 2020;30(4):294–300. https://doi.org/10.1016/j.nmd.2020.02.010.

    Article  PubMed  Google Scholar 

  66. Allen J, Astin R, Smith C, Banks D, Turner C. Expiratory muscle strength training improves measures of pressure generation and cough strength in a patient with myotonic dystrophy type 1. Neuromuscul Disord. 2020;30(9):750–5. https://doi.org/10.1016/j.nmd.2020.07.003.

    Article  PubMed  Google Scholar 

  67. Silverman EP, Miller S, Zhang Y, Hoffman-Ruddy B, Yeager J, Daly JJ. Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis. Mult Scler J Exp Transl Clin. 2017;3(2):2055217317710829. https://doi.org/10.1177/2055217317710829.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Kahrilas PJ, Logemann JA, Krugler C, Flanagan E. Volitional augmentation of upper esophageal sphincter opening during swallowing. Am J Physiol. 1991;260(3 Pt 1):G450-6. https://doi.org/10.1152/ajpgi.1991.260.3.G450.

    Article  CAS  PubMed  Google Scholar 

  69. Mendelsohn M, McConnel FM. Function in the pharyngoesophageal segment. Laryngoscope. 1987;97(4):483–9. https://doi.org/10.1288/00005537-198704000-00014.

    Article  CAS  PubMed  Google Scholar 

  70. Wheeler-Hegland KM, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hearing Res. 2008;51(5):1072–87. https://doi.org/10.1044/1092-4388(2008/07-0016).

    Article  Google Scholar 

  71. 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. https://doi.org/10.1007/s00455-011-9385-6.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Macrae P, Anderson C, Taylor-Kamara I, Humbert I. The effects of feedback on volitional manipulation of airway protection during swallowing. J Mot Behav. 2014;46(2):133–9. https://doi.org/10.1080/00222895.2013.878303.

    Article  PubMed  Google Scholar 

  73. McCullough GH, Kamarunas E, Mann GC, Schmidley JW, Robbin JA, Crary MA. Effects of Mendelsohn maneuver on measures of swallowing duration post-stroke. Top Stroke Rehabil. 2012;19(3):234–43. https://doi.org/10.1310/tsr1903-234.

    Article  PubMed  PubMed Central  Google Scholar 

  74. 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. https://doi.org/10.1007/s00455-013-9461-1.

    Article  PubMed  Google Scholar 

  75. Inamoto Y, Saitoh E, Ito Y, Kagaya H, Aoyagi Y, Shibata S, et al. The Mendelsohn maneuver and its effects on swallowing: kinematic analysis in three dimensions using dynamic area detector CT. Dysphagia. 2018;33(4):419–30. https://doi.org/10.1007/s00455-017-9870-7.

    Article  PubMed  Google Scholar 

  76. Doeltgen SH, Ong E, Scholten I, Cock C, Omari T. Biomechanical quantification of Mendelsohn maneuver and effortful swallowing on pharyngoesophageal function. Otolaryngol Head Neck Surg. 2017;157(5):816–23. https://doi.org/10.1177/0194599817708173.

    Article  PubMed  Google Scholar 

  77. Guedes R, Azola A, Macrae P, Sunday K, Mejia V, Vose A, et al. Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults. Physiol Behav. 2017;174:155–61. https://doi.org/10.1016/j.physbeh.2017.03.018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Azola AM, Sunday KL, Humbert IA. Kinematic visual biofeedback improves accuracy of learning a swallowing maneuver and accuracy of clinician cues during training. Dysphagia. 2017;32(1):115–22. https://doi.org/10.1007/s00455-016-9749-z.

    Article  PubMed  Google Scholar 

  79. Byeon H. Combined effects of NMES and Mendelsohn maneuver on the swallowing function and swallowing-quality of life of patients with stroke-induced sub-acute swallowing disorders. Biomedicines 2020:8(1). https://doi.org/10.3390/biomedicines8010012

  80. Shaker R, Kern M, Bardan E, Taylor A, Stewart ET, Hoffmann RG, et al. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol. 1997;272(6 Pt 1):G1518–22.

    CAS  PubMed  Google Scholar 

  81. Mepani R, Antonik S, Massey B, Kern M, Logemann J, Pauloski B, et al. Augmentation of deglutitive thyrohyoid muscle shortening by the Shaker exercise. Dysphagia. 2009;24(1):26–31. https://doi.org/10.1007/s00455-008-9167-y.

    Article  PubMed  Google Scholar 

  82. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(5):1314–21. https://doi.org/10.1053/gast.2002.32999.

    Article  PubMed  Google Scholar 

  83. 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.

    Article  PubMed  Google Scholar 

  84. Ohba S, Yokoyama J, Kojima M, Fujimaki M, Anzai T, Komatsu H, et al. Significant preservation of swallowing function in chemoradiotherapy for advanced head and neck cancer by prophylactic swallowing exercise. Head Neck. 2016;38(4):517–21. https://doi.org/10.1002/hed.23913.

    Article  PubMed  Google Scholar 

  85. Park JS, Hwang NK, Oh DH, Chang MY. Effect of head lift exercise on kinematic motion of the hyolaryngeal complex and aspiration in patients with dysphagic stroke. J Oral Rehabil. 2017;44(5):385–91. https://doi.org/10.1111/joor.12492.

    Article  CAS  PubMed  Google Scholar 

  86. Choi JB, Shim SH, Yang JE, Kim HD, Lee DH, Park JS. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. NeuroRehabilitation. 2017;41(4):753–7. https://doi.org/10.3233/NRE-172145.

    Article  PubMed  Google Scholar 

  87. Kim KD, Lee HJ, Lee MH, Ryu HJ. Effects of neck exercises on swallowing function of patients with stroke. J Phys Ther Sci. 2015;27(4):1005–8. https://doi.org/10.1589/jpts.27.1005.

    Article  Google Scholar 

  88. 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. https://doi.org/10.1007/s00455-015-9651-0.

    Article  PubMed  Google Scholar 

  89. Fujiki RB, Oliver AJ, Malandraki JB, Wetzel D, Craig BA, Malandraki GA. The recline and head lift exercises: a randomized clinical trial comparing biomechanical swallowing outcomes and perceived effort in healthy older adults. J Speech Lang Hearing Res. 2019;62(3):631–3. https://doi.org/10.1044/2018_JSLHR-S-18-0117.

    Article  Google Scholar 

  90. Yoon WL, Khoo JKP, Liow SJR. 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.

    Article  PubMed  Google Scholar 

  91. Sze WP, Yoon WL, Escoffier N, Liow SJR. 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.

    Article  PubMed  Google Scholar 

  92. Kılınç HE, Arslan SS, Demir N, Karaduman A. The effects of different exercise trainings on suprahyoid muscle activation, tongue pressure force and dysphagia limit in healthy subjects. Dysphagia. 2020;35(4):717–24. https://doi.org/10.1007/s00455-019-10079-w.

    Article  PubMed  Google Scholar 

  93. Park JS, An DH, Oh DH, Chang MY. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation. 2018;42(2):191–7. https://doi.org/10.3233/NRE-172250.

    Article  PubMed  Google Scholar 

  94. Kim HH, Park JS. Efficacy of modified chin tuck against resistance exercise using hand-free device for dysphagia in stroke survivors: a randomised controlled trial. J Oral Rehabil. 2019;46(11):1042–6. https://doi.org/10.1111/joor.12837.

    Article  CAS  PubMed  Google Scholar 

  95. Gao J, Zhang HJ. Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med. 2017;53(3):426–32. https://doi.org/10.23736/s1973-9087.16.04346-x.

    Article  PubMed  Google Scholar 

  96. Wada S, Tohara H, Iida T, Inoue M, Sato M, Ueda K. Jaw-opening exercise for insufficient opening of upper esophageal sphincter. Arch Phys Med Rehabil. 2012;93(11):1995–9. https://doi.org/10.1016/j.apmr.2012.04.025.

    Article  PubMed  Google Scholar 

  97. Matsubara M, Tohara H, Hara K, Shinozaki H, Yamazaki Y, Susa C, et al. High-speed jaw-opening exercise in training suprahyoid fast-twitch muscle fibers. Clin Interv Aging. 2018;13:125–31. https://doi.org/10.2147/CIA.S152821.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Kraaijenga SAC, Van Der Molen L, Stuiver MM, Teertstra HJ, Hilgers FJM, van Den Brekel MWM. Effects of strengthening exercises on swallowing musculature and function in senior healthy subjects: a prospective effectiveness and feasibility study. Dysphagia. 2015;30(4):392–403. https://doi.org/10.1007/s00405-014-3379-6.

    Article  CAS  PubMed  Google Scholar 

  99. Kraaijenga SA, Molen LVD, Stuiver MM, Takes RP, Al-Mamgani A, van Den Brekel MWM, et al. Efficacy of a novel swallowing exercise program for chronic dysphagia in long-term head and neck cancer survivors. Head Neck. 2017;39(10):1943–61. https://doi.org/10.1002/hed.24710.

    Article  PubMed  Google Scholar 

  100. Oh DH, Won JH, Kim YA, Kim WJ. Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study. J Phys Ther Sci. 2017;29(10):1817–8. https://doi.org/10.1589/jpts.29.1817.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Koyama Y, Sugimoto A, Hamano T, Kasahara T, Toyokura M, Masakado Y. Proposal for a modified jaw opening exercise for dysphagia: a randomized, controlled trial. Tokai J Exp Clin Med. 2017;42(2):71–8.

    CAS  PubMed  Google Scholar 

  102. Choi JB, Jung YJ, Park JS. Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift exercise for dysphagic stroke: a pilot study. Medicine. 2020;99(38):e22136. https://doi.org/10.1097/MD.0000000000022136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. •• Rogus-Pulia NM, Plowman EK. Shifting tides toward a proactive patient-centered approach in dysphagia management of neurodegenerative disease. Am J Speech Lang Pathol. 2020;29(2S):1094–109. https://doi.org/10.1044/2020_AJSLP-19-00136. Convincing viewpoint concerning need to consider proactive approaches to maintain swallowing for as long as possible in individuals with degenerative disease.

    Article  PubMed  PubMed Central  Google Scholar 

  104. • McKenna VS, Zhang B, Haines MB, Kelchner LN. A systematic review of isometric lingual strength-training programs in adults with and without dysphagia. Am J Speech Lang Pathol. 2017;26(2):524–39. https://doi.org/10.1044/2016_AJSLP-15-0051. Systematic review of lingual resistance training highlighting strengths and limitations of current evidence and providing suggestions for future research.

    Article  PubMed  PubMed Central  Google Scholar 

  105. • Smaoui S, Langridge A, Steele CM. The effect of lingual resistance training interventions on adult swallow function: a systematic review. Dysphagia. 2020;35(5):745–61. https://doi.org/10.1007/s00455-019-10066-1. Systematic review of lingual resistance training highlighting strengths and limitations of current evidence and providing suggestions for future research.

    Article  PubMed  Google Scholar 

  106. •• Krekeler BN, Rowe LM, Connor NP. Dose in exercise-based dysphagia therapies: a scoping review. Dysphagia. 2021;36(1):1–32. https://doi.org/10.1007/s00455-020-10104-3. Strong scoping review of exercise-based dysphagia rehabilitation providing strengths, limitations, and future directions.

    Article  PubMed  Google Scholar 

  107. Krekeler BN, Vitale K, Yee J, Powell R, Rogus-Pulia N. Adherence to dysphagia treatment recommendations: a conceptual model. J Speech Lang Hearing Res. 2020;63(6):1641–57. https://doi.org/10.1044/2020_JSLHR-19-00270.

    Article  Google Scholar 

  108. Malandraki GA, Rajappa A, Kantarcigil C, Wagner E, Ivey C, Youse K. The intensive dysphagia rehabilitation approach applied to patients with neurogenic dysphagia: a case series design study. Arch Phys Med Rehabil. 2016;97(4):567–74. https://doi.org/10.1016/j.apmr.2015.11.019.

    Article  PubMed  Google Scholar 

  109. Jenks J, Pitts LL. Effects of an intensive exercise-based swallowing program for persons with Parkinson’s disease and complex medical history: a single-case experiment. Am J Speech Lang Pathol. 2019;28(3):1268–74. https://doi.org/10.1044/2019_AJSLP-18-0168.

    Article  PubMed  Google Scholar 

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  1. Department of Communication Sciences and Disorders, University of Houston, Melcher Life Sciences, 3875 Holman St. Room M156, Houston, TX, 77204-6018, USA

    Cecilia C. Félix-Lusterman, Megan E. Joseph & Stephanie K. Daniels

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Félix-Lusterman, C.C., Joseph, M.E. & Daniels, S.K. Update on Exercise-Based Rehabilitation Approaches for Neurogenic Dysphagia. Curr Phys Med Rehabil Rep 9, 252–266 (2021). https://doi.org/10.1007/s40141-021-00333-4

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