Swallowing Exercise for Dysphagia

[포르투칼나비]

정상적으로 나이가 들어가는 사람들도 Neurological condition을 지닌 환자들도 나이가 들수록 swallowing 문제를 경험할 확률이 높다.

Aspiration을 줄이기 위한 연습방법 몇가지를 정리해본다.

(Aspiration: material from your stomach and intestines enters into your respiratory tract)

Dysphagia를 경험할 수 있는 고위험군 

(Dysphagia: material from your stomach and intestines enters into your respiratory tract. This serious situation can lead to pneumonia and other problems. As a result, dysphagia should be diagnosed and treated promptly)

- Stroke

- Parkinson's disease/Other neurological diseases

- Muscular dystrophies

- Mouth lesions

- Obstruction in the esophagus

• 1. Take a deep breath and hold it. Keep holding your breath while you swallow. Immediately after swallowing, cough. (This is called the supraglottic swallow.) Repeat a few times.

• 2. Inhale and hold your breath very tightly. Bear down (like you are having a bowel movement). Keep holding your breath and bearing down as you swallow. (This is called a super-supraglottic swallow.) Repeat a few times. There is no need to use food or liquid with either of these exercises. This exercise should be done with caution and people with uncontrolled blood pressure should not do this exercise as bearing down can increase blood pressure. 

• 3. Take a breath. Keep holding your breath as you bear down. Hold for a few seconds and then relax. Repeat a few times.

• 4. Hold your breath tightly. Place both hands under your chair. Pull as if you are trying to lift up your chair with you in it. Let go of your breath and say “ah” while you continue to pull. Relax. Repeat a few times.

• 5. Hold your breath tightly. Turn your head to the left or to the right. Let go of your breath and say “ah” while your head is still turned. Relax. Repeat a few times.

출처: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/swallowing-exercises-closure-of-the-larynx-exercises

Mauneuvers (clinicians use to change the timing or strength of particular movements of swallowing)

Effortful swallow —increases posterior tongue base movement to facilitate bolus clearance. The patient is instructed to swallow and push hard with the tongue against the hard palate (Huckabee & Steele, 2006).

Mendelsohn maneuver —designed to elevate the larynx and open the esophagus during the swallow to prevent food/liquid from falling into the airway. The patient holds the larynx in an elevated position at the peak of hyolaryngeal elevation.

Supraglottic swallow —designed to close the vocal folds by voluntarily holding one's breath before and during swallow in order to protect the airway. The patient is instructed to hold his or her breath just before swallowing to close the vocal folds. The swallow is followed immediately by a volitional cough.

Super-supraglottic swallow —designed to voluntarily move the arytenoids anteriorly, closing the entrance to the laryngeal vestibule before and during the swallow. The super-supraglottic swallow is similar to the supraglottic swallow; however, it involves increased effort during the breath hold before the swallow, which facilitates glottal closure (Donzelli & Brady, 2004).

Oral/Motor Exercises

Laryngeal elevation —similar to the Mendelsohn maneuver (discussed in "Maneuvers" section above), the patient uses laryngeal elevation exercises to lift and maintain the larynx in an elevated position. The patient is asked to slide up a pitch scale and hold a high note for several seconds. This maintains the larynx in an elevated position.

Masako or tongue hold —the patient holds the tongue forward between the teeth while swallowing; this is performed without food or liquid in the mouth, to prevent coughing or choking. Although sometimes referred to as the Masako "maneuver," the Masako (tongue hold) is considered an exercise (not a maneuver), and its intent is to improve movement and strength of the posterior pharyngeal wall during the swallow.

Shaker exercise, head-lifting exercises —the patient rests in a supine position and lifts his or her head to look at the toes to facilitate an increased opening of the upper esophageal sphincter through increased hyoid and laryngeal anterior and superior excursion.

Lingual isometric exercises —the patient is provided lingual resistance across exercises to increase strength.

출처: https://www.asha.org/PRPSpecificTOpic.aspx?folderid=8589942550&section=Treatment