Effortful Swallow

Chapter

Abstract

As one of the first techniques to emerge in the management of the patient with swallowing impairment, the effortful swallow technique provides an excellent example of how our thinking has evolved in this area of clinical practice. This chapter will summarize the literature related to the application of effortful swallowing first as a compensatory mechanism, then as a task emphasizing strength training and finally ­representing the paradigm shift to skill training in dysphagia rehabilitation. Despite potential positive influences on swallowing physiology, no intervention is without potential for complication, thus clinicians are encouraged to understand potential adverse ramifications and judiciously apply this technique to patient populations.

References

  1. 1.
    Logemann JL. Treatment for aspiration related to dysphagia: an overview. Dysphagia. 1986;1(1):31–8.CrossRefGoogle Scholar
  2. 2.
    Bulow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers. Dysphagia. 1999;14(2):67–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Bulow 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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Doeltgen SH, Witte U, Gumbley F, Huckabee ML. Evaluation of manometric measures during tongue-hold swallows. Am J Speech Lang Pathol. 2009;18(1):65–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Huckabee ML, 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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Folland JP, Williams AG. The adaptations to strength training: morphological and neurological contributions to increased strength. Sports Med. 2007;37(2):145–68.PubMedCrossRefGoogle Scholar
  9. 9.
    Rasch PJ, Morehouse LE. Effect of static and dynamic exercises on muscular strength and hypertrophy. J Appl Phys. 1957;11(1):29–34.Google Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Langmore SE. Efficacy of behavioral treatment for oropharyngeal dysphagia. Dysphagia. 1995;10(4):259–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Robbins J, Butler SG, Daniels SK, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51(1):S276–300.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosenbek JC. Efficacy in dysphagia. Dysphagia. 1995;10(4):263–7.PubMedCrossRefGoogle Scholar
  14. 14.
    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 Hear Res. 2008;51(5):1072–87.PubMedCrossRefGoogle Scholar
  15. 15.
    Ohmae Y, Sugiura M, Matumura Y. Role of anterior tongue as an anchor during swallow. In: Yoshimura H, Kida A, Arai T, Niimi S, Kaneko M, Kitahara S, editors. Bronchology and bronchoesophagology: State of the Art; Proceedings of the 11th World Congress for Bronchology (WCB) & the 11th World Congress for Bronchoesophagology (WCBE). Elsevier; 2001. p. 433–5.Google Scholar
  16. 16.
    Witte U, Huckabee ML, Doeltgen SH, Gumbley F, Robb M. The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants. Arch Phys Med Rehabil. 2008;89(5):822–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Hiss SG, Huckabee ML. Timing of pharyngeal and upper esophageal sphincter pressures as a function of normal and effortful swallowing in young healthy adults. Dysphagia. 2005;20(2):149–56.PubMedCrossRefGoogle Scholar
  18. 18.
    Perlman AL, Christensen J. Topography and functional anatomy of the swallowing structures. In: Perlman AL, Schulze-Delrieu K, editors. Deglutition and its disorders: Anatomy, physiology, clinical diagnosis, and management. New York: Thompson Delmar Learning; 1997.Google Scholar
  19. 19.
    Miller AJ. The neuroscientific principles of swallowing and dysphagia. San Diego: Singular Publishing Group; 1999.Google Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    Steele CM, Huckabee ML. The influence of orolingual pressure on the timing of pharyngeal pressure events. Dysphagia. 2007;22(1):30–6.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Pouderoux P, Kahrilas PJ. Deglutitive tongue force modulation by volition, volume, and viscosity in humans. Gastroenterology. 1995;108(5):1418–26.PubMedCrossRefGoogle Scholar
  24. 24.
    Bulow 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.PubMedCrossRefGoogle Scholar
  25. 25.
    Garcia JM, Hakel M, Lazarus C. Unexpected consequence of effortful swallowing: case study report. J Med Speech Lang Pathol. 2004;12(2):59–66.Google Scholar
  26. 26.
    Bryant M. Biofeedback in the treatment of a selected dysphagic patient. Dysphagia. 1991;6(3):140–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Crary MA. A direct intervention program for chronic neurogenic dysphagia secondary to brain-stem stroke. Dysphagia. 1995;10(1):6–18.PubMedCrossRefGoogle Scholar
  28. 28.
    Huckabee ML, Cannito MP. Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: a retrospective evaluation. Dysphagia. 1999;14(2):93–109.PubMedCrossRefGoogle Scholar
  29. 29.
    Aizawa H, Inase M, Mushiake H, Shima K, Tanji J. Reorganization of activity in the supplementary motor area associated with motor learning and functional recovery. Exp Brain Res. 1991;84(3):668–71.PubMedCrossRefGoogle Scholar
  30. 30.
    Hamdy S, Aziz Q, Rothwell JC, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115(5):1104–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Tyc F, Boyadjian A, Devanne H. Motor cortex plasticity induced by extensive training revealed by transcranial magnetic stimulation in human. Eur J Neurosci. 2005;21(1): 259–66.PubMedCrossRefGoogle Scholar
  32. 32.
    Nudo RJ, Milliken GW, Jenkins WM, Merzenich MM. Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys. J Neurosci. 1996;16(2):785–807.PubMedGoogle Scholar
  33. 33.
    Recanzone GH, Schreiner CE, Merzenich MM. Plasticity in the frequency representation of primary auditory-cortex following discrimination-training in adult owl monkeys. J Neurosci. 1993;13(1):87–103.PubMedGoogle Scholar
  34. 34.
    Karni A, Bertini G. Learning perceptual skills: behavioral probes into adult cortical plasticity. Curr Opin Neurobiol. 1997;7(4):530–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Jensen JL, Marstrand PCD, Nielsen JB. Motor skill training and strength training are associated with different plastic changes in the central nervous system. J Appl Phys. 2005;99(4):1558–68.CrossRefGoogle Scholar
  36. 36.
    Remple MS, Bruneau RM, VandenBerg PM, Goertzen C, Kleim JA. Sensitivity of cortical movement representations to motor experience: evidence that skill learning but not strength training induces cortical reorganization. Behav Brain Res. 2001;123(2):133–41.PubMedCrossRefGoogle Scholar
  37. 37.
    Hogan N, Krebs HI, Rohrer B, et al. Motions or muscles? Some behavioral factors underlying robotic assistance of motor recovery. J Rehabil Res Dev. 2006;43(5):605–18.PubMedCrossRefGoogle Scholar
  38. 38.
    Nelles G, Jentzen W, Jueptner M, Muller S, Diener HC. Arm training induced brain plasticity in stroke studied with serial positron emission tomography. Neuroimage. 2001;13(6):1146–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Ziemann U, Muellbacher W, Hallett M, Cohen LG. Modulation of practice-dependent plasticity in human motor cortex. Brain. 2001;124:1171–81.PubMedCrossRefGoogle Scholar
  40. 40.
    Koski L, Mernar TJ, Dobkin BH. Immediate and long-term changes in corticomotor output in response to rehabilitation: Correlation with functional improvements in chronic stroke. Neurorehabil Neural Repair. 2004;18(4):230–49.PubMedCrossRefGoogle Scholar
  41. 41.
    Piron L, Piccione F, Tonin P, Dam M. Clinical correlation between motor evoked potentials and gait recovery in poststroke patients. Arch Phys Med Rehabil. 2005;86(9):1874–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Sessle BJ, Adachi K, Avivi-Arber L, et al. Neuroplasticity of face primary motor cortex control of orofacial movements. Arch Oral Biol. 2007;52(4):334–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Sessle BJ, Yao D, Nishiura H, et al. Properties and plasticity of the primate somatosensory and motor cortex related to orofacial sensorimotor function. Clin Exp Pharmacol Physiol. 2005;32(1–2):109–14.PubMedCrossRefGoogle Scholar
  44. 44.
    Barnett ML, Ross D, Schmidt RA, Todd B. Motor skills learning and the specificity of training principle. Res Q. 1973;44(4):440–7.PubMedGoogle Scholar
  45. 45.
    Barritt AW, Smithard DG. Role of cerebral cortex plasticity in the recovery of swallowing function following dysphagic stroke. Dysphagia. 2009;24(1):83–90.PubMedCrossRefGoogle Scholar
  46. 46.
    Hamdy S, Rothwell JC, Aziz Q, Thompson DG. Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke. Clin Sci. 2000;99(2):151–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Gallas S, Marie JP, Leroi AM, Verin E. Impact of swallowing and ventilation on oropharyngeal cortical representation. Respir Physiol Neurobiol. 2009;167(2):208–13.PubMedCrossRefGoogle Scholar
  48. 48.
    Moreau CE, Moreau SR. Chiropractic management of a professional hockey player with recurrent shoulder instability. J Manipulative Physiol Ther. 2001;24(6):425–30.PubMedCrossRefGoogle Scholar
  49. 49.
    Rose DJ, Christina RW. A multilevel approach to the study of motor control and learning. 2nd ed. San Francisco: Pearson Education Incorporated; 2006.Google Scholar
  50. 50.
    Gow D, Rothwell J, Hobson A, Thompson D, Hamdy S. Induction of long-term plasticity in human swallowing motor cortex following repetitive cortical stimulation. Clin Neurophysiol. 2004;115(5):1044–51.PubMedCrossRefGoogle Scholar
  51. 51.
    Wallace DA, Beard DJ, Gill RHS, Carr AJ. Reflex muscle contraction in anterior shoulder instability. J Shoulder Elbow Surg. 1997;6(2):150–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Borsa PA, Sauers EL, Lephart SM. Functional training for the restoration of dynamic stability in the PCL-injured knee. J Sport Rehabil. 1999;8(4):362–78.Google Scholar
  53. 53.
    Lephart SM, Giraldo JL, Borsa PA, Fu FH. Knee joint proprioception: a comparison between female intercollegiate gymnasts and controls. Knee Surg Sports Traumatol Arthrosc. 1996;4(2):121–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997;25(1):130–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Edgerton VR, Tillakaratne NJK, Bigbee AJ, de Leon RD, Roy RR. Plasticity of the spinal neural circuitry after injury. Annu Rev Neurosci. 2004;27:145–67.PubMedCrossRefGoogle Scholar
  56. 56.
    Holmich P. Adductor-related groin pain in athletes. Sports Med Arthro Rev. 1997; 5(4):285–91.Google Scholar
  57. 57.
    Zhang J, Yang R, Pendlebery W, Luo P. Monosynaptic circuitry of trigeminal proprioceptive afferents coordinating jaw movement with visceral and laryngeal activities in rats. Neuroscience. 2005;135(2):497–505.PubMedCrossRefGoogle Scholar
  58. 58.
    Zhang JD, Luo PF, Pendlebury WW. Light and electron microscopic observations of a direct projection from mesencephalic trigeminal nucleus neurons to hypoglossal motoneurons in the rat. Brain Res. 2001;917(1):67–80.PubMedCrossRefGoogle Scholar
  59. 59.
    Zhang JD, Pendlebury WW, Luo PF. Synaptic organization of monosynaptic connections from mesencephalic trigeminal nucleus neurons to hypoglossal motoneurons in the rat. Synapse. 2003;49(3):157–69.PubMedCrossRefGoogle Scholar
  60. 60.
    Hamdy S, Aziz Q, Rothwell JC, Hobson A, Barlow J, Thompson DG. Cranial nerve modulation of human cortical swallowing motor pathways. Am J Physiol Gastro Liver Phys. 1997;35(4):G802–8.Google Scholar
  61. 61.
    Hamdy S, Aziz Q, Rothwell JC, Hobson A, Thompson DG. Sensorimotor modulation of human cortical swallowing pathways. J Physiol Lond. 1998;506(3):857–66.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Swallowing Rehabilitation Research Lab at the New Zealand Brain Research InstituteThe University of CanterburyChristchurchNew Zealand
  2. 2.Swallowing Rehabilitation Research Lab at the Van der Veer InstituteThe University of CanterburyChristchurchNew Zealand

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