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Dysphagia 22:251265 (2007) DOI: 10.1007/s00455-006-9074-z
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Strength-Training Exercise in Dysphagia Rehabilitation: Principles, Procedures, and Directions for Future Research
Lori M. Burkhead, PhD,1,3, Christine M. Sapienza, PhD,2,3 and John C. Rosenbek, PhD1,3
1Department of Communicative Disorders, University of Florida, Gainesville, Florida, USA; 2Department of Communication Sciences and Disorders, University of Florida, Gainesville, Florida, USA; and 3Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, Gainesville, Florida, USA
Abstract. Dysphagia rehabilitation, historically, has focused a great deal on various compensations during swallowing to prevent aspiration and/or improve safety and eciency. Exercise, in general, has been a part of the dysphagia rehabilitation landscape. However, heightened discussions in the eld regarding best practices for exercise training, particularly strengthening, raise more questions than answers. The intent of this paper is to (1) explore the overriding principles of neuromuscular plasticity with regard to strength training, (2) evaluate how current exercise-training interventions in dysphagia rehabilitation correspond to these principles, and (3) postulate directions for future study of normal and disordered swallowing and determine how to incorporate these principles into dysphagia rehabilitation.
Key words: Deglutition Deglutition disorders Dysphagia Swallowing Exercise Strengthening Muscle.
Dysphagia is a pervasive and potentially life-threatening condition that can emerge from a variety of disturbances aecting neural, motor, and/or sensory systems that underlie swallowing function. Published reports indicate a high incidence and prevalence of dysphagia among neurologically impaired individuals
[14], those with head and neck cancer [58], and those with tracheostomy and/or ventilator dependency without neurologic/structural disturbances that would otherwise precipitate dysphagia [912]. Regardless of etiology, the potential health risks that can stem from dysphagia are great and include increased likelihood for malnutrition, pulmonary infection [13], and death [14].
Dysphagia can negatively impact medical recovery, resulting in longer hospitalizations and an increased need for long-term care [15]. Aspiration pneumonia, a common sequela of dysphagia, is associated with a signicant risk for morbidity and mortality [16]. It has been reported that in the eight-year period from 1991 to 1998, the number of patients hospitalized for aspiration pneumonia increased by93.5%, making it the second most common reason for hospitalization [17]. Identifying more eective methods of diagnosis and treatment has been designated as a top priority in rehabilitation research [18] in order to improve the health and quality of life and...