Traditional Dysphagia Therapy Improves Swallowing Function in MS Patients, Pilot Study Shows

Traditional Dysphagia Therapy Improves Swallowing Function in MS Patients, Pilot Study Shows

Rehabilitation using traditional dysphagia therapy improved swallowing function in multiple sclerosis patients with dysphagia, a pilot study shows.

The research article with that finding, “The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial” was published in the Journal of Bodywork and Movement Therapies.

Traditional dysphagia therapy (TDT) is a potential rehabilitation strategy for multiple sclerosis (MS) patients with dysphagia (difficulty swallowing). While TDT may improve dysphagia, medical data is lacking about its effect on swallowing function in MS patients.

That is why researchers from the Tehran University of Medical Sciences and the Iran University of Medical Sciences, in Iran, investigated the effects of TDT on dysphagia in MS patients.

“To the best of our knowledge, this pilot study was the first randomized clinical trial to date investigating the effects of the traditional dysphagia therapy on the swallowing function in MS patients with dysphagia,” the researchers wrote.

The study was a randomized, double-blinded, trial, which means study information was withheld from participants and examiners to avoid influencing the results.

A total of 20 MS patients were enrolled, with a mean age of 43.7 years, and mean disease duration of 6.6 years. Eleven patients (55%) had relapsing-remitting MS (RRMS), three patients (15%) had primary progressive MS (PPMS), and six patients (30%) had secondary progressive MS (SPMS).

Participants were divided randomly into two groups: the experimental TDT group (10 patients) and the control group (10 patients).The TDT group learned strategies to improve oral motor control, a range of motion exercises, swallowing maneuvers, and approaches to increase sensory input. “TDT strategies are generally designed to change the physiology of swallowing by improving range of motion of the oral and pharyngeal structures,” the research team wrote.The control group received supervision for feeding and precautions for safe swallowing — including training in specific postural changes, in modifying food volume, consistency and viscosity, and improving sensory oral awareness. According to the team, the strategies applied in the control group aimed “to control the food flow and eliminate the clinical symptoms such as aspiration. However, these strategies do not change the physiology of the swallowing,” like TDT, they wrote.All participants in both groups received 18 treatment sessions, three times a week (every other day).

The team assessed the patients’ swallowing ability, through the Mann Assessment of Swallowing Ability (MASA), before treatment, after the end of nine sessions, after the end of 18 sessions, and 6sixweeks after the end of treatment. Two other scales — the Penetration-Aspiration Scale (PAS) and the Pharyngeal Residue Rating Scale (PRRS) — were used to measure dysphagia.

Results showed that the patients’ swallowing abilities after study completion were improved in both groups, although the improvement in MASA scores was different. In the TDT group, MASA scores progressively improved, increasing at every time point analyzed; whereas in the control group, MASA scores improved at the end of nine sessions but didn’t really change after 18 sessions, and began to decrease six weeks after treatment ended.

Overall, the TDT group showed more improvements in swallowing ability measured by the MASA score at an increased rate across all times analyzed, compared to the control group.

Dysphagia decreased in both groups, given that PAS and PRRS scores were decreased six weeks after treatment completion. However, the reduction in PAS and PRRS scores (meaning decreased swallowing difficulty) in the TDT group was greater than in the control group — a reduction of 3.18 and 2.26 points in PAS and PRSS in the TDT group, compared with a 2.75 and 2.06 reduction, respectively, in the control group.

The findings indicate that although swallowing function becomes safer after treatment in both groups, TDT techniques seem to be better at reducing penetration, aspiration, and pharyngeal residue than the usual care techniques.

“The findings of the current study [imply] that the traditional dysphagia therapy techniques may improve the underlying pathophysiology, mainly weakness and reduced endurance, sensory thresholds, tone, timing, and coordination,” in MS patients with dysphagia, researchers concluded.

Nonetheless, the team emphasized that future studies, with larger sample sizes, are needed to confirm these results.

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2 comments

  1. Justice Joe says:

    They never teach you the actual techniques or explain them in junk like this, just boast about results. It’s not helpful to those looking for a way to swallow their own food better. Give you a little hope, but no instructions or directions, just leave you hanging. Typical. Who’s book do I have to buy? Or what “expert” wants money for the answer?

    • Jonathan Grinstein says:

      Hi Justice,

      The researchers describe the strategies employed in TDT as the following:

      1) Exercise programs: Oral motor control Exercises; Range of motion tongue Exercises; Resistance Exercises; Bolus control Exercises; Bolus propulsion Exercises; Laryngeal elevation.
      2) Pharyngeal swallowing maneuvers: Mendelsohn maneuver; Supraglottic swallow; Super supraglottic swallow; Effortful swallow; Masako maneuver.
      3) Compensatory swallowing strategies: Viscosity changes to food and liquids; Positional changes; Clear throat or cough after each bite/sip; No straws; Place food on right or left side of mouthAlternate bite/sip.
      4) Sensory stimuli: Changing the taste, volume, temperature, or carbonation of the bolus; Thermal tactile stimulation; Additional pressure on the tongue with a spoon.

      I hope this helps provide you with some clarification.

      Best,
      Jonathan D. Grinstein, PhD

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