Clark Heather M, Shelton Natalia
Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA,
Dysphagia. 2014 Oct;29(5):553-63. doi: 10.1007/s00455-014-9544-7. Epub 2014 Jun 10.
The effortful swallow achieves overload through high effort. It was predicted that both immediate effects on biomechanics and long-term neuromuscular adaptations would be facilitated by maximal overload during this exercise. This study examined how high-effort sips from small-diameter straws influenced linguapalatal swallow pressures. Additionally, training effects of effortful swallows preceded by high-effort sips were compared to two other exercise conditions: effortful swallows preceded by maximum effort lingual elevation and effortful swallows performed in isolation. Training outcomes included linguapalatal pressures produced during effortful and noneffortful swallows, and maximum isometric pressure (MIP) produced during tongue elevation and interlabial compression. Forty healthy adults participated in the experiment. Lingual-palatal swallowing pressure during non effortful and effortful swallows and MIPs were measured prior to and after 4 weeks of training. Prior to training, anterior linguapalatal pressures were significantly higher during effortful compared to noneffortful swallows. Anterior linguapalatal pressures did not significantly differ during swallows preceded by sips from high-resistance straws. Weak correlations were observed between tongue MIP and linguapalatal pressures during effortful swallows. After training, anterior linguapalatal pressures significantly increased, with training effects more dramatic for effortful swallows. Anterior tongue MIP also significantly increased. Gains in anterior linguapalatal pressure were not correlated with gains in tongue MIP. Training effects did not vary across exercise condition. The study failed to find a training advantage of pairing the effortful swallow with a precursor movement. The results demonstrated specificity of training, with more dramatic benefits observed for effortful swallows relative to noneffortful swallows. Further investigation is needed to characterize training effects in older adults and patients with dysphagia.
用力吞咽通过高强度努力实现超负荷。据预测，在此运动过程中，最大超负荷将促进对生物力学的即时影响和长期神经肌肉适应。本研究考察了从小直径吸管进行的高强度啜饮如何影响舌腭吞咽压力。此外，将高强度啜饮后进行的用力吞咽的训练效果与其他两种运动条件进行了比较：最大努力舌上抬后进行的用力吞咽和单独进行的用力吞咽。训练结果包括用力和非用力吞咽时产生的舌腭压力，以及舌上抬和唇间压缩时产生的最大等长压力（MIP）。40名健康成年人参与了该实验。在训练4周前后测量了非用力和用力吞咽时的舌腭吞咽压力以及MIP。训练前，用力吞咽时的前舌腭压力明显高于非用力吞咽时。从高阻力吸管啜饮后进行的吞咽过程中，前舌腭压力没有显著差异。在用力吞咽时，观察到舌MIP与舌腭压力之间存在弱相关性。训练后，前舌腭压力显著增加，用力吞咽的训练效果更显著。前舌MIP也显著增加。前舌腭压力的增加与舌MIP的增加无关。训练效果在不同运动条件下没有差异。该研究未能发现将用力吞咽与前驱动作配对的训练优势。结果表明了训练的特异性，相对于非用力吞咽，用力吞咽观察到更显著的益处。需要进一步研究以明确老年人和吞咽困难患者的训练效果。
