Vibration over the larynx increases swallowing and cortical activation for swallowing.

Mulheren RW, Ludlow CL.

J Neurophysiol. 2017 Sep 1;118(3):1698-1708. doi: 10.1152/jn.00244.2017. Epub 2017 Jul 5

Imagem retirada internet 


Sensory input can alter swallowing control in both the cortex and brainstem. Electrical stimulation of superior laryngeal nerve afferents increases reflexive swallowing in animals, with different frequencies optimally effective across species. Here we determined 1) if neck vibration overlying the larynx affected the fundamental frequency of the voice demonstrating penetration of vibration into the laryngeal tissues, and 2) if vibration, in comparison with sham, increased spontaneous swallowing and enhanced cortical hemodynamic responses to swallows in the swallowing network. A device with two motors, one over each thyroid lamina, delivered intermittent 10-s epochs of vibration. We recorded swallows and event-related changes in blood oxygenation level to swallows over the motor and sensory swallowing cortexes bilaterally using functional near infrared spectroscopy. Ten healthy participants completed eight 20-min conditions in counterbalanced order with either epochs of continuous vibration at 30, 70, 110, 150, and 70 + 110 Hz combined, 4-Hz pulsed vibration at 70 + 110 Hz, or two sham conditions without stimulation. Stimulation epochs were separated by interstimulus intervals varying between 30 and 45 s in duration. Vibration significantly reduced the fundamental frequency of the voice compared with no stimulation demonstrating that vibration penetrated laryngeal tissues. Vibration at 70 and at 150 Hz increased spontaneous swallowing compared with sham. Hemodynamic responses to swallows in the motor cortex were enhanced during conditions containing stimulation compared with sham. As vibratory stimulation on the neck increased spontaneous swallowing and enhanced cortical activation for swallows in healthy participants, it may be useful for enhancing swallowing in patients with dysphagia.NEW & NOTEWORTHY Vibratory stimulation at 70 and 150 Hz on the neck overlying the larynx increased the frequency of spontaneous swallowing. Simultaneously vibration also enhanced hemodynamic responses in the motor cortex to swallows when recorded with functional near-infrared spectroscopy (fNIRS). As vibrotactile stimulation on the neck enhanced cortical activation for swallowing in healthy participants, it may be useful for enhancing swallowing in patients with dysphagia.



A Systematic Review of Isometric Lingual Strength-Training Programs in Adults With and Without Dysphagia

McKenna VS, Zhang B, Haines MB, Kelchner LN.

Am J Speech Lang Pathol. 2017

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Purpose: This systematic review summarizes the effects of isometric lingual strength training on lingual strength and swallow function in adult populations. Furthermore, it evaluates the designs of the reviewed studies and identifies areas of future research in isometric lingual strength training for dysphagia remediation.
Method: A comprehensive literature search of 3 databases and additional backward citation search identified 10 studies for inclusion in the review. The review reports and discusses the isometric-exercise intervention protocols, pre- and postintervention lingual-pressure data (maximum peak pressures and lingual-palatal pressures during swallowing), and oropharyngeal swallowing measures such as penetration-aspiration scales, oropharyngeal residue and duration, lingual volumes, and quality-of-life assessments.
Results: Studies reported gains in maximum peak lingual pressures following isometric lingual strength training for both healthy adults and select groups of individuals with dysphagia. However, due to the variability in study designs, it remains unclear whether strength gains generalize to swallow function.
Conclusion: Although isometric lingual strength training is a promising intervention for oropharyngeal dysphagia, the current literature is too variable to confidently report specific therapeutic benefits. Future investigations should target homogenous patient populations and use randomized controlled trials to determine the efficacy of this treatment for individuals with dysphagia.

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Clinical diagnosis of hyposalivation in hospitalized patients.

Berti-Couto Sde A1, Couto-Souza PH, Jacobs R, Nackaerts O, Rubira-Bullen IR, Westphalen FH, Moysés SJ, Ignácio SA, Costa MB, Tolazzi AL.J Appl Oral Sci. 2012 Mar-Apr;20(2):157-61.

Fonte: Oral Science


OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients.

MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheeks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination.

RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05).

CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.


Dysphagia in the Elderly

Review articleSmukalla SM, et al. Curr Treat Options Gastroenterol. 2017

Fonte: Pharmaceutical Journal


OPINION STATEMENT: Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation. Nascent technologies such as the functional luminal imaging probe (FLIP) and advances in esophageal manometry are improving our understanding of the pathophysiology of oropharyngeal dysphagia. Recent developments in the treatment of specific causes of oropharyngeal dysphagia, including endoscopic balloon dilations for upper esophageal sphincter (UES) dysfunction, show promise and are expected to enhance with further research. Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause. The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status. However, the increasing availability of less invasive solutions to specific esophageal pathologies has augmented the number of treatment options available to this population, where an individualized approach to patient care is paramount. This review focuses on the evaluation and management of dysphagia in the elderly and delineates how standard and novel therapeutics are contributing to more nuanced and personalized management.



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CATAO, Maria Helena Chaves de Vasconcelos; OLIVEIRA, Polyana Sarmento de; COSTA, Roniery de Oliveira and CARNEIRO, Vanda Sanderana Macêdo. 

Rev. CEFAC [online]. 2013, vol.15, n.6 [cited 2017-08-17], pp.1601-1608. 

OBEJTIVO: avaliar a eficácia do laser de baixa intensidade no tratamento da dor em pacientes com desordens temporomandibulares. 

MÉTODO:consistiu de um ensaio clínico randomizado divididos em dois grupos: Grupo 1: laser AsGaAl, Grupo 2: laser InGaAlP, do qual participaram 20 pacientes entre 19 e 35 anos de idade, com diagnóstico de sinais e sintomas de DTM. Os pacientes tinham a amplitude de movimento para abertura máxima da boca e lateralidade registados no início e no final do tratamento a laser. O Laser foi aplicado em quatro pontos pré-auriculares, totalizando 12 sessões três vezes por semana, durante um mês. Dor dos pacientes foi registrado com base na utilização da escala analógica visual (EAV) e também por exame físico dos pontos álgicos. 

RESULTADOS: observou-se redução significante (p<0,028) do nível de dor em ambos os grupos, porém no G1 a significância foi maior. A evolução do limiar de sensibilidade muscular evidenciou diferença estatisticamente significante (p<0,05) para G1 e G2. A laserterapia no Grupo 1 melhorou a abertura bucal em média de 4,643 mm, enquanto no Grupo 2, a média foi de 3,71 mm por paciente. 

CONCLUSÃO: houve eficácia em ambos os lasers no controle da dor e abertura bucal dos pacientes.


Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

Irina Claudia Fernandes Alves
Claudia Regina Furquim de Andrade

Imagem: Pinterest 


O objetivo desta pesquisa foi verificar se há melhora funcional do padrão de deglutição em indivíduos identificados com risco para disfagia orofaríngea após quatro semanas da realização de exercícios orofaríngeos específicos com intensidade e duração pré-determinados.
Esta pesquisa é de caráter longitudinal de efeito funcional, determinado por medidas comparativas inicial e final. A população-alvo foi constituída de indivíduos adultos e idosos selecionados por 24 meses. Foi incluído para esta pesquisa um total de 68 indivíduos. Foi realizada avalição clínica da deglutição e observados sinais clínicos para disfagia. Os indivíduos foram divididos em dois grupos de acordo com o nivelamento inicial na escala ASHA NOMS. No Grupo 1 (G1) – ASHA NOMS, inicial de níveis 1 e 2; Grupo 2 (G2) – ASHA NOMS, inicial de níveis 3, 4 e 5. Todos os indivíduos realizaram um protocolo de exercícios por quatro semanas. O protocolo conta com sessões presenciais e continuidade das atividades em ambiente domiciliar. Ao final, foi realizada nova mensuração do desempenho de deglutição.
Para o grupo G2 houve melhora estatisticamente significante. Para o G1, a relação não foi significante, apesar de mudança intensa na escala ASHA NOMS, porém, neste grupo, temos um número reduzido de indivíduos devido à gravidade do perfil.
O programa se mostrou efetivo, pois, após as quatro sessões de exercícios, houve melhora importante no padrão de deglutição, demonstrada pela escala funcional.


Swallowing Function After Continuous Neuromuscular Electrical Stimulation of the Submandibular Region Evaluated by High-Resolution Manometry

Jungheim, M., Schubert, C., Miller, S. et al. Dysphagia (2017) 32: 501.

Fonte imagem:


Although neuromuscular electrical stimulation (NMES) is increasingly used in dysphagia therapy, patient responses to NMES are inconsistent and conflicting results have been reported. This, together with a lack of information about the effects of NEMS on the swallowing process, has led to an ongoing debate about its impact on swallowing function. In order to address this, we set out to (i) collect baseline information on the physiological effects of NMES on the complex pharyngeal phase of swallowing and (ii) to compare two different stimulation protocols. In doing so, we provide information useful for evaluating the therapeutic effectiveness of NMES on the swallowing process. In a prospective study, 29 healthy participants performed water swallows after receiving continuous NMES for 10 min. The stimulus was applied in the submandibular region using one of two different stimulation protocols: low-frequency stimulation (LFS) and mid-frequency stimulation (MFS). Swallowing parameters of the pharynx and UES were measured using high-resolution manometry. Maximum tongue base pressure increased by 8.4% following stimulation with the MFS protocol. Changes in UES function were not found. LFS stimulation did not result in any significant changes in the parameters examined. The MFS protocol enhances tongue base retraction during swallowing in healthy volunteers. The magnitude of the effect, however, was small, possibly due to the ability of healthy subjects to compensate for external influences, such as NMES, and may actually prove to be much greater in patients with diminished tongue base retraction. Thus, further studies are needed to determine whether a similar effect is also achievable in dysphagic patients with impaired bolus propulsion, possibly allowing MFS stimulation of the tongue base region to be used as an additional treatment tool.

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