Hot Topics in Dysphagia Research

Speech pathologists from all over the world meet at the Dysphagia Research Society conference every year to present and discuss the latest and greatest in swallowing research.  Many of these studies eventually go on to be published in peer-reviewed journals, but since publication can be a time-consuming process, the DRS presentations allow a sneak peek at the most current findings in dysphagia research before they are even “hot off the press”.

Of the dozens and dozens of presentations given at the 2011 conference, below are the hot topics that I believe might lead to significant differences in swallowing therapy…

Adherence to Swallowing Exercises on Swallowing Outcomes for Head and Neck Cancer Patients.

This study evaluated the effectiveness of prescribed swallowing exercises on improving therapy outcomes with patients following treatment for head and neck cancer.   The exercises prescribed included the Shaker, Mendelsohn maneuver, supraglottic swallow, falsetto glides, Masako, and effortful swallow.

Conclusion:  Patients who performed swallowing exercises during radiation treatment had significantly higher outcomes at 6 months, 1 year, and 2 years after radiation treatment.  These results suggest that adherence to swallowing exercises may be effective in preventing decline in swallowing-related quality of life after radiation treatmentUniversity of Texas MD Anderson Cancer Center (Shinn E, et al).

Jen’s comments:  The study further supports the hopefully growing trend of referring patients who are being treated for head and neck cancer to a speech pathologist BEFORE they develop swallowing problems.   There are increasing reports that doing swallowing exercises and myofascial release before, during, and immediately following radiation treatment (vs. years after radiation when dysphagia has gotten severe) can significantly help preserve strength and range of motion of the swallowing mechanism.

 

Training for Dysphagia with Metronome Improves Swallowing Function in Parkinson’s Disease

Twenty patients with Parkinson’s Disease and moderate dysphagia were divided into 2 groups.  The experimental therapy consisted of cervical stretching, lingual exercise, and deglutition of jelly to the rhythm of six beats of a metronome.  The control therapy was identical but without the metronome.  When the subjects were evaluated with a Modified Barium Swallow study, the amount of residuals in the valleculae and pyriform sinuses when swallowing jelly was decreased after training with the metronome vs. training without the metronome.

ConclusionTraining with the metronome during swallowing was effective for shortening oral transit time and decreasing the amount of residuals in the pharynx for patients with Parkinson’s disease.  University of Health Science, Kobe, Hyogo, Japan.  (Nozaki S, et al.)

Jen’ comments:   Patient’s with Parkinson’s disease often have significant difficulty with coordination of the swallow which eventually leads to weakness and dysphagia.  The use of the metronome likely helps improve coordination and control during the swallow, which are some of the most challenging aspects to treat with this population.   It will be interesting to see more details about this type of therapy as it is researched further.


Effects of Effortful Swallow on Esophageal Peristalsis

Esophageal dysfunctions are typically treated using medications with varying success.  This study manometrically examined the effects of an effortful pharyngeal swallow to assess the impact it may have on esophageal function.  The effortful swallow yielded greater esophageal amplitudes and longer esophageal duration which decreased incomplete bolus clearance.

Conclusion:  The effortful swallow may offer a behavioral manipulation of esophageal dysfunction.  Further studies will determine its clinical potential in patients with esophageal dysmotility. Wake Forest University, Winston-Salem NC (Butler, et al)

Jen’s comments:  While speech pathologists have many available treatments to effectively treat oral and pharyngeal dysphagia, we currently have no tools to actively improve esophageal dysfunction.  So these are very promising findings.

 

McNeill Dysphagia Therapy Program (MDTP) (2 studies)

Independent Evaluation and Outcome Data with Moderate to Severe Chronic Oropharyngeal Dysphagia

Five patients (1 stroke, 4 head and neck cancer) who were an average of 7.7 years post onset who had all failed previous trials of traditional swallowing therapy completed 15 sessions of MDTP.  Four out of five showed marked improvements in all measurements of swallowing.

Conclusion:  The positive outcomes of MDTP can be generalized to different clinical programs.  MDTP is emerging as a promising therapy for patients with chronic, mod-severe oropharyngeal dysphagia.  Antwerp University Hospital (VanNuffelen G, et al)

Jen’s comments:  Previously the research about MDTP had only been conducted by the developers of the program at University of Florida, so it is great to see that the high level of success with this program  for patients with chronic dysphagia is being replicated elsewhere.

 

Improved Temporal Coordination of Swallowing Following MDTP

Eight patients with chronic dysphagia completed 15 sessions of MDTP.  The patients demonstrated significant changes in timing of swallowing speed.

ConclusionDysphagia therapy with MDTP improves timing of physiologic events during swallowingUniversity of Florida (Lan Y, et al)

Jen’s comments:  Since the MDTP program is designed to restore both strength and speed of swallowing function, both which are vital for normal swallowing, it is not a surprise that the program would result in improved swallowing speed.  This is likely one of the first studies about MDTP to objectively document this change in swallowing speed as a result of the treatment.

 

A complete list of all the presentations given at the 2011 DRS conference can be found in the December issue of Dysphagia (2011) 26:432–47.

 photo courtesy of rosefirerising Flickr Creative Commons License

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About Jennifer Carter

Jen is a Denver speech pathologist that specializes in providing treatment for swallowing difficulty (called dysphagia). She has provided speech therapy to patients for 18 years and opened the Carter Swallowing Center because of her passion for helping patients recover from swallowing problems.

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