Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization.
OBJECTIVE
To investigate the feasibility of cervical spine mobilization in elderly dementia patients with dysphagia, and its effect on swallowing capacity.


METHODS
Fifteen nursing home residents (9 women, 6 men, age range 77-98 years) with severe dementia (median Mini Mental State Examination score=8/30, percentile (P)25-75=4-13) and known dysphagia participated in a randomized controlled trial with cross-over design. Cervical spine mobilization was administered by trained physiotherapists. Control sessions consisted of socializing visits. Feasibility (attendance, hostility, complications) and maximal swallowing volume (water bolus 1-20 ml) were assessed following one session and one week (3 sessions) of treatment and control.


RESULTS
Ninety percent of cervical spine mobilization sessions were completed successfully (3 sessions could not be carried out due to the patient's hostility and 2 due to illness) and no complications were observed. Swallowing capacity improved significantly after cervical spine mobilization (from 3 ml (P25-75=1-10) to 5 ml (P25-75=3-15) after one session p=0.01 and to 10 ml (P25-75=5-20) (+230%) after one week treatment p=0.03) compared with control (no significant changes, difference in evolution after one session between treatment and control, p=0.03).


CONCLUSIONS
Cervical spine mobilization is feasible and can improve swallowing capacity in cognitively impaired residents in nursing homes. Given the acute improvements following treatment, it is probably best provided before meals.
Frailty in Ageing Research Group, Vrije Universiteit Brussel, Laarbeeklaan103, BE-1090 Brussels, Belgium. ivan.bautmans@vub.ac.be
Ivan
I
Bautmans
Jeroen
J
Demarteau
Bjorn
B
Cruts
Jean-Claude
JC
Lemper
Tony
T
Mets
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000503:physiopathology; D002574:Cervical Vertebrae; D003072:Cognition Disorders / Q000150:complications* / Q000503:physiopathology; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D009735:Nursing Homes; D016896:Treatment Outcome