Functional and Physiological Outcomes from an Exercise-Based Dysphagia Therapy: A Pilot Investigation of the McNeill Dysphagia Therapy Program

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• 作者：Michael A. Crary ; PhD^a ; ^{mcrary@phhp.ufl.edu" class="auth_mail" title="E-mail the corresponding author} ; Giselle D. Carnaby ; PhD^b ; Lisa A. LaGorio ; MS^a ; Pamela J. Carvajal ; MA^a
• 关键词：Deglutition ; Deglutition disorders ; Exercise ; Physiology ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2012
• 出版时间：July 2012
• 年：2012
• 卷：93
• 期：7
• 页码：1173-1178
• 全文大小：351 K

文摘

Crary MA, Carnaby GD, LaGorio LA, Carvajal PJ. Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program.

Objective

To investigate functional and physiological changes in swallowing performance of adults with chronic dysphagia after an exercise-based dysphagia therapy.

Design

Intervention study: before-after trial with 3-month follow-up evaluation.

Setting

Outpatient clinic within a tertiary care academic health science center.

Participants

Adults (N=9) with chronic (>12mo) 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.

Interventions

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.

Main Outcome Measures

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 (3wk) exercise-based intervention in a sample of subjects with chronic dysphagia. Physiological changes after therapy implicate improved neuromuscular functioning within the swallow mechanism.