Effects of Laryngeal Restriction on Pharyngeal Peristalsis and Biomechanics: Clinical Implications

To date, rehabilitative exercises aimed at strengthening the pharyngeal muscles have not been developed due to the inability to successfully overload and fatigue these muscles during their contraction, a necessary requirement for strength training. The purpose of this study was to test the hypothesis that applying resistance against anterosuperior movement of the hyolaryngeal complex will overload the pharyngeal muscles and by repetitive swallowing will result in their fatigue manifested by a reduction in pharyngeal peristaltic amplitude. Studies were done in two groups. In group 1 studies 15 healthy subjects (age: 42 ± 14 yr, 11 females) were studied to determine whether imposing resistance to swallowing using a handmade device can affect the swallow-induced hyolaryngeal excursion and related upper esophageal sphincter (UES) opening. In group 2, an additional 15 healthy subjects (age 56 ± 25 yr, 7 females) were studied to determine whether imposing resistance to the anterosuperior excursion of the hyolaryngeal complex induces fatigue manifested as reduction in pharyngeal contractile pressure during repeated swallowing. Analysis of the video recordings showed significant decrease in maximum deglutitive superior laryngeal excursion and UES opening diameter (P \u3c 0.01) due to resistive load. Consecutive swallows against the resistive load showed significant decrease in pharyngeal contractile integral (PhCI) values (P \u3c 0.01). Correlation analysis showed a significant negative correlation between PhCI and successive swallows, suggesting “fatigue” (P \u3c 0.001). In conclusion, repeated swallows against a resistive load induced by restricting the anterosuperior excursion of the larynx safely induces fatigue in pharyngeal peristalsis and thus has the potential to strengthen the pharyngeal contractile function

Swallow Strength Training Exercise For Elderly: A Health Maintenance Need

Background: Recent studies have shown high prevalence of oropharyngeal dysphagia associated with frailty‐ and age‐related muscle weakness. Strength training exercises have been advocated for locomotive health maintenance in the elderly and have shown positive outcomes. As muscles involved in oropharyngeal phase of swallowing are also comprised of striated muscles, the aim of this study was to determine biomechanical effect of a novel resistance exercise program, Swallowing Against Laryngeal Restriction (SALR), on pharyngeal phase swallowing in the healthy elderly. Methods: A total of 28 volunteers (75 + 7 years; 17 females) with no complaint of dysphagia were studied using video fluoroscopy before and after 6 weeks of the swallow strength training exercise. Eighteen of these volunteers also underwent high‐resolution pharyngeal manometry non‐concurrent with fluoroscopy. Ten additional volunteers (81 + 6 years; 9 females) were studied by videofluoroscopy before and after 6 weeks of a sham exercise. Key Results: Swallow resistance exercise but not the sham exercise resulted in a significant increase in maximum upper esophageal sphincter opening (P \u3c .01), superior and anterior laryngeal excursion (P \u3c .01) as well as posterior pharyngeal wall thickness (P \u3c .01). Resistance exercise but not sham exercise also resulted in a significant increase in deglutitive pharyngeal contractile integral (P \u3c .01). Conclusions & Inferences: Strength training of muscles involved in the pharyngeal phase of swallowing using the swallowing against laryngeal restriction technique is feasible and significantly improves key physiologic features of the pharyngeal phase of swallowing. These findings provide the basis for consideration of developing an exercise‐based swallow health maintenance program for the elderly swallow health maintenance program for the elderly