ABSTRACT
This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands.
Subject(s)
Humans , Male , Arthritis, Rheumatoid , Chin , Deglutition , Deglutition Disorders , Exercise , Hand , Hyoid Bone , Paralysis , Stroke , Upper ExtremityABSTRACT
@#Objective To compare the effect of Shaker exercise and Chin Tuck Against Resistance(CTAR)exercise on dysphagia after radiotherapy for nasopharyngeal carcinoma(NPC).Methods From August,2015 to February,2017,90 patients with dysphagia after radio-therapy for NPC were randomly divided into control group,Shaker group and CTAR group equally.The control group received routine swal-lowing training,while the Shaker group accepted Shaker exercise and CTAR group accepted CTAR exercise in addition.They were assessed with Penetration-Aspiration Scale under video fluoroscopic swallowing study(VFSS)before,and two weeks,four weeks and six weeks af-ter exercise.Results There was no significant difference in VFSS score among the three groups before intervention(F=0.551,P>0.05).The score decreased after intervention in Shaker group and CTAR group(F>5.317,P<0.001),but varied less in the control group(F=1.774,P>0.05).However,it was less in Shaker group and CTAR group than in the control group(P<0.001),and it was not significantly different be-tween Shaker group and CTAR group after 4 weeks and 6 weeks of intervention (P>0.05).The total effective rate was 86.67% in CTAR group and 76.67% in Shaker group,that was significantly higher than 43.33% in the control group(χ2>2.079,P<0.05),and it was not signifi-cantly different between Shaker group and CTAR group(P>0.05).Conclusion CTAR exercise is effective on dysphagia after radiotherapy for NPC,which is similar to those of Shaker exercise,and more acceptable and easier to persist.
ABSTRACT
OBJECTIVE: To evaluate the effect of chin tuck maneuver on aspiration and pharyngeal residue using both videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). METHOD: Subjects with dysphagia were trained by occupational therapists for chin tuck maneuver at least for a week. After training, all participants underwent VFSS and FEES simultaneously with each neutral and chin tuck posture with various tests diets. The modified penetration-aspiration scale (mPAS) and a new scale for pharyngeal residue were used for evaluation of aspiration and pharyngeal residue. RESULT: A total of 35 patients (mean age, 64.2±12.1 years) were included. A significant change in the mPAS was caused by chin tuck posture in thin liquid (P=0.02) only in the VFSS evaluation. The vallecular residues were decreased by chin tuck posture in rice porridge (right, P=0.01; left, P=0.009), and thin liquid (right, P=0.007; left, P=0.01). The pyriform sinus residues were also decreased by chin tuck posture in rice porridge (right: P=0.02; left: P=0.03), curd-type yogurt (right, P=0.02; left, P=0.005), and thin liquid (right, P=0.001; left, P=0.003). CONCLUSION: Chin tuck maneuver is effective in preventing penetration or aspiration and in decreasing pharyngeal residues when evaluated by simultaneous VFSS and FEES.