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强化训练对健康老年受试者吞咽肌肉组织及功能的影响:一项前瞻性有效性和可行性研究。

Effects of Strengthening Exercises on Swallowing Musculature and Function in Senior Healthy Subjects: a Prospective Effectiveness and Feasibility Study.

作者信息

Kraaijenga S A C, van der Molen L, Stuiver M M, Teertstra H J, Hilgers F J M, van den Brekel M W M

机构信息

Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.

出版信息

Dysphagia. 2015 Aug;30(4):392-403. doi: 10.1007/s00455-015-9611-8. Epub 2015 Apr 4.

Abstract

Head and neck cancer (HNC) patients may develop dysphagia due to muscle atrophy and fibrosis following chemoradiotherapy. Strengthening of the swallowing muscles through therapeutic exercise is potentially effective for improving swallowing function. We hypothesize that a customized Swallow Exercise Aid (SEA), developed for isometric and isokinetic strengthening exercises (against resistance), can help to functionally strengthen the suprahyoid musculature, which in turn can improve swallowing function. An effectiveness/feasibility study was carried out with ten senior healthy volunteers, who performed exercises 3 times per day for 6 weeks. Exercises included chin tuck against resistance (CTAR), jaw opening against resistance (JOAR), and effortful swallow exercises with the SEA. Multidimensional assessment consisted of measurements of maximum chin tuck and jaw opening strength, maximum tongue strength/endurance, suprahyoid muscle volume, hyoid bone displacement, swallowing transport times, occurrence of laryngeal penetration/aspiration and/or contrast residue, maximum mouth opening, feasibility/compliance (questionnaires), and subjective swallowing complaints (SWAL-QOL). After 6-weeks exercise, mean chin tuck strength, jaw opening strength, anterior tongue strength, suprahyoid muscle volume, and maximum mouth opening significantly increased (p < .05). Feasibility and compliance (median 86 %, range 48-100 %) of the SEA exercises were good. This prospective effectiveness/feasibility study on the effects of CTAR/JOAR isometric and isokinetic strengthening exercises on swallowing musculature and function shows that senior healthy subjects are able to significantly increase swallowing muscle strength and volume after a 6-week training period. These positive results warrant further investigation of effectiveness and feasibility of these SEA exercises in HNC patients with dysphagia.

摘要

头颈部癌(HNC)患者在放化疗后可能会因肌肉萎缩和纤维化而出现吞咽困难。通过治疗性锻炼增强吞咽肌肉可能对改善吞咽功能有效。我们假设,为等长和等速抗阻锻炼开发的定制吞咽锻炼辅助器(SEA)有助于从功能上增强舌骨上肌群,进而改善吞咽功能。对10名健康的老年志愿者进行了一项有效性/可行性研究,他们每天进行3次锻炼,持续6周。锻炼包括抗阻收下巴(CTAR)、抗阻张口(JOAR)以及使用SEA进行用力吞咽锻炼。多维评估包括测量最大收下巴和张口力量、最大舌力/耐力、舌骨上肌肉体积、舌骨位移、吞咽运输时间、喉穿透/误吸和/或造影剂残留的发生率、最大张口度、可行性/依从性(问卷调查)以及主观吞咽不适(SWAL-QOL)。经过6周锻炼后,平均收下巴力量、张口力量、舌前力量、舌骨上肌肉体积和最大张口度显著增加(p < .05)。SEA锻炼的可行性和依从性良好(中位数86%,范围48 - 100%)。这项关于CTAR/JOAR等长和等速抗阻锻炼对吞咽肌肉组织和功能影响的前瞻性有效性/可行性研究表明,健康的老年受试者在经过6周训练期后能够显著增加吞咽肌肉力量和体积。这些积极结果值得进一步研究这些SEA锻炼在吞咽困难的HNC患者中的有效性和可行性。

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