Mary Gorham-Rowan, PhD, CCC-SLP Katherine Walden, M.S., CCC-SLP K. Bailey Stone, B.S. Mary Gorham-Rowan, PhD, CCC-SLP Katherine Walden, M.S., CCC-SLP Melissa Carter, M.S., CCC-SLP

Disclosure Statement No authors had any financial or non-financial conflicts of interest associated with the content of this presentation.

Background Incidence of dysphagia post-anterior cervical fusion (ACF) surgery ranges from 1.7 to 70%. Decreased laryngeal elevation post-ACF surgery may result in excess residue in the piriform sinuses and valleculae. Excess residue can increase the risk of aspiration. Common treatment strategies for dysphagia include diet modification, postural changes, and/or specific exercises to improve muscular strength and function.

Background Adapting techniques used in physical therapy may also be effective in treating or managing dysphagia. Kinesio Tape (KT) was developed to support athletes and improve blood and lymph flow as well as relieve pain in injured joints and muscles. Application of KT to the suprahyoid muscles, sternocleidomastoid, and upper trapezius has been shown to improve hyoid excursion and epiglottic inversion among individuals with post-stroke dysphagia. These findings suggest that KT provides improved support and stability without limiting range of motion.

Purpose The purpose of this study was to examine the immediate effects of KT on hyolaryngeal elevation in a patient with persistent dysphagia post- ACF surgery.

Methods The participant was a 75-year-old male 1-year post-ACF surgery. Initial evaluation revealed mild to moderate pharyngeal dysphagia characterized by piecemeal deglutition, reduced hyolaryngeal excursion and base of tongue (BOT) retraction, and pharyngeal residue. Follow-up evaluation one month later revealed reduced epiglottic inversion with persistent pharyngeal residue. KT applied to the suprahyoid musculature 4 months after initiation of therapy.

Methods: Materials Evaluation of KT effectiveness completed via FEES assessment. Four bolus types were administered: 1 tsp of water 1 tsp of applesauce 1 tsp of fruit cup 1/4 of graham cracker

Methods Two trials of each consistency were completed. trial 1: without KT trial 2: with KT

Results: Inter-rater reliability was high: rs (6) = .90 to .98. 1 tsp of Water (a. & b.) – no difference in residue ratings with or without KT 1 tsp of fruit cup (c. & d.) – moderate-severe residue without KT; trace residue with KT 1 tsp of Applesauce – mild residue without KT: trace residue with KT ¼ of Graham cracker – no difference in residue ratings with or without K Overall impression: reduced residue with KT

Discussion Data suggest that the KT had a positive effect on reducing the residue in the valleculae and the piriform sinuses in 2 of the four bolus types: peaches and applesauce. The positive results of the fruit cup and applesauce boluses could be attributed to the KT stabilizing of the larynx in a elevated position, which would allow for the boluses to move safely into the pharynx. The positive results of the peaches and applesauce boluses could also be attributed to the patient’s prior dysphagia therapy and successful use of compensatory strategies. The raters perceived no change in the residue levels for the graham cracker bolus. These results could be attributed to the dry consistency of the graham cracker, making it more difficult to swallow over all.

Discussion The raters found that there was no change in the residue levels for the water bolus. These results could be attributed to the compensatory strategies used by the patient throughout the trials. Small volume of trials may also have affected the extent to which laryngeal elevation was assisted by KT.

Conclusion The study aimed to investigate whether KT applied to the suprahyoid muscles to provide suspension and support would in turn reduce residue in the piriform sinuses and valleculae. KT was beneficial for semi-solid and pureed boluses. Findings are limited to one participant and a small number of trials; future studies should examine a wider range of patients and a greater number of trials with variability in volume and viscosity. MBS assessment should be incorporated to more fully determine the effect of KT on hyolaryngeal excursion and epiglottic inversion. Long-term as well as short-term effects of KT use should be examined.

References Carucci, L.R., et al. (2015). Dysphagia secondary to anterior cervical fusion: Radiologic evaluation and findings in 74 patients. Am J Rotengenol, 204, 768-775. Logemann, J.A. (1983). Evaluation and treatment of swallowing disorders. San Diego, CA: College-Hill Press. Csapo, R., & Alegre, L. (2015). Effects of kinesio taping on skeletal muscular strength – A meta-analysis of current evidence. J Med Sci Sport, 18, 50-456. Heo, S.Y., & Kim, K.M. (2015).  Immediate effects of Kinesio Tape on the movement of the hyoid bone and epiglottis during swallowing by stroke patients with dysphagia. J Phys Ther Sci, 27, 3355-3357.