title: Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program.
abstract: OBJECTIVE
  To investigate functional and physiological changes in swallowing performance of adults with chronic dysphagia after an exercise-based dysphagia therapy.
  
  
  METHODS
  Intervention study: before-after trial with 3-month follow-up evaluation.
  
  
  METHODS
  Outpatient clinic within a tertiary care academic health science center.
  
  
  METHODS
  Adults (N=9) with chronic (>12 mo) dysphagia after unsuccessful prior therapies. Subjects were identified from among patients referred to an outpatient dysphagia clinic. Subjects had dysphagia secondary to prior treatment for head/neck cancer or from neurologic injury. All subjects demonstrated clinical and fluoroscopic evidence of oropharyngeal dysphagia. No subject withdrew during the course of this study.
  
  
  METHODS
  All subjects completed 3 weeks of an intensive, exercise-based dysphagia therapy. Therapy was conducted daily for 1h/d, with additional activities completed by subjects each night between therapy sessions.
  
  
  METHODS
  Primary outcomes were clinical and functional change in swallowing performance with maintenance at 3 months after intervention. Secondary, exploratory outcomes included physiological change in swallow performance measured by hyolaryngeal elevation, lingual-palatal and pharyngeal manometric pressure, and surface electromyographic amplitude.
  
  
  RESULTS
  Clinical and functional swallowing performances improved significantly and were maintained at the 3-month follow-up examination. Subject perspective (visual analog scale) on functional swallowing also improved. Four of 7 subjects who were initially feeding tube dependent progressed to total oral intake after 3 weeks of intervention. Physiological indices demonstrated increased swallowing effort after intervention.
  
  
  CONCLUSIONS
  Significant clinical and functional improvement in swallowing performance followed a time-limited (3 wk) exercise-based intervention in a sample of subjects with chronic dysphagia. Physiological changes after therapy implicate improved neuromuscular functioning within the swallow mechanism.
authors.affiliation: Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL 32610, USA. mcrary@phhp.ufl.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Crary
authors.forename: Giselle D
authors.initials: GD
authors.lastname: Carnaby
authors.forename: Lisa A
authors.initials: LA
authors.lastname: LaGorio
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Carvajal
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D001676:Biofeedback, Psychology; D002908:Chronic Disease; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000534:rehabilitation*; D004576:Electromyography; D005081:Exercise Therapy / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015397:Program Evaluation; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome