Exercise Training for Cervicogenic Dysphagia
Condition: Dysphagia, Esophageal
MeSH terms: Deglutition Disorders
Study type: Interventional

Summary: 
      Background: Cervicogenic dysphagia is a swallowing difficulty caused by cervical problems
      that negatively impact pulmonary health, and quality of life and may increase the risk of
      mortality.

      Study design: Randomized Controlled Study Purpose: The purpose was to explore the effect of a
      structured exercise training program composed of cervical stretching, strengthening and
      stabilizing exercises on the swallowing function, craniovertebral angle, and pulmonary
      function in patient with cervicogenic dysphagia.

      Methods: 32 patients (age 35-50 years) with cervicogenic dysphagia were randomly allocated
      into study group (n=17) and control group (n=15). The craniovertebral angle (CVA), the
      swallowing function (using the swallow-difficulty questionnaire "SDQ") and the pulmonary
      function (including the forced vital capacity "FVC" and forced expiratory volume in one
      second "FEV1") were evaluated pre-study and post-study. All participants received three
      sessions/week for 8-weeks. The study group received the structured exercise program, in
      addition to the swallow resistance exercise (SRE), while the control group received the
      swallow resistance exercise only.
    

Detailed description: 
      Dysphagia is a common complaint in patients with cervical problems, and it is usually
      transient and responds favorably to rehabilitation programs. Cervicogenic dysphagia is
      difficulty in swallowing due to cervical spine pathology. Considering the close proximity of
      the cervical spine to the oropharynx and esophagus; the existence of any cervical pathology
      can adversely impact the pharynx and esophagus dimensions, through direct compression on the
      esophagus resulting in epiglottic tilt, cricopharyngeal spasm, and disturbed laryngeal inlet
      closure pattern, ending in disturbing the normal swallowing that can be evaluated by the
      swallowing disturbance questionnaire results in which the lower scores on the swallowing
      difficulty questionnaire reflects better swallowing status than higher scores, furthermore;
      with the cut-off value for 12.5 is a good predictor of the disturbed swallowing function.

      Cervical malalignment is associated with an increased incidence of dysphagia. Cervical
      kyphosis is associated with malfunctional pharyngeal structure and disturbed swallowing.
      Additionally; cervical kyphosis is associated with deep cervical flexor muscles' weakness
      that in turn can significantly disturb cervical stability during swallowing. The combined
      effect of muscle weakness and poor cervical posture negatively impacts the laryngeal and
      cricopharyngeal sphincteric action and ends in cervical kyphosis.

      Disturbed swallowing can negatively impact respiratory function, causing rapid deterioration
      in patients' ventilatory function and increasing the rate of pulmonary disorders'
      exacerbations. Maintaining normal swallowing function is essential in preventing consequent
      pulmonary complications.

      Mal-aligned cervical spine predisposes to altered pulmonary functions that can be
      successfully corrected with therapeutic exercises, and manual therapy approaches.

      A proper dysphagia management program is important not only to restore the normal coordinated
      swallowing-breathing pattern; but also, to eliminate the dysphagia-associated morbidity and
      health-related economic burden. Since cervicogenic dysphagia results from cervical spine
      pathologies or deformities, management of cervicogenic dysphagia should be focused on the
      treatment of cervical disturbances.

      Postural correction therapeutic approaches are essential components in the dysphagia
      management program, but current evidence about their efficacy in dysphagia treatment is still
      limited. Although it is difficult to achieve a complete cervicogenic dysphagia cure;
      conservative therapies targeting postural realignment can alleviate the symptoms and treat
      cervicogenic dysphagia.

      Definitely, there is a confirmed correlation between cervical spine pathologies and
      oropharyngeal dysphagia, further research is warranted to further explore the efficacy of the
      different rehabilitative non-surgical approaches in the treatment of cervicogenic dysphagia.

      The objective of this study was to explore the efficacy of the structured physical therapy
      treatment program on pulmonary function, swallowing difficulty, and craniovertebral angle in
      patient with cervicogenic dysphagia.
    

Intervention name(s): Structured exercise training program + The swallow resistance exercise program.; Only the swallow resistance exercise program.
Intervention type(s): Other; Other
Intervention description(s): Structured exercise training program + The swallow resistance exercise program.; Only the swallow resistance exercise program.
Other intervention name(s): Intervention for the study group.; Intervention for the control group.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Deglutition Disorders; Pulmonary Functions; Manipulation; Physical Therapy