Arquivo da categoria: Treatment

Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

J Oral Rehabil. 2016 Jun;43(6):426-34. doi: 10.1111/joor.12390. Epub 2016 Mar 9.
Park JS1, Oh DH2, Hwang NK3, Lee JH4.


Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients.


Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial

Park JS, Oh DH, Chang MY.

Gerodontology. 2016 May 16. doi: 10.1111/ger.12234.

EMST2 Imagem:



This study aimed to investigate the effect of expiratory muscle strength training (EMST) on swallowing-related muscle strength in community-dwelling elderly individuals.


Expiratory muscle strength training is an intervention for patients with oropharyngeal dysphagia. This training is associated with respiration, coughing, speech and swallowing, and its effectiveness has been proven in previous studies. However, the effects of EMST on elderly individuals and evidence are still lacking.


This study included 24 community-dwelling senior citizens aged ≥65 years (12 men and 12 women). The experimental group trained at the 70% threshold value of the maximum expiratory pressure using an EMST device 5 days per week for 4 weeks and comprised five sets of five breaths through the device for 25 breaths per day. The placebo group trained with a resistance-free sham device. Post-intervention, muscle strength of the bilateral buccinator and the orbicularis oris muscles (OOM) was measured using the Iowa Oral Performance Instrument. Surface electromyography was used to measure activation of the suprahyoid muscles (SM).


After intervention, the strength of the buccinator and the OOM in the experimental group showed statistically significant improvement. There was also statistically significant activation of the SM. In the placebo group, the strength of the orbicularis oris muscle alone improved. No statistically significant differences between groups were found for the strength of the buccinator and the OOM and the activation of the SM.


EMST had a positive effect on swallowing-related muscle strength in elderly participants.


O uso da bandagem elástica Kinesio no controle da sialorréia em crianças com paralisia cerebral

Mariana de Oliveira Ribeiro1; Renata de Oliveira Rahal1; Andréa Siqueira Kokanj; Daniela Pimenta Bittar

Acta Fisiatrica; Dezembro 2009 – Volume 16 – Número 4


OBJETIVO: Verificar a eficiência da bandagem elástica Kinesio no controle de deglutição de saliva em crianças com paralisia cerebral.
MATERIAL E MÉTODO: A pesquisa foi realizada no Setor Escolar da Associação de Assistência à Criança Deficiente (AACD). Participaram 42 crianças com idades entre 4 e 15 anos (média = 8 anos e 9 meses), de ambos os sexos, com diagnóstico de paralisia cerebral e queixa de sialorréia. Foi realizado um checklist com os pais da criança com perguntas referentes a sialorréia e posteriormente realizadas duas escalas para pontuação da freqüência e da gravidade dessa. Foram realizadas oito aplicações da Kinesio Tape na musculatura supra-hióidea e então, o checklist e as escalas foram reaplicados.
RESULTADOS: Verificou-se que houve redução estatisticamente significante nos parâmetros utilizados para verificação da sialorréia, sendo eles: número de toalhas utilizadas por dia para secar a baba, pontuação na escala de freqüência e pontuação na escala de gravidade da sialorréia.
CONCLUSÃO: Conclui-se que o método Kinesio Taping é eficaz na melhora do controle de deglutição de saliva em crianças com Paralisia Cerebral.



Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence.

J Speech Lang Hear Res. 2008 Feb;51(1):S276-300. doi: 10.1044/1092-4388(2008/021).
Robbins J1, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, Martin-Harris B, McCabe D, Musson N, Rosenbek J.



This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The intent is to stimulate thought and propose potential research directions.


A working group of experts in swallowing and dysphagia reviews 10 principles of neural plasticity and integrates these advancing neural plastic concepts with swallowing and clinical dysphagia literature for translation into treatment paradigms. In this context, dysphagia refers to disordered swallowing associated with central and peripheral sensorimotor deficits associated with stroke, neurodegenerative disease, tumors of the head and neck, infection, or trauma.


The optimal treatment parameters emerging from increased understanding of neural plastic principles and concepts will contribute to evidence-based practice. Integrating these principles will improve dysphagia rehabilitation directions, strategies, and outcomes. A strategic plan is discussed, including several experimental paradigms for the translation of these principles and concepts of neural plasticity into the clinical science of rehabilitation for oropharyngeal swallowing disorders, ultimately providing the evidence to substantiate their translation into clinical practice.


Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke

NeuroRehabilitation. 2015 Jan 1;36(1):101-6. doi: 10.3233/NRE-141197.
Hägg MK, Tibbling LI.
BACKGROUND: Most patients with post-stroke dysphagia are also affected by facial dysfunction in all four facial quadrants. Intraoral stimulation can successfully treat post-stroke dysphagia, but its effect on post-stroke facial dysfunction remains unknown. OBJECTIVE: This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia. METHODS: Thirty-one stroke patients were treated with intraoral stimulation and assessed with a facial activity test, lip force test, and swallowing capacity test at three time-points: before treatment, at the end of treatment, and at late follow-up (over one year after the end of treatment). RESULTS: Facial activity, lip force, and swallowing capacity scores were all improved between baseline and the end of treatment (P < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated short and late after stroke. CONCLUSIONS: Treatment with intraoral stimulation significantly improved post-stroke dysfunction in all four facial quadrants, swallowing capacity, and lip force even in cases of long-standing post-stroke dysfunction. Furthermore, such improvement remained for over one year after the end of treatment.

Hyoid and laryngeal excursion kinematics – magnitude, duration and velocity – changes following successful exercise-based dysphagia rehabilitation: MDTP.

Sia I, Carvajal P, Lacy AA, Carnaby GD, Crary MA.

J Oral Rehabil. 2014 Dec 8


Acesse o periódico


Variability in magnitude of deglutitional hyolaryngeal excursion in patients with dysphagia suggests that it does not adequately represent the kinematics of swallowing difficulties or recovery following rehabilitation. On the other hand, reduced hyolaryngeal excursion velocity has been reported in patients with dysphagia. While increased movement velocity often accompanies clinical and functional recovery in many diseases, velocity changes in swallowing-related movement following dysphagia therapy have not been well studied. This study evaluated changes in hyoid and laryngeal excursion (magnitude, duration and velocity) before and following successful dysphagia therapy to provide a more comprehensive representation of improvement to swallowing kinematics in patients who have experienced successful rehabilitation. A secondary analysis of case series data was completed. Eight patients with severe, chronic dysphagia completed a standard course of an exercise-based dysphagia treatment programme (McNeill dysphagia therapy program, MDTP). Pre- and post-treatment, kinematic aspects of swallowing were evaluated for thin liquid, thick liquid and pudding swallows. Maximum hyoid and laryngeal excursion magnitude and excursion duration were measured. Excursion velocities were calculated from excursion magnitude and duration measures. Successful treatment for dysphagia facilitated increased hyolaryngeal excursion magnitude, duration and velocity. These changes were most prominent for the hyoid and most often observed with thin liquids. By examining hyoid and laryngeal excursion velocity in patients who have experienced successful dysphagia rehabilitation, this study demonstrated the value of evaluating spatial and temporal aspects of swallowing kinematics in a single measure for a more comprehensive representation of positive changes underlying functional recovery.

Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease?

NeuroRehabilitation. 2013 Jan 1;32(4):949-55. doi: 10.3233/NRE-130918.


Division of Neurology and Epidemiology, Federal University of Bahia, Salvador, Brazil.



To investigate the effect of motor swallowing exercises on swallowing dynamic, quality of life and swallowing complaints in Parkinson’s disease (PD).


A before-after trial.


University Medical Center.


Parkinson’s disease patients with dysphagia complaints.


Motor swallowing exercises designed to increase the strength and range of motion of the mouth, larynx and pharyngeal structures, coordination between breathing and swallowing, and airway protection. Patients should perform the exercises twice a day, five days a week, for five weeks.


The primary outcome was the difference before and after the intervention in number of swallowing videofluoroscopic events (Swallowing Score). The secondary outcomes were quality of life (QOL) and swallowing complaints.


Fifteen patients concluded the study (10 man/5 woman; mean age 59.2 ± 9.17). The videofluoroscopic events with greater improvement were loss of bolus control (P < 0.03), piecemeal swallow (P = 0.05) and residue on the tongue (P < 0.01), valleculae (P = 0.01) and pyriform sinuses (P = 0.05). Lingual pumping and dental absence were interfering factors associated with treatment failure (beta standardized coefficient = -16.6, 26.2; P = 0.02, 0.002, respectively). The domains with greater improvements in QOL were fear (P = 0.02) and symptom frequency (P = 0.05). Regarding swallowing complaints, patients reported to have reduced mainly their difficulty in moving food in the mouth when chewing (P = 0.02). Reduction in swallowing disorders was not related with QOL improvement (cor = 0.13, [95% CI, 0.6-0.4], P = 0.63).


Motor swallowing exercises may reduce swallowing disorders in PD patients without lingual pumping and dental absence and impact positively QOL and swallowing complaints in individuals with PD.


Non-pharmacological therapies for dysphagia in Parkinson’s disease.

Cochrane Database Syst Rev. 2001;(1):CD002816.



Dysphagia occurs frequently in Parkinson’s disease although patients themselves may be unaware of swallowing difficulties. Speech and language therapists in conjunction with nurses and dietitians use techniques that aim to improve swallowing and reduce the risk of choking, aspiration and chest infections.


~Bullet~To compare the efficacy and effectiveness of non-pharmacological swallowing therapy for dysphagia versus placebo or no intervention in patients with Parkinson’s disease. ~Bullet~To compare one form of non-pharmacological swallowing therapy for dysphagia with another in patients with Parkinson’s disease.


Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials,, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews.


Only randomised controlled trials (RCT) were included. We did not examine any trials using drugs or surgery to treat the dysphagia. We did not examine any trials where part of the therapist’s advice was to insert a nasogastric or percutaneous gastrostomy tube.


Not applicable.


No randomised controlled trials or controlled trials were found that examined the efficacy of non-pharmacological swallowing therapy for the treatment of dysphagia in Parkinson’s disease. However there is one large RCT currently recruiting patients that will compare ‘chin down’ posture with thickened liquids in the treatment of dysphagia. The main outcomes will be the rates of aspiration and pneumonia.


There is currently no evidence to support or refute the efficacy of non-pharmacological swallowing therapy for dysphagia in Parkinson’s disease. Large well designed placebo-controlled RCTs are required to assess the effectiveness of swallowing therapy for dysphagia in Parkinson’s disease and reported according to CONSORT guidelines. Suitable outcome measures should be chosen so that the efficacy and effectiveness of non-pharmacological swallowing therapy can be assessed and an economic analysis performed. Outcomes which have meaning to patients and carers should be used wherever possible since they need to know the value of this therapy in practical terms. The patients should be followed for at least 6 months to determine the duration of any improvement.

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“Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy

Carnaby-Mann G; Crary MA; Schmalfuss I; Amdur R

Int J Radiat Oncol Biol Phys;83(1):210-9, 2012 May 1.

PURPOSE: Dysphagia after chemoradiotherapy is common. The present randomized clinical trial studied the effectiveness of preventative behavioral intervention for dysphagia compared with the “usual care.” METHODS AND MATERIALS: A total of 58 head-and-neck cancer patients treated with chemoradiotherapy were randomly assigned to usual care, sham swallowing intervention, or active swallowing exercises (pharyngocise). The intervention arms were treated daily during chemoradiotherapy. The primary outcome measure was muscle size and composition (determined by T(2)-weighted magnetic resonance imaging). The secondary outcomes included functional swallowing ability, dietary intake, chemosensory function, salivation, nutritional status, and the occurrence of dysphagia-related complications. RESULTS: The swallowing musculature (genioglossus, hyoglossuss, and mylohyoid) demonstrated less structural deterioration in the active treatment arm. The functional swallowing, mouth opening, chemosensory acuity, and salivation rate deteriorated less in the pharyngocise group. CONCLUSION: Patients completing a program of swallowing exercises during cancer treatment demonstrated superior muscle maintenance and functional swallowing ability.


Dysphagia–pathophysiology, diagnosis and treatment

Cecconi E; Di Piero V

Front Neurol Neurosci;30:86-9, 2012.

Dysphagia is an extremely common disorder after stroke, affecting as many as half of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. For this reason, dysphagia significantly affects outcome and is associated with increased morbidity and mortality. Formal dysphagia screening protocols significantly reduce the rate of pneumonia and improve general outcome. Furthermore, early behavioral swallowing interventions are associated with a more favorable outcome in dysphagic stroke patients. This chapter reviews the pathophysiology of swallowing dysfunction, and the diagnosis and treatment of patients with dysphagia after an acute stroke.