Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening.
OBJECTIVE
We evaluated the effect of a novel rehabilitative exercise on restoration of deglutition in a group of patients with deglutitive failure caused by abnormal upper esophageal sphincter (UES) opening manifested by postswallow residue and aspiration necessitating percutaneous tube feeding.


METHODS
We studied a total of 27 patients by videofluoroscopy and functional assessment of swallowing scores before and after 6 weeks of a head-raising exercise program. Seven of 27 patients, assigned randomly, participated in a sham exercise before entering the tested exercise program. Eleven of 27 were randomized to the real exercise program.


RESULTS
Although there was no change in swallow function and biomechanics after the sham exercise, following 6 weeks of real exercise, all 11 patients exhibited a significant improvement in their UES opening, anterior laryngeal excursion (P < 0.01), as well as resolution of postdeglutitive aspiration and were able to resume oral feeding. Similar results were found when the 7 patients in the sham group were crossed over to the real exercise group. Comparison of before and after exercise values for anteroposterior UES opening (P < 0.01) and laryngeal anterior excursion (P < 0.05), as well as functional outcome assessment of swallowing (P < 0.05) in the entire group of 27 patients also showed significant improvement. Etiology and duration of dysphagia did not affect the outcome.


CONCLUSIONS
The proposed suprahyoid muscle strengthening exercise program is effective in restoring oral feeding in some patients with deglutitive failure because of abnormal UES opening.
Shaker
Reza
R
MCW Dysphagia Institute, Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, Wisconsin 53226, USA. rshaker@mcw.edu
Easterling
Caryn
C
Kern
Mark
M
Nitschke
Terilynn
T
Massey
Benson
B
Daniels
Stephanie
S
Grande
Barbara
B
Kazandjian
Marta
M
Dikeman
Karen
K
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D018592:Cross-Over Studies; D003679:Deglutition; D003680:Deglutition Disorders / Q000534:rehabilitation*; D004750:Enteral Nutrition; D004943:Esophagogastric Junction / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010608:Pharyngeal Diseases / Q000534:rehabilitation*; D015203:Reproducibility of Results