Dysphagia Treatment

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Questions and Answers

What are the four general steps of EBP?

Generate a clinical question Search for available scientific evidence Review and evaluate the evidence Integrate clinical expertise, client’s perspective and reviewed evidence

Strategies, not therapy that aim to ensure safe swallows without directly improving the physiology of swallowing __________ ?

Compensatory management strategies (correct)

Therapeutic exercises

Medical management

Modalities

The effortful swallow, mendelsohn maneuver and tongue hold/masako maneuver are therapeutic exercises.

False

What are the four principles of neuromuscular rehabilitation?

Use it or lose it- Taub’s principle of non-use (Taub, 1980) Use it and improve it Specificity- targeting the mechanism of dysfunction Transference and carryover to deglutition Signup and view all the answers

Modalities elicit brain plasticity which enables the recovery of muscle function. It allows you to target CN and muscles that are difficult to treat with conventional treatment. Provide 2 examples of how they facilitate cortical reorganization.

Providing sensory stimulation. Providing movement (kinesthetic) feedback. Promoting functional, task-specific use patterns. Inducing repetitive swallows, muscle patterns. Signup and view all the answers

What is the basic function of EMG?

To see how well a muscle is activated. Signup and view all the answers

The treatment must match an understanding of the mechanism of dysfunction. When developing a treatment plan you must remember to ask yourself, what is our goal? Please list these four goals.

<ol> <li>To restore function…</li> <li>To manage/reduce symptoms…</li> <li>Protect the airway…</li> <li>Optimize nutrition…</li> </ol> Signup and view all the answers

According to EBP who is suitable to use compensatory strategies?

Patients who have adequate memory and attention to perform the strategies consistently Patients who have caregivers who can assist to implement the strategies Signup and view all the answers

This maneuver is used to augment UES opening via sustained laryngeal elevation

Mendelsohn manueuver Signup and view all the answers

Rehabilitative swallowing therapy involves exercises and techniques that aim to achieve long-term improvement in the ____________ of swallowing.

Neuromuscular control Signup and view all the answers

What is biofeedback? What is the benefit of biofeedback?

The use of an external tool to provide the patient with a representation of their physical effort It provides patients with a real-time visual and auditory representation of their effort thereby increasing the effort evoked Signup and view all the answers

Why is ultrasound a powerful tool to use during articulation therapy?

It provides a ‘snapshot’ of tongue movements that allow the speech pathologist to better guide the client so they can adjust their movements to produce sounds more accurately. Signup and view all the answers

Provide 3 examples of the consequences of dysphagia.

Aspiration- respiratory distress, pneumonia, death Choking - airway compromise Tracheostomy Malnutrition/dehydration Weight loss Chronic respiratory illness Artificial feeding: PEG, NG, OG, or G Tube/J Tube Placement Signup and view all the answers

Who is not suitable for the use of compensatory strategies?

Patients with severe/low cognitive impairments Patients who cannot or refuse to follow the recommendations Signup and view all the answers

This maneuver is utilized for laryngeal protection. The patient holds breath before & during the swallow & exhales afterwards.

Supraglottic swallow Signup and view all the answers

_________ targets the suprahyoid muscles, to facilitate the opening of the upper esophageal sphincter and improving bolus transfer. A flexible object (ball, towel) is required.

Chin tuck against resistance (CTAR) Signup and view all the answers

The external measurement of muscle recruitment via microvolts:

sEMG Signup and view all the answers

Uses sound waves to produce pictures of the inside of the body

Ultrasound Signup and view all the answers

This is a treatment modality that uses elasticity of cotton tapes on the skin to affect muscle and nerve. It can enhance postural control for neural position and stability.

Neuromuscular taping Signup and view all the answers

How can neuromuscular taping benefit patients?

Enhance postural control for neural position and stability Improve muscle function for RoM, strengths, and sensory feedback Create or re-educate muscle memory and correct muscle imbalance Reduce muscle atrophy Signup and view all the answers

What are the four types of treatment options?

Compensatory Therapeutic exercises Medical management Modalities Signup and view all the answers

Provide 3 examples of compensatory maneuvers that are utilized to better protect the airway immediately before, during and after swallows.

Supraglottic swallow Super-supraglottic swallow Effortful swallow Mendelsohn maneuver Signup and view all the answers

Oral motor exercises are designed to increase the range of movement in your tongue, lips, and jaw and can improve the strength of the swallowing musculature.

False Signup and view all the answers

This head-life exercise strengthens the suprahyoids and increases the opening of the UES.

Shaker Signup and view all the answers

When utilizing ultrasound for swallowing, the most common application for observing the tongue, larynx, and hyoid-bone movement.

True Signup and view all the answers

What are the benefits of submental taping?

It provides directional sensory stimuli for swallow and laryngeal elevation Can prolong effect of NMES Signup and view all the answers

When developing a treatment plan, you should only include one type of therapy.

False Signup and view all the answers

Evidence shows this maneuver produces high pharyngeal pressure and results in reduction or elimination of pharyngeal residue. It’s the most common, easiest maneuver for patients to understand.

Effortful swallow Signup and view all the answers

What makes a patient suitable for rehabilitative swallowing therapy?

Adequate cognitive skills Motivation to improve Willingness to practice independently or with assistance A need to increase muscle strength and range of motion Signup and view all the answers

Although _______ is a “non-swallow” exercise, there is evidence of transference in which respiratory strength training facilitates improvements in deglutition

Expiratory muscle strength training (EMST) Signup and view all the answers

This modality uses of electrical pulses that are modified and manipulated to excite peripheral nerves and evoke an action potential through a transcutaneous medium i.e. surface electrodes.

NMES/Electrotherapy Signup and view all the answers

The only accessible swallowing muscles for external electrode placement are the suprahyoids.

True Signup and view all the answers

What is the primary goal of Evidence-Based Practice (EBP) in dysphagia treatment?

To integrate individual clinical expertise with the best available external clinical evidence from research Signup and view all the answers

What is a critical aspect of developing a treatment plan for dysphagia?

Understanding the mechanism of dysfunction Signup and view all the answers

What are the four goals of a treatment plan in dysphagia rehabilitation?

To restore function, manage symptoms, protect the airway, and optimize nutrition Signup and view all the answers

What is the primary focus of rehabilitative swallowing therapy?

To achieve long-term improvement in the physiology of swallowing Signup and view all the answers

What is a key principle of rehabilitation in dysphagia treatment?

YOU MUST HAVE A PLAN OF BIOLOGICAL PLAUSIBILITY Signup and view all the answers

What is the primary goal of compensatory management strategies in dysphagia treatment?

To ensure safe swallows without directly improving the physiology of swallowing Signup and view all the answers

What is the main limitation of conventional swallowing treatment?

It does not address the underlying dysfunction Signup and view all the answers

What is a crucial factor to consider when developing a treatment plan for dysphagia?

The patient's cognitive ability Signup and view all the answers

What is the main benefit of using modalities in dysphagia treatment?

They facilitate cortical reorganization and recovery of muscle function Signup and view all the answers

What is the primary goal of compensatory swallowing maneuvers?

To better protect the airway immediately before, during and after swallows Signup and view all the answers

What is the primary goal of rehabilitative swallowing therapy?

To achieve long-term improvement in the physiology of swallowing Signup and view all the answers

Which maneuver is used to augment UES opening via sustained laryngeal elevation?

Mendelsohn maneuver Signup and view all the answers

What is the problem associated with the supraglottic swallow maneuver?

Reduce or late VF closure; delayed pharyngeal swallow Signup and view all the answers

What is a common consequence of dysphagia?

Malnutrition Signup and view all the answers

What is the purpose of the 'buffet table philosophy' in dysphagia treatment?

To consider all available treatment options Signup and view all the answers

Which of the following is a therapeutic exercise that can be used to strengthen swallowing muscles?

Effortful swallow Signup and view all the answers

What is the purpose of the head rotation/turn maneuver?

To divert the bolus to the intact side Signup and view all the answers

What is a key factor in determining the effectiveness of compensatory management strategies?

Instrumental evaluation Signup and view all the answers

Which of the following is NOT a compensatory swallowing posture?

Tongue hold Signup and view all the answers

What is the primary goal of therapeutic exercises in dysphagia treatment?

To strengthen the swallowing muscles Signup and view all the answers

What is the most important consideration when selecting a treatment approach for dysphagia?

The underlying mechanism of dysfunction Signup and view all the answers

What is the goal of rehabilitative swallowing therapy?

To achieve long-term improvement in the neuromuscular control of swallowing Signup and view all the answers

Which of the following is a benefit of using compensatory strategies?

Reducing the risk of penetration/aspiration Signup and view all the answers

What is the rationale behind the super-supraglottic swallow maneuver?

To protect the airway; effortful breath hold tilts arytenoids forward, closing airway entrance before and during swallow Signup and view all the answers

What is the purpose of the consecutive throat clear and swallow maneuver?

To clear residue when occasional wet voice is noted Signup and view all the answers

What is the primary goal of the Chin Tuck Against Resistance (CTAR) exercise?

To facilitate the opening of the upper esophageal sphincter Signup and view all the answers

What is the main benefit of the Thermal Tactile Oral Stimulation (TTOS) modality?

To provide heightened oral awareness and faster swallow trigger Signup and view all the answers

What is the primary goal of the Shaker Exercise?

To increase the opening of the upper esophageal sphincter Signup and view all the answers

Which of the following is a contraindication for the Shaker Exercise?

All of the above Signup and view all the answers

What is the primary cause of morbidity and mortality in patients with advanced neurogenic conditions?

Respiratory dysfunction Signup and view all the answers

What is the primary effect of muscle weakness and incoordination on respiratory function in neurogenic patients?

Impaired ventilation Signup and view all the answers

Which of the following is NOT a characteristic of neurogenic patient populations?

Increased respiratory muscle strength Signup and view all the answers

What is the primary benefit of exercises that target the suprahyoid muscles?

Facilitated opening of the upper esophageal sphincter Signup and view all the answers

What is the primary goal of neuromuscular rehabilitation?

To promote muscle recovery and improve function Signup and view all the answers

Which of the following principles of neuromuscular rehabilitation is MOST relevant to the treatment of swallowing disorders?

Transference and carryover Signup and view all the answers

What is the primary benefit of using EMST in improving cough and airway protection?

It generates excessive force and continued airflow during exhalation Signup and view all the answers

How often should the resistance be increased during Breather Training for Swallowing Protocol?

About once a week Signup and view all the answers

What is the total number of reps completed by the end of each day during Breather Training for Swallowing Protocol?

40 reps Signup and view all the answers

What is the frequency of Breather Training for Swallowing Protocol?

6 days a week for 4 weeks Signup and view all the answers

What is the primary benefit of respiratory strength training in EMST?

It facilitates improvements in deglutition Signup and view all the answers

What is the primary consequence of respiratory muscle dysfunction?

Heightened sensations of dyspnea Signup and view all the answers

What is the term for breathing that is too shallow or too slow to meet the needs of the body?

Hypoventilation Signup and view all the answers

What is the most common type of pneumonia that occurs due to aspiration event?

Right lower lobe pneumonia Signup and view all the answers

What is the primary goal of Respiratory Muscle Strength Training (RMST)?

To target muscles essential for ventilation and airway protective functions Signup and view all the answers

What is the term for the shrunken, infected, airless state of the lungs?

Atelectasis Signup and view all the answers

What is the benefit of Expiratory Muscle Strength Training (EMST) in swallow function?

All of the above Signup and view all the answers

What is the suggested duration of EMST training for improving swallow safety and/or cough?

5 weeks Signup and view all the answers

What is the term for the temporary decrease in oxygen concentration in the blood during sleep?

Nocturnal desaturation Signup and view all the answers

What is the primary benefit of using resistive trainers in RMST?

They provide adjustable and independent inspiratory and expiratory pressure settings Signup and view all the answers

What is the term for the respiratory failure that occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body?

Type 2 Respiratory Failure Signup and view all the answers

What is the primary benefit of using modalities in speech and dysphagia rehabilitation?

To elicit brain plasticity and enable recovery of muscle function Signup and view all the answers

What is the primary function of neuromuscular electrical stimulation (NMES) in swallowing treatment?

To stimulate the muscles involved in swallowing Signup and view all the answers

What is the primary benefit of repetitive transcranial magnetic stimulation (rTMS) in speech and dysphagia rehabilitation?

To facilitate cortical reorganization and neural plasticity Signup and view all the answers

What is the primary goal of using ultrasound in swallowing treatment?

To observe the movement of the tongue, larynx, and hyoid bone Signup and view all the answers

What is the primary benefit of biofeedback in speech and dysphagia rehabilitation?

To provide sensory stimulation and movement feedback Signup and view all the answers

What is the primary goal of neuromuscular taping?

To create or re-educate muscle memory and correct muscle imbalance Signup and view all the answers

What is the benefit of submental taping?

Directional sensory stimuli for swallow and laryngeal elevation Signup and view all the answers

What is the limitation of neuromuscular taping?

It cannot improve or change what is already normal and functioning at its optimum state Signup and view all the answers

What is the basis of neuromuscular learning?

What fires together, is wired together Signup and view all the answers

What is the benefit of neuromuscular taping for muscle function?

It can improve muscle function for range of motion, strength, and sensory feedback Signup and view all the answers

What is the primary goal of neuromuscular rehabilitation?

To normalize function and reduce muscle atrophy Signup and view all the answers

What is the purpose of using surface EMG in swallowing therapy?

To measure the objective numerical data of muscle recruitment during swallowing Signup and view all the answers

What is the benefit of using EMG in dysphagia treatment?

It is a cost-effective and safe modality for patients across the lifespan Signup and view all the answers

What is the role of neuromuscular taping in dysphagia management?

To enhance postural control for neural position and stability Signup and view all the answers

What is the primary function of electromyography?

To see how well a muscle is activated Signup and view all the answers

What is the benefit of using ultrasound in dysphagia management?

It provides a clear image of the inside of the body without radiation Signup and view all the answers

What is the effect of muscle weakness and incoordination on respiratory function in neurogenic patients?

It leads to breathing that is too shallow or too slow to meet the needs of the body Signup and view all the answers

What is the purpose of the CTAR exercise in dysphagia treatment?

To increase the opening of the UES via sustained laryngeal elevation Signup and view all the answers

What is the benefit of using biofeedback in dysphagia treatment?

It provides an external tool to represent the patient's physical effort during swallowing Signup and view all the answers

What is the purpose of the 'buffet table philosophy' in dysphagia treatment?

To allow patients to choose from a variety of treatment options Signup and view all the answers

What is the contraindication of the Shaker Exercise in dysphagia treatment?

Not specified in the content Signup and view all the answers

What is the advantage of using surface electromyography (sEMG) in biomechanics?

It provides objective quantification of muscle energy Signup and view all the answers

What is the importance of accuracy in collecting and interpreting sEMG data?

It is essential for reliability and validity of the data Signup and view all the answers

What is the purpose of collecting sEMG readings every 5 sessions or 9 sessions?

To measure therapeutic progress Signup and view all the answers

What is the rationale behind placing electrodes on the suprahyoid muscles?

They are the only accessible swallowing muscles Signup and view all the answers

What is the benefit of combining sEMG with adjunctive swallowing therapies?

It results in true neuromuscular re-education Signup and view all the answers

What is the principle of maximal effort in sEMG treatment?

Patients should attempt maximal effortful swallows Signup and view all the answers

What is the importance of controlling for bolus size and viscosity in sEMG data collection?

It ensures accurate data collection Signup and view all the answers

What is the purpose of the 'open display' feature in some sEMG devices?

It enables continuous data collection during exercises Signup and view all the answers

What is the role of games in sEMG treatment?

They enhance patient motivation and engagement Signup and view all the answers

Why is it essential to remember to only target the suprahyoid muscles in sEMG treatment?

Because they are the only accessible muscles Signup and view all the answers

What is the primary benefit of using ultrasound in swallowing assessment?

It is portable and can be used at the bedside Signup and view all the answers

During the oropharyngeal phase, what is essential for effective and safe swallowing?

Tongue movement and laryngeal elevation Signup and view all the answers

What is the main advantage of ultrasound over VFSS in assessing oropharyngeal dysphagia?

Ultrasound is less invasive and does not require radiation Signup and view all the answers

What is the purpose of the transducer in ultrasound imaging?

To generate sound waves that pass through the body Signup and view all the answers

What is the primary application of submental ultrasonography in swallowing assessment?

To visualize the tongue motion and hyoid bone displacement Signup and view all the answers

Why is ultrasound a valuable tool in articulation therapy?

It allows for real-time visualization of tongue movements during speech Signup and view all the answers

What is the benefit of using ultrasound in combination with other therapies for comprehensive habilitation/rehabilitation?

It facilitates a more comprehensive understanding of swallowing function Signup and view all the answers

What is the primary characteristic of liquids on sonography imaging?

They appear black on the monitor because they are anechoic Signup and view all the answers

What is the primary benefit of using real-time biofeedback in articulation therapy?

It allows for real-time visualization of tongue movements during speech Signup and view all the answers

What is the primary advantage of using ultrasound in swallowing assessment compared to other imaging modalities?

It is a non-invasive and radiation-free technique Signup and view all the answers

What is the primary benefit of using ultrasound in swallowing therapy?

To provide visual feedback for speech production and swallowing function Signup and view all the answers

What is the goal of NMES treatment in swallowing therapy?

To maintain and strengthen muscle mass during inactive periods Signup and view all the answers

What is the primary mechanism of action of neuromuscular taping?

It provides outside in, bottom up, superficial to deep stimuli Signup and view all the answers

What is the typical duration of an NMES treatment session?

30 minutes, 3-4 times per week, for 6-8 weeks Signup and view all the answers

What is the primary benefit of using NMES in swallowing therapy?

It maintains and strengthens muscle mass during inactive periods Signup and view all the answers

What is the primary goal of neuromuscular taping in swallowing therapy?

To enhance postural control for neural position and stability Signup and view all the answers

What is the primary effect of NMES on motor units?

It changes the mechanism of action of motor units Signup and view all the answers

What is the primary benefit of using ultrasound in speech therapy?

It provides visual feedback for speech production Signup and view all the answers

What is the primary goal of NMES treatment in swallowing therapy?

To maintain and strengthen muscle mass during inactive periods Signup and view all the answers

What is the primary mechanism of action of NMES?

It uses electrical pulses to stimulate peripheral nerves and evoke an action potential Signup and view all the answers

Study Notes

Dysphagia and Swallowing Disorders

Dysphagia is likely the result of multiple contributing factors, including: • Decreased neural drive to the swallowing musculature • Insufficient sensory feedback for efficient motor control • Myofascial restrictions as a result of disuse • Disruption of air flow gradients • Anatomical changes to the swallowing musculature • Muscle atrophy as a result of disuse
Consequences of Dysphagia: • Aspiration: respiratory distress, pneumonia, death • Choking: airway compromise • Tracheostomy • Malnutrition/dehydration: weight loss, chronic respiratory illness • Artificial feeding: PEG, NG, OG, or G Tube/J Tube Placement

Effective Dysphagia Management

The "buffet table philosophy" involves considering four areas of available treatments and determining what the patient needs to improve swallowing: • Compensatory strategies • Therapeutic exercises • Medical management • Modalities

Compensatory Strategies

Modify or manage symptoms, but do not strengthen muscles: • Head turn • Chin tuck • Modified diet • Supra- and super-supra-glottic swallows • Effortful swallow • Volitional breath hold
Compensatory management strategies: • Proceed with caution, as they are not technically therapeutic and have limited evidence • Should be proven to be effective for the client under instrumental evaluation • May not be suitable for all patients, especially those with severe cognitive impairments

Therapeutic Exercises

Oromotor exercises: • Designed to increase the range of movement in the tongue, lips, and jaw • Do not improve strength and should be used minimally
Rehabilitative swallowing therapy: • Goal: Achieve long-term improvement in the neuromuscular control of swallowing • Suitable for patients with adequate cognitive skills, motivation, and willingness to practice independently • Not suitable for patients with severe cognitive impairments
4 general principles of neuromuscular rehabilitation: • Use it or lose it (Taub's principle of non-use) • Use it and improve it • Specificity: targeting the mechanism of dysfunction • Transference and carryover to deglutition

Respiratory Muscle Strength Training (RMST)

Targets muscles essential for ventilation and airway protective functions of cough and swallow
Types of resistive trainers: • Airport devices • General mechanism: different sized ports that increase or lessen resistance
Benefits of RMST: • Improves both ventilatory and non-ventilatory functions • Improves strength of cough and decreases penetration-aspiration scale
Suggested EMST training protocol: • 5 weeks, 40 reps a day, 20 AM and 20 PM, 6 days a week • Use a pressure-threshold device

Evidence-Based Practice (EBP)

Definition: The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
Promotes the use of best available research evidence, clinical expertise, and client's/caregiver's values and perspectives in making clinical decisions

Respiratory Dysfunction in Neurogenic Patient Populations

Neurogenic patient populations often have respiratory dysfunction, including: • Muscle weakness, spasticity, motor incoordination, and postural abnormalities • Reduced activity due to fatigue, further reducing respiratory muscle function • Impaired ventilation, which is a major cause of morbidity and mortality in patients with advanced neurogenic conditions
Breather training for swallowing protocol: • 2 sets, each consisting of 20 reps per set, 6 days a week, for 4 weeks • Increase resistance every week### Management of Dysphagia
Customized treatment plan includes:
- Stopping at each treatment table to create a customized "plate" with sEMG/Biofeedback paired with CTAR exercise
- Electrical stimulation to the suprahyoid paired with effortful swallow
- Neuromuscular taping to support laryngeal elevation
- EMST paired with dietary modifications/positioning while eating/drinking
- Non-oral feeding options, if medically necessary, paired with Ultrasound
Modalities do not work in isolation

Introduction to Biofeedback

Biofeedback: the use of an external tool to provide the patient with a representation of their physical effort
sEMG: the external measurement of muscle recruitment via microvolts, measuring the amount of muscle recruited
Benefits: provides clear, objective, numerical data to measure baseline and results of intervention

Fundamentals of sEMG

Electromyography (EMG): the non-invasive study of muscle function through analysis of electrical signals produced during muscular contractions
EMG involves:
- Detection, amplification, recording, analysis, and interpretation of electrical signals
- Measures muscle firing
Surface EMG uses:
- 2 bipolar surface electrodes placed on the surface of the skin to detect voltage differences due to asynchronous activation of motor units
- Small signals detected by the active pair of electrodes on the surface of the skin over the muscle are compared to the signal detected by a reference electrode ("ground") placed over connective tissues
The basic function of EMG is to see how well a muscle is activated
Maximal voluntary contraction (MVC) of the muscle is used to determine muscle force

Literature

Surface EMG (sEMG) has been successfully used for:
- Identifying the presence of swallowing activity
- Analyzing swallowing functions (timing and amplitude)
- As a biofeedback training strategy in the treatment of swallowing disorders
Studies:
- Ashida (2010): analyzed the pattern of suprahyoid muscle activity during pharyngeal swallowing of foods by healthy young subjects
- Vaiman (2007): determined that sEMG was a statistically reliable assessment tool for children, adults, and older adults
- Deluca (1997): discussed the use of surface electromyography in biomechanics

Clinical Responsibility

Data collection and interpretation:
- Accuracy is imperative with sEMG
- Reliability and validity of the data are essential
Inaccurate data is worthless because the practitioner (and patient) may draw incorrect conclusions

SEMG Advantages

Validates the effectiveness of interventions
Provides objective quantification of the energy of a muscle
Allows the observer to see the muscle energy at rest and changing continuously over the course of a moment
Blends valuable information concerning how the nervous system participates in the orchestration of muscle movement

SEMG Protocol

Clean and prepare the skin with an ESTIM prep pad
Place two new electrodes on the suprahyoid muscles (for initial and re-evaluation data collection)
Place the black ground electrode on the back of the neck or collar bone
Exercise: skill specific (salience), coordination, endurance, and speed

Daily Application

sEMG can be used as part of the daily treatment plan
Should be used in conjunction with other therapies
Patient should attempt anywhere from 5-10 of their maximal effortful swallows, or attempt to perform a swallow maneuver per trial

Electrode Placement

Suprahyoids and Thyrohyoid
Rationale: the only accessible swallowing muscles for external electrode placement are the suprahyoids

Ultrasound

Introduction: provides clinicians with non-invasive opportunities to study the dynamics of the oral pharyngeal system and the muscles of the oropharynx during swallowing
Uses: visualization of essential swallowing structures in real-time, observation of tongue motion and hyoid bone displacement, and assessment of VF function

Neuromuscular Electrical Stimulation (NMES)

Definition: the use of electrical pulses that are modified and manipulated to excite peripheral nerves and evoke an action potential through a transcutaneous medium
History: dates back to Hippocrates and the Romans and Greeks
Common uses: reduce joint swelling and inflammation, tissue healing, muscle re-education, improve circulation, and pain management

NMES and Swallowing Function

Maintains and strengthens muscle mass during inactive periods
Maintains and gains ROM for optimal hyolaryngeal excursion and airway closure
Facilitates voluntary motor control for swallowing maneuvers
Increases sensory awareness
Restores normal balance to the system as ascending sensory information is reintegrated into movement patterns

NMES "Ingredients"

Parameters: pulse rate, pulse duration, amplitude, and ramp up
Typical NMES treatment session: 30 minutes, 3-4 times a week, for 6 weeks

Neuromuscular Taping

Definition: a treatment modality that uses the elasticity of cotton tapes on the skin to affect muscle and nerve
Mimics the qualities of the skin, aka "functional taping"
Provides outside-in, bottom-up, superficial to deep stimuli
Can assist in normalization of physiological functions when applied appropriately on the target tissues
Can be worn for extended periods with continued therapeutic effect with little or minimal negative side effects

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