Functional change in the pattern of swallowing through the performance of orofacial exercises

Alves, Irina Claudia Fernandes; Andrade, Claudia Regina Furquim de

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Original Article • CoDAS 29 (3) • 2017 • https://doi.org/10.1590/2317-1782/20172016088 copy

Functional change in the pattern of swallowing through the performance of orofacial exercises

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

The objective was to determine if there was functional improvement of swallowing pattern in subjects identified with risk of oropharyngeal dysphagia after four weeks of specific oropharyngeal exercises. These exercises have pre-determined intensity and duration.

Methods

It is a longitudinal study of functional effect, determined by initial and final comparative measures. Participants were adults and elderly, selected in a period of 24 months. A total of 68 participants were included. All subjects had a clinical evaluation of swallowing, and an initial measure in a functional scale. The individuals were split into two groups, according to the initial levelling of ASHA NOMS scale. In Group 1 (G1) - ASHA NOMS, initial of levels 1 and 2; Group 2 (G2) - ASHA NOMS, initial of levels 3, 4 and 5. All subjects executed an exercise protocol performed for four weeks. The protocol includes sessions with a speech therapist, and continuity of activities in home environment. Finally, new measurement of swallowing performance was held.

Results

For G2 group there was statistically significant improvement. For G1, the relation was insignificant, despite the intense change in ASHA NOMS scale, however, in this group there was a reduced number of individuals due to the profile severity.

Conclusion

The program was effective because after four exercise sessions, there was significant improvement in swallowing pattern, demonstrated by functional scale.

Keywords
Speech, Language and Hearing Sciences; Deglutition; Deglutition Disorders; Rehabilitation; Exercise Therapy

Procedure	Training
Session 1
The participant is guided to say “CA” in high vocal intensity.	3 sets of 10 repetitions. 30-second interval between the sets.
The participant is instructed to perform vertical and horizontal movements with the tongue.	3 sets of 10 repetitions for each movement. 30-second interval between the sets.
It is instructed to the patient to perform maximum tongue protrusion sustaining for three seconds.	3 sets of 5 repetitions. 30-second interval between the sets.
The participant is guided to say “RA” with sputum movement.	3 sets of 10 repetitions. 30-second interval between the sets.
Session 2
The participant is guided to say “CA” in high vocal intensity, while performing shove movement with the hands in hooking.	3 sets of 10 repetitions. 30-second interval between the sets.
The participant is instructed to perform vertical and horizontal movements with the tongue, sustaining for three seconds at each movement.	3 sets of 10 repetitions for each movement. 30-second interval between the sets.
It is instructed to the patient to perform maximum tongue protrusion sustaining for five seconds.	3 sets of 10 repetitions. 30-second interval between the sets.
The participant is guided to say “RA” with sputum movement.	3 sets of 10 repetitions. 30-second interval between the sets.
Session 3
The participant is guided to say “ZA”, extending “Z” the maximum possible.	3 sets of 10 repetitions. 30-second interval between the sets.
The participant is guided to position the tongue in cheek, with occluded lips and perform counter resistance with the forefinger.	3 sets of 5 repetitions for each side. 30-second interval between the sets.
It is instructed to the patient to perform vocal glissando, with “I”, starting with low pitched tone and evolving to high pitched.	3 sets of 5 repetitions. 30-second interval between the sets.
The participant is guided to hold the tongue among the teeth and swallow saliva (tongue-hold).	3 sets of 5 repetitions. 30-second interval between the sets.
Session 4
The participant is guided to say ”Z”, the longest the possible.	3 sets of 10 repetitions. 30-second interval between the sets.
The participant is guided to position the tongue in cheek, with occluded lips and perform counter resistance with the forefinger.	3 sets of 10 repetitions. 30-second interval between the sets.
It is instructed to the patient to perform vocal glissando, with “I”, starting with low pitched tone and evolving to high pitched.	3 sets of 10 repetitions for each side. 30-second interval between the sets.
The participant is guided to hold the tongue among the teeth and swallow saliva (tongue-hold).	3 sets of 10 repetitions. 30-second interval between the sets.

Groups	ASHA NOMS
Groups	Initial level ≤ 5	Final level ≥ 6
G1 (N=17)	17	14
G2 (N=51)	51	42

	G1 (N=17)		G2 (N=51)
	Initial	Final	Initial	Final
Wet voice	6	0	12	0
Multiple swallowing	14	7	24	10
Cough	12	0	34	1
Chocking	8	0	8	0
Noisy Cervical Auscultation	10	0	14	0
Total signs for dysphagia	50	7	92	11

Group G1		N	Average	Sum of the categories	Z	Asymp. Sig. (2-tailed)
Total Final Total Initial	Negative categories	16	8.50	136.00	-3.575	.000
	Positive categories	16	.00	.00
	Relations	1
	Total	16

Group G2		N	Average	Sum of the categories	Z	Asymp. Sig. (2-tailed)
Total Final Total Initial	Negative categories	45	23.00	1035.00	-5.944	.000
	Positive categories	0	.00	.00
	Relations	6
	Total	51

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E-mail: revista@codas.org.br

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[1] Conflict of interests: nothing to declare.