Device Adjustments and Tongue Exercises

  • Devices allow adjustments for strength training (example: 60 kilopascals).

  • Patients can perform exercises without in-person supervision.

Limitations of Existing Devices

  • Prior devices had limitations due to a single bot.

  • Newer devices are being developed by researchers, previously called:

    • MOS (Muscle Orbital Strength)

    • Swallow Strong

  • These devices may appear under different names as they return to the market.

Features of New Device

  • New device has four valves, allows for patient-specific adaptations.

  • Users must mold the mouthpiece to fit individual oral cavity structures, enhancing comfort and consistency.

  • Capable of testing anterior, posterior, left, and right tongue strength simultaneously.

  • Molded design prevents excessive movement, providing more accurate measurement during exercises.

  • Includes a biting part for patient stability during exercises.

Standard Protocol for Tongue Exercises

  • Conducted three times daily: 10 repetitions each time, for a total of 30 repetitions daily.

  • Exercises should not be done back-to-back to allow muscle recovery:

    • Recommend Monday, Wednesday, Friday, or alternate days (e.g., Tuesday, Thursday).

  • Recovery period is crucial; muscle strength increases during rest, not during the exercise itself.

Biofeedback and Device Efficiency

  • Device provides real-time biofeedback based on tongue strength:

    • Target zone indicated by a green zone on the device.

    • Trials are only counted if the strength reaches the green zone.

Molding Time Considerations

  • Molding takes approximately 30 minutes, noted as a potential obstacle for clinicians due to time constraints.

Jaw Opening Device

  • Jaw opening challenges seen in patients with head and neck cancer post-radiation therapy.

  • Hand-operated device provides passive jaw stretching; ideal opening is three fingers wide.

  • Recommended protocol:

    • Seven repetitions, each held for seven seconds, seven times a day, for up to seven weeks.

Biofeedback in Swallowing Rehabilitation

  • Definition of biofeedback:

    • An objective measure that improves learning and execution accuracy in swallowing exercises.

  • Ideal candidates are cognitively intact patients who can see and use the screen/device.

  • Learning curves exist for operating biofeedback devices or apps.

Types of Biofeedback Devices

  1. SEMG (Surface Electromyography)

    • Surface electrodes detect muscle activity related to swallowing.

    • Commonly used in submental or suprahyoid regions.

  2. Other devices include:

    • FIS (Force Insertion Devices)

    • Airfield valves

    • Manometry devices

EMG Exercises

  • Most often used for:

    • Effortful swallow

    • Mandibular manipulation

  • Goal for effortful swallow is to exceed baseline amplitude on EMG readings.

  • For mandible exercises, maintain pressure for extended periods (goal: one to three seconds).

EMG Considerations

  • Electrodes require care in placement due to muscle overlap in the area.

  • Consistency in electrode placement is critical for accurate readings:

    • Maintain half-centimeter distance between electrodes if using multiple.

Electrical Stimulation (NMES)

  • Employs electrodes for muscle contraction around the suprahyoid area.

  • Offers low-voltage electrical currents to facilitate muscle activation.

  • Research indicates mixed results; some studies show suppression of hyoid elevation.

  • Important notes for application:

    • Requires patient tolerance and clear understanding of target muscle groups.

    • Should not be used as sole intervention—evidence must be considered.

Exercise Parameters

  1. Target Impairments: Clearly define what impairment is being addressed.

  2. Frequency and Intensity: Apply principles of neuroplasticity:

    • Frequency of exercises impacts muscle adaptation.

    • Intensity relates to how challenging the exercise is for the patient.

  3. Specificity: Practice should focus directly on the behavior needing improvement, such as swallowing skills over generalized muscle training.

  4. Repetitions and Overload: Incorporating the overloading principle to enhance muscle engagement.

Pain Perception and Patient Compliance

  • Use scales (e.g. Borg Scale) post-exercise to measure effort or fatigue levels in patients.

  • Assess patient adaptation to potential maladaptive behaviors during training, maintaining focus on relevant swallowing techniques.