Exercise-based approaches to dysphagia rehabilitation.

Rehabilitative techniques for dysphagia (swallowing impairment) increasingly employ exercise modeled on methods used to train muscles in sports medicine. Three techniques in particular show promise for improving muscle strength and function related to swallowing: the Shaker exercise, expiratory muscle strength training, and tongue pressure resistance training. All three techniques invoke principles of task specificity, muscular load, resistance, and intensity, and aim to achieve functional changes in swallowing through changes in muscle physiology derived from strength or endurance training. To date, studies of treatment benefit arising from these techniques involve small sample sizes; this is particularly true of randomized studies with controls receiving standard treatment or experiencing spontaneous recovery. Nevertheless, a review of the available literature shows that improvement of penetration-aspiration is a common finding for individuals with dysphagia receiving one of these three treatment approaches. Although hypothesized as an expected outcome of swallow muscle strength training, improvements in post-swallow residues are noted to be uncommon as an outcome of these exercise-based approaches. The available evidence suggests that exercise-based approaches to swallowing rehabilitation do succeed in changing muscle strength and function, but generalization to true swallowing tasks may be somewhat limited.