What We Do: Swallowing Rehabilitation

Oral pharyngeal dysphagia is a medically and socially debilitating condition that affects as many as 10 million Americans.  Etiologies may be secondary to a myriad of acute and chronic illnesses, including cerebrovascular accident, traumatic brain injury, oral pharyngeal carcinoma and a wide range of degenerative and/or neuromuscular diseases.  Management of the dysphagic patient can involve a wide array of multi-disciplinary practices.  These practices range from simple diet manipulation to more invasive surgical interventions.  Rehabilitative efforts focus on the mastery of compensatory strategies for immediate, but transient, airway protection and/or lasting modification of the physiology of the swallow through muscle retraining.  These rehabilitative efforts have escalated within the past 5-8 years, propelled both by the rapid outgrowth of research efforts to explicitly define the nature of swallowing and swallowing disorders, as well as greater recognition from medical personnel that dysphagia is an often treatable disorder.

Swallowing disorders can occur at different stages in the swallowing process:

    • Oral Phase-sucking, chewing and moving food or liquid into the throat.
    • Pharyngeal Phase-starting the swallowing reflex, squeezing food down the throat and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking.
    • Esophageal Phase-relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach.

In physical therapy muscle retraining is frequently a very visible process.  A patient contracts the biceps and the arm flexes; greater strength and greater movement is observed.  In this process, the patient receives direct feedback of the adjustment in motor behavior.  Swallowing treatment is less obvious.  Frequently geriatric and/or brain injured patients are asked to execute complex tasks using muscle groups that have previously operated primarily under automatic response.  Execution of these tasks is many times not observable to the naked eye and success or failure is extremely difficult to measure.  Surface electromyography (surface EMG, EMG or sEMG) biofeedback supplies an alternative system of proprioception, thus extending the patient’s or clinician’s awareness of one aspect of swallowing behavior.  By yielding a visible representation of even the smallest motor response, a window to rehabilitative efforts is opened, allowing the patient and clinician a means of confronting automatic physiologic behaviors and enhancing access to volitional motor control.

Patient populations that have responded will to some application of sEMG include:

  • Cortical and brain stem stroke
  • Oral pharyngeal carcinoma s/p resection and radiation
  • General surgical patients with disuse atrophy
  • Neurodegenerative disorders
  • Cerebral palsy

Treatment may focus on:

  • Muscle relaxation and inhibition
  • Coordination and patterning of muscle response
  • Muscle recruitment

Effective treatment relies on accurate diagnosis and individualization of the treatment plan to the specific physiology.  Diagnostic evaluation may include one or more of the following: video fluoroscopy, fiber optic endoscopic assessment of swallowing, manometer and scintigraphy.  sEMG is not considered a diagnostic tool but may provide the clinician with valuable insights into swallowing behavior.

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