Exercise science principles strengthen swallowing rehabilitation

Just thinking about swallowing makes it harder to do.

Head and neck cancer, a stroke, brain tumor, brain injury or even a tracheostomy tube and mechanical ventilation needed to sustain life can make it impossible.

Dysphagia, or swallowing problems, can also result from aging and accompanying loss of muscle strength.

"We swallow a thousand times or more per day, just our own saliva, without even thinking about it," says Dr. Lori Burkhead, speech-language pathologist and clinical research scientist at the Medical College of Georgia Department of Otolaryngology Head and Neck Surgery. "We swallow in our sleep. Babies do it in utero. It is something we do without giving it much thought, but it's actually a very complex act that involves an intricate coordination between the brain, muscles and respiratory system."

An estimated 18 million Americans have difficulty with this routine function that, at worst, can lead to aspiration pneumonia, malnutrition, dehydration and death.

Evidence suggests that the same exercise science principles that strengthen bodies can help restore this fundamental function using mouth and throat muscles. Because swallowing muscles are not easy to access, applying the usual principles of exercise is more difficult. "Physical therapists can put a weight in someone's hand and exercise them or they can give patients external assistance and get them to complete a movement," says Dr. Burkhead. "I can't put weights on throat muscles for strengthening and I can't get at those muscles to help patients finish the movements they cannot do on their own."

Theories about the amount of resistance needed to strengthen a muscle, the number of repetitions and specificity of exercise along with technology such as biofeedback may help speech-language pathologists put more science and success into helping patients regain the ability to swallow, according to a review article authored by Dr.

Contact: Toni Baker
Medical College of Georgia

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