Effortful swallow enhances vertical hyolaryngeal movement and prolongs duration after maximal excursion

Abstract

Effortful swallowing (EFS) is a common compensatory swallowing manoeuver for dysphagia patients. We investigated the influence of EFS on temporal and spatial characteristics of the movements of the hyoid bone, larynx and epiglottis in healthy subjects. A total of 41 volunteers swallowed 10 mL of diluted barium solution using two swallowing strategies: usual and effortful swallowing (USS and EFS). The motions of the hyoid bone, larynx and epiglottis were tracked using frame-by-frame kinematic motion analysis of videofluoroscopic images. Maximal velocities and maximal displacements of hyoid and larynx, the maximal angle of the epiglottic tilt, and the durations of hyoid excursion, laryngeal elevation and epiglottic tilt were measured. Compared to USS, EFS was associated with significantly greater vertical displacement of the hyoid (P < 0.001), vertical and horizontal displacement of the larynx (P = 0.003, P = 0.019), and maximal angle of the epiglottic tilt (P = 0.001). In addition, the durations of the vertical and horizontal excursions of the hyoid, vertical excursion of the larynx and the epiglottic tilt were greater in EFS, compared with USS. Effortful swallowing was also associated with significantly greater maximum velocities of the hyoid and larynx during swallowing. In conclusion, the EFS manoeuver facilitates vertical speed and distance of hyolaryngeal excursion and epiglottic tilt and extends the duration of excursion and the epiglottic tilt, especially after reaching maximal excursion in healthy subjects. These results confirm the temporal and kinematic benefits of airway protection induced by the EFS manoeuver.

Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double‐blind, randomized controlled trial

“…As a result, a compensatory technique was initially introduced for the purpose of improving the clearance of vallecular residues in the pharyngeal phase (Jang et al . ).…”

“…Recently, Jang et al . () reported the effects of EST on hyolaryngeal movement in healthy adults. EST proved to be more effective for the anterior–superior movements of the hyolaryngeal than for normal swallowing.…”

“…In addition, videomanometric studies have reported an increased effort during bolus swallowing, a rapid increase in pressure on the bolus and thus a decreased pharyngeal residue (Hind et al 2001). As a result, a compensatory technique was initially introduced for the purpose of improving the clearance of vallecular residues in the pharyngeal phase (Jang et al 2015).…”

Evaluation of hyoid movement during swallowing using a bend sensor

“…Previous studies have found that hyoid movement is affected by bolus size3,4 and viscosity, 5 as well as by swallowing manoeuvres such as effortful swallowing 22. In those tasks, the correlation between the LM value and the y-axis displacement was stronger than that with the x-axis displacement.…”

Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

“…Due to population aging and the increase on the number of people affected by diseases that lead to swallowing alterations, the early identification and management of dysphagia must be a priority to reduce the risk of severe complications and improve the results with vulnerable populations (2) . Besides using adaptations at the moment of oral intake, it has been suggested a variety of exercise protocols to improve the swallowing capacity aiming at larger range of movement (3) , increase at the swallowing effort (4)(5)(6) and sensorial system impulse (7) . Among them are tongue-hold (8,9) , Shaker exercise (10) , counter-resistance exercise with head lowered (11) , tongue exercises (12) , Iowa Oral Performance Instrument -IOPI (13) , etc.…”