Adoption into clinical practice of two therapies to manage swallowing disorders

Abstract

Purpose of review This article reviews recent literature depicting a shift in dysphagia rehabilitation in adults. Distinguishing rehabilitation from compensation in dysphagia management, a review of basic exercise principles is followed by description of recent publications depicting exercise based therapies. Subsequently, transcutaneous electrical stimulation is reviewed as it may contribute to exercise based dysphagia rehabilitation in adults. Recent findings Surveys have documented extensive variability in the clinical application of dysphagia therapy techniques. Despite this variability, two trends are emerging in dysphagia rehabilitation research: 1- documentation of physiologic plus functional changes within the swallowing mechanism subsequent to therapy; and 2- prophylactic exercise based therapies. In addition, extensive efforts have emerged describing the potential application of transcutaneous electrical stimulation in dysphagia rehabilitation. Though results of these efforts are conflicted, transcutaneous electrical stimulation may serve a useful role as an adjunct to well-developed exercise based rehabilitation for dysphagia. Summary The focus of dysphagia rehabilitation in adults is changing. Current efforts indicate that exercise based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. Transcutaneous electrical stimulation may function as an adjunctive modality; however, current practices should be evaluated to develop additional parameters of stimulation that are focused toward specific dysphagia impairments.

Early Feasibility of an Activity-Based Intervention for Improving Ingestive Functions in Older Adults with Oropharyngeal Dysphagia

“…The safety criterion of clinical signs of aspiration in less than 20% of the therapeutic swallowing attempts was achieved for all the participants. In addition, adverse events were not reported, which aligns with similar intervention approaches [ 41 ]. However, the safety criterion was only just met for cases 5 and 7, which may further signal that the ACT-ING program might be less suitable for participants with severe OD.…”

“…The success criterion for both was a proportion of ≥70%. Safety was assessed during each therapy session using records on clinical signs of aspiration (e.g., wet voice, throat clearing, coughing, or gagging) which might increase briefly during exercise progression but are expected to decrease as the participants’ skills increase [ 41 ]. The success criterion was that clinical signs of aspiration occurred in less than 20% of the therapeutic swallowing attempts in 80% of the therapy sessions for 100% of the participants.…”

A fully integrated, standalone stretchable device platform with in-sensor adaptive machine learning for rehabilitation

“…According to the gold standard, the clinical evaluation for post-surgical laryngeal rehabilitation mainly focuses on four typical events (i.e., talking, swallowing, drinking water, and coughing) with long-term and extensive efforts 70 . To help automatically evaluate the post-surgical rehabilitative condition, a CNN-based 2D-like sequential feature extractor (2D-SFE) is explored to classify and infer pathological status based on the classi cation of physiological events (Fig.…”

Dysphagia Therapy in Adults with a Tracheostomy: A Scoping Review Protocol

“…Intervention, rehabilitation, management and exercise are some of the terms used to describe oropharyngeal dysphagia therapy. Therapy is a multimodal approach which aims to restore swallow function (Crary & Carnaby, 2014;Smithard, 2016). Examples may include 'effortful swallowing' targeting the contact between base of tongue and posterior pharyngeal wall (Logemann, 1991); 'Mendelsohn manoeuvre' for laryngeal elevation (Mendelsohn et al, 1987) and the 'head lift' to improve hyoid displacement (Shaker et al, 1997).…”