Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial

Abstract

Expiratory muscle strength training (EMST) involves forcible blowing as a means of generating high expiratory pressure, against adjustable resistance. EMST has recently been introduced as a potential treatment for dysphagia. This study was performed to investigate the effects of EMST on the activity of suprahyoid muscles, aspiration and dietary stages in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group performed EMST with a 70% threshold value of maximal expiratory pressure, using an EMST device, 5 days a week for 4 weeks. The placebo group trained with a sham device. The EMST regime involved 5 sets of 5 breaths through the EMST device for a total of 25 breaths per day. Activity in the suprahyoid muscle group was measured using surface electromyography (sEMG). Further, the penetration-aspiration scale (PAS) was used to assess the results of the videofluoroscopic swallowing study (VFSS). In addition, dietary stages were evaluated using the Functional Oral Intake Scale (FOIS). The experimental group exhibited improved suprahyoid muscle group activity and PAS results, when compared to the placebo group. Following intervention, statistical analysis indicated significant differences in measured suprahyoid muscle activity (P = 0·01), liquid PAS outcomes (P = 0·03) and FOIS results (P = 0·06), but not semisolid type PAS outcomes (P = 0·32), between the groups. This study confirms EMST as an effective treatment for the development of suprahyoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

“…Several studies have been focused on swallowing rehabilitation. To date, a positive effect of expiratory muscle resistance training has been documented in improving suprahyoid muscle activity [172,173]. Furthermore, head lift exercises showed a beneficial impact on swallowing movements [174,175], and tongue strengthening exercises have been reported to enhance tongue strength [176,177].…”

Expiratory muscle strength training for radiation‐associated aspiration after head and neck cancer: A case series

“…[6][7][8][9] Trials examining a progressive-resistive exercise paradigm of EMST in patients with or at risk for dysphagia related to neurogenic pathologies (i.e., Parkinson disease [PD], amyotrophic lateral sclerosis [ALS], and stroke) report improvement in airway protection after a 5-week strengthening exercise program (detailed summary in Table I). 5,[8][9][10] EMST accordingly is gaining popularity among various populations with swallowing disorders, but to our knowledge the results of EMST have not been published in patients with radiationassociated aspiration. Thus, the purpose of this case series was to examine the therapeutic potential of EMST among head and neck cancer (HNC) survivors with chronic radiation-associated aspiration.…”

Morfofisiologia dos exercícios orofaríngeos: revisão integrativa

“…A revisão de literatura selecionada 16 apresenta os tipos de tratamentos não cirúrgico para reabilitação da deglutição. Parece importante notar que os estudos que apontam dados da morfofisiologia de exercícios orofaríngeos são aqueles que enfocam os quadros de disfagia [16][17][18][19][20][21][22][23][24] .…”

“…Em outro estudo 18 com uma amostra de pacientes com câncer de cabeça e pescoço, foram aplicados os exercícios: queixo contra a resistência, abertura mandibular contra resistência e esforço da deglutição. Segundo os autores, o exercício de abertura mandibular contra resistência e esforço da deglutição favorecem o aumento da retração da base da língua e diminuição da quantidade de anterior 19 de que a forte contração dos músculos supra-hióideos afeta diretamente o movimento superior e anterior do osso hióide e da laringe. Acrescentam ainda que, durante o treinamento de força muscular expiratória, os receptores sensoriais da língua e orofaringe aumentam em vários estímulos aferentes, desencadeando a ativação do centro da deglutição localizado na medula oblonga do tronco encefálico.…”