title: Augmentation of deglutitive thyrohyoid muscle shortening by the Shaker Exercise.
abstract: Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy (p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy (p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation.
authors.affiliation: MCW Dysphagia Institute, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Mepani
authors.forename: Stephen
authors.initials: S
authors.lastname: Antonik
authors.forename: Benson
authors.initials: B
authors.lastname: Massey
authors.forename: Mark
authors.initials: M
authors.lastname: Kern
authors.forename: Jerilyn
authors.initials: J
authors.lastname: Logemann
authors.forename: Barbara
authors.initials: B
authors.lastname: Pauloski
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Caryn
authors.initials: C
authors.lastname: Easterling
authors.forename: Reza
authors.initials: R
authors.lastname: Shaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D006928:Hyoid Bone; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D010609:Pharyngeal Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013957:Thyroid Cartilage; D016896:Treatment Outcome