What causes permanent improvement in Dysphagia (Difficulty Swallowing)?

From the Guidelines

Permanent improvement in Dysphagia (Difficulty Swallowing) can be achieved through targeted exercises and maneuvers, with the Shaker head lift and chin-down technique being among the most effective approaches, as evidenced by recent studies 1. To address Dysphagia, it's essential to understand that a variety of interventions exist, ranging from direct to indirect, isolated to combined, and those incorporating swallowing and non-swallowing tasks. The goal of these interventions is to change and improve swallowing physiology in force, speed, or timing, aiming for long-term effects.

Some key points to consider in Dysphagia management include:

• The Shaker head lift has been shown to improve strengths and endurance of the suprahyoid muscles and upper esophageal sphincter opening, reducing residues and aspiration events 1.
• The chin-down technique is beneficial for patients with decreased airway protection, reducing aspiration risk by approximately 50% in some studies 1.
• Tongue strength training has also been found to improve swallowing variables like vallecular residues and swallowing safety 1.
• Expiratory muscle strength training (EMST) has shown significant effects on swallowing safety in various patient groups, including those with Parkinson's disease and subacute stroke patients 1.

In terms of specific recommendations:

• Patients with weakness of the suprahyoid muscles and impaired opening of the upper esophageal sphincter may benefit from the Shaker head lift exercise, which involves a head rising exercise with an isometric high-intensity portion and an isokinetic low-intensity portion 1.
• For patients with decreased airway protection, the chin-down technique can be instructed, where the patient is asked to “bring their chin to their chest” and maintain this posture throughout the duration of the swallow 1.
• Tongue strength training can be tailored to the individual's needs, with the goal of improving tongue strength and reducing the risk of aspiration 1.
• EMST can be considered for patients with swallowing difficulties, as it has been shown to strengthen the expiratory and submental muscles, improving swallowing safety 1.

It's crucial to note that while these exercises and maneuvers show promise, the scientific evidence is heterogeneous, and more large-scale RCTs are needed to provide definitive clinical meaningful endpoints 1. Nonetheless, based on the current evidence, a comprehensive approach combining these targeted exercises and maneuvers can lead to permanent improvement in Dysphagia, enhancing the patient's quality of life and reducing the risk of complications associated with swallowing difficulties.

From the Research

Causes of Permanent Improvement in Dysphagia

There are no research papers to assist in answering this question, as the provided studies focus on delayed sleep phase disorder and its treatment, rather than dysphagia (difficulty swallowing).

Related Studies on Delayed Sleep Phase Disorder

• The studies provided investigate the effects of bright light and melatonin treatment on delayed sleep phase disorder 2, 3.
• Research suggests that a gradual advancement of rise times can improve subjective daytime sleepiness, fatigue, and cognitive function in patients with delayed sleep phase disorder 2, 3.
• The use of bright light and melatonin treatment has been shown to maintain positive effects on sleep phase over time 3.
• The endogenous circadian temperature period length (tau) has been found to be longer in individuals with delayed sleep phase disorder compared to good sleepers 4.
• Chronotherapy, a treatment that resets the circadian clocks of patients with delayed sleep phase insomnia, has been shown to be effective in resetting the biological clocks of patients 5.
• The etiology of delayed sleep phase disorder is thought to be related to a delay in the circadian clock, and treatments have focused on advancing the biological clock and sleep timing 6.