Hansen Tina, Staal Sabina Mette, Rauhe Harreby Nete Deela, Andersen Ulla, Holm Masumi Takeuchi, von Bülow Cecillie, Wæhrens Eva Ejlersen
Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Amager and Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark.
Occupation-Centered Occupational Therapy, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
Geriatrics (Basel). 2024 Oct 22;9(6):138. doi: 10.3390/geriatrics9060138.
BACKGROUND/OBJECTIVES: Age-related dysphagia involves sarcopenia and nervous system changes affecting ingestion. The ACT-ING program, a novel task-based occupational therapy intervention, has been developed to improve strength, endurance, and ingestive skills using real-world eating and drinking tasks for older adults with age-related dysphagia. This narrative review evaluates the outcomes and neuromuscular adaptations of task-based eating and drinking interventions in aging animal models to inform potential refinements of the ACT-ING program and interpret results from an ongoing proof-of-concept study.
Publications were obtained from PubMed, SCOPUS, CINAHL, and EMBASE, and selected following the PRISMA guideline. Thirteen randomized trials investigated a task-based fluid-licking intervention in rats, combining strength, endurance, and skill training.
Results suggested benefits in improving muscle strength, endurance, and swallowing skills in terms of quantity and speed. Although neuromuscular adaptations were less conclusive, the intervention appeared to induce cortical plasticity and increase fatigue-resistant muscle fibers in the involved muscles.
While these findings are promising, methodological concerns and potential biases were identified. Therefore, further research is necessary to refine the ACT-ING program, including both clinical studies in humans and preclinical studies in aging animal models that clearly define interventions targeting all aspects of ingestion-related skills within a motor learning and strength training framework.
背景/目的：与年龄相关的吞咽困难涉及肌肉减少症和影响吞咽的神经系统变化。ACT-ING项目是一种基于任务的新型职业治疗干预措施，旨在通过为患有与年龄相关吞咽困难的老年人安排现实生活中的饮食任务来提高力量、耐力和吞咽技能。本叙述性综述评估了衰老动物模型中基于任务的饮食干预的结果和神经肌肉适应性，以为ACT-ING项目的潜在改进提供信息，并解释正在进行的概念验证研究的结果。
从PubMed、SCOPUS、CINAHL和EMBASE获取出版物，并按照PRISMA指南进行选择。13项随机试验研究了大鼠基于任务的舔液干预，结合了力量、耐力和技能训练。
结果表明，在改善肌肉力量、耐力和吞咽技能的数量和速度方面有好处。虽然神经肌肉适应性不太明确，但干预似乎能诱导皮质可塑性，并增加受累肌肉中抗疲劳肌纤维的数量。
虽然这些发现很有前景，但也发现了方法学问题和潜在偏差。因此，有必要进行进一步研究以完善ACT-ING项目，包括针对人类的临床研究和针对衰老动物模型的临床前研究，这些研究应在运动学习和力量训练框架内明确定义针对吞咽相关技能各个方面的干预措施。
