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健康成年人功能性吞咽中吞咽动作训练及已训练行为向喉前庭运动学的转化研究

Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults.

作者信息

Guedes Renata, Azola Alba, Macrae Phoebe, Sunday Kirstyn, Mejia Veerley, Vose Alicia, Humbert Ianessa A

机构信息

Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States; AC Camargo Cancer Center, Brazil.

Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States.

出版信息

Physiol Behav. 2017 May 15;174:155-161. doi: 10.1016/j.physbeh.2017.03.018. Epub 2017 Mar 18.

Abstract

Swallowing maneuvers are routinely trained in dysphagia rehabilitation with the assumption that practiced behaviors transfer to functional swallowing, however transfer is rarely examined in the deglutition literature. The goal of this study was to train the volitional laryngeal vestibule closure (vLVC) maneuver, which is a swallowing maneuver that targets prolonged laryngeal vestibule closure (LVC). In two different training experiments, 69 healthy adults underwent Long-hold (hold vLVC as long as possible) or Short-hold vLVC training (hold vLVC for 2s). Before and after vLVC training, natural swallows (swallowing without a therapeutic technique) were completed. The outcome variables included laryngeal vestibule closure reaction time and the duration of laryngeal vestibule closure. Results indicate that during both Long-hold and Short-hold vLVC trainings, vLVC swallows had faster laryngeal vestibule closure reaction times and longer durations of laryngeal vestibule closure than in pre-training 5ml liquid swallows. However, only faster laryngeal vestibule closure reaction times transferred to post-training 5ml liquid swallows (20-24% faster), but not prolonged durations of laryngeal vestibule closure. Our findings suggest that swallowing maneuver training has the potential to induce transfer of what was practiced to functional swallowing behavior, although not all practiced behaviors may generalize. These findings are significant for bolstering the effectiveness of dysphagia management in medical settings and should be tested in individuals with dysphagia.

摘要

吞咽动作在吞咽困难康复中经常被训练,其假设是练习过的行为会转化为功能性吞咽,但在吞咽文献中很少对这种转化进行研究。本研究的目的是训练自主喉前庭闭合(vLVC)动作,这是一种以延长喉前庭闭合(LVC)为目标的吞咽动作。在两个不同的训练实验中,69名健康成年人接受了长时间保持(尽可能长时间保持vLVC)或短时间保持vLVC训练(保持vLVC 2秒)。在vLVC训练前后,完成了自然吞咽(不使用治疗技术的吞咽)。结果变量包括喉前庭闭合反应时间和喉前庭闭合持续时间。结果表明,在长时间保持和短时间保持vLVC训练期间,与训练前的5毫升液体吞咽相比,vLVC吞咽的喉前庭闭合反应时间更快,喉前庭闭合持续时间更长。然而,只有更快的喉前庭闭合反应时间转化到训练后的5毫升液体吞咽中(快20 - 24%),而喉前庭闭合持续时间并未延长。我们的研究结果表明,吞咽动作训练有可能促使练习过的行为转化为功能性吞咽行为,尽管并非所有练习过的行为都能普遍化。这些发现对于提高医疗环境中吞咽困难管理的有效性具有重要意义,并且应该在吞咽困难患者中进行测试。

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