We demonstrated that neuromuscular electrical stimulation applied to the infrahyoid region combined with effortful swallowing effectively increased hyoid bone movement and reduced aspiration in dysphagic patients with Parkinson's disease.

The head lift exercise (HLE) is a head-raising workout performed in a supine position. This exercise facilitates activation of the submental muscles located above the hyoid bone in front of the neck. HLE is a potential method to improve the movement of the hyolaryngeal movement and swallowing functions. The purpose of this study was to investigate the effect of HLE on the hyolaryngeal movement and aspiration in patients with dysphagic stroke. A total of 27 patients with stroke were randomly assigned either into the experimental (n = 13) or the control group (n = 14). The experimental group performed HLE 5 days a week for 4 weeks (a total of 20 sessions). Both groups received the same conventional dysphagia therapy. Two-dimensional analysis of the hyolaryngeal movement was carried out using Image J program based on a videofluoroscopic swallowing study. Penetration-aspiration was assessed using Penetration-Aspiration Scale (PAS). The experimental group showed a significant increase in the only superior movements of the hyoid bone compared with the control group (P = 0·033). Aspiration in liquid also exhibited a significant decrease in the experimental group compared with the control group (P = 0·044). Findings from this study confirmed that HLE is an effective intervention to improve hyoid movement and decrease aspiration.

Background Chin tuck against resistance (CTAR) exercise has been recently reported to be a new therapeutic exercise method that can help improve swallowing function in patients with dysphagia. However, due to the differences in exercise protocols, methods and the tools used across studies of CTAR exercise, an overall systematic review of these studies is necessary. Objective The present study investigated the exercise protocols, methods and tools used in various studies of CTAR exercise and summarised their findings. Methods We searched for studies related to CTAR exercise using electronic databases and selected nine articles for review. The articles were categorised on the basis of four criteria: study design and quality, training protocol, outcome measures and clinical effect. Results Four articles reported that CTAR exercise not only helped activate the suprahyoid muscle in healthy adults, but also activated the sternocleidomastoid muscle less than Shaker exercise. In addition, five articles reported that CTAR exercise was effective in improving swallowing function and oral diet stage in the pharyngeal phase, including reduction of airway aspiration in patients with dysphagia after stroke. Conclusions CTAR exercise more selectively activates the suprahyoid muscle and is an effective therapeutic exercise for improving swallowing function in patients with dysphagia. Because it is less strenuous than Shaker exercise, it requires less physical burden and effort, allowing greater compliance.

Background: Electromyographic biofeedback (EMG-BF) is known to be an effective therapy for stroke rehabilitation. However, because few studies have investigated the therapy in patients with dysphagia, its effectiveness is not yet clear. This study aimed to investigate the effect of neuromuscular electrical stimulation (NMES) using EMG-BF on swallowing function in stroke patients with oropharyngeal dysphagia. Methods: In this study, 10 patients with dysphagia were recruited. The 1-group, pre−post study design was adopted. All subjects received NMES combined with EMG-BF in the suprahyoid area. Electrical stimulation was provided as a reward when the electrical signal generated by effortful swallowing reached a preset threshold. The intervention was provided for 30 minutes a day, 5 times a week for 4 weeks. The videofluoroscopic dysphagia scale (VDS) and penetration–aspiration scale (PAS) based on the videofluoroscopic swallowing study were used to evaluate the swallowing function. Results: Pre-intervention showed no significant differences in all items of VDS (P > .05). However, there was a statistically significant change in VDS from 13.36 ± 5.94 to 9.36 ± 5.14 (P = .015) in the oral phase, and from 38.36 ± 7.42 to 20.71 ± 14.61 (P = .016) in the pharyngeal phase. The PAS scores showed significant change from 5.14 ± 2.27 to 3.00 ± 1.00 (P = .031). Conclusion: This study demonstrated that the use of NMES combined with EMG-BF had the potential to improve oropharyngeal swallowing in stroke patients with dysphagia.

Background: It has recently been shown that suprahyoid muscle exercise using kinesiology taping (KT) increases the activation of the suprahyoid muscle in healthy adults, suggesting a potential therapeutic clinical exercise for dysphagia rehabilitation. This study investigated the effect of dysphagia rehabilitation using KT in stroke patients with dysphagia. Methods: Thirty subjects in South Korea were enrolled in this prospective placebo-controlled double-blind study. Participants were randomly assigned to the experimental and sham groups. In the experimental group, the tape was attached to the hyolaryngeal complex, pulled downward with approximately 70% tension, and then attached to the sternum and the clavicle bilaterally. In the sham group, the tape was applied similarly but without the tension. Both groups performed voluntary swallowing 50 times (10 times swallowing per set, times 5 sets) a day for 4 weeks with KT applied. Outcome measures were assessed using portable ultrasound equipment. The parameter measured was the change in thickness of the tongue muscle, mylohyoid muscle, and the anterior belly of the digastric muscle. Results: The experimental group showed statistically significant changes in the thickness of the tongue muscle, mylohyoid muscle, and anterior belly of the digastric muscle than the sham group (p = 0.007, 0.002, and 0.001). Conclusion: Dysphagia rehabilitation using KT is a technique that may promote oropharyngeal muscle thickness in patients with dysphagia after stroke.