Volume 122, Issue 5, Pages 1314-1321 (May 2002) Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening  Reza Shaker, Caryn Easterling, Mark Kern, Terilynn Nitschke, Benson Massey, Stephanie Daniels, Barbara Grande, Marta Kazandjian, Karen Dikeman  Gastroenterology  Volume 122, Issue 5, Pages 1314-1321 (May 2002) DOI: 10.1053/gast.2002.32999 Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 1 (A) Comparison of FOAMS scores before and after exercise for the sham exercise group (n = 7) and the real exercise group (n = 11). The FOAMS scores after the sham exercise are not significantly different from those before exercise, whereas the FOAMS scores after the real exercise are significantly different from those before the real exercise (P < 0.01). Furthermore, after real exercise FOAMS scores are significantly different from those of after sham exercise scores (P < 0.01). Each patient in each exercise group is identified by a geometric shape that has been kept constant before and after exercise. (B) Although there was no significant difference between the before exercise and after exercise values for the sham exercise group, after 6 weeks of real exercise the maximum deglutitive anteroposterior diameter of the UES opening increased significantly compared with the before-exercise values (P < 0.01). The difference between after real exercise and after sham exercise values, however, did not reach statistical significance (P = 0.4). Gastroenterology 2002 122, 1314-1321DOI: (10.1053/gast.2002.32999) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 2 (A) Comparison of the effect of sham and real exercises on deglutitive biomechanics. Following 6 weeks of real exercise there was a significant increase in the anteroposterior diameter of maximum UES opening (P < 0.01) and maximum anterior excursion of the larynx (P < 0.05) during swallowing 5-mL barium bolus, compared with both before and after sham exercise values. The sham exercise did not change the measured parameters significantly. (B) Comparison of the FOAMS between sham and real exercise regimens. Although the sham exercise had no effect on swallow function, the real exercise resulted in significant improvement in swallow function (*P < 0.05). Gastroenterology 2002 122, 1314-1321DOI: (10.1053/gast.2002.32999) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 3 Effect of exercise on deglutitive biomechanics in all 27 patients. Following 6 weeks of exercise, there was a significant increase in the anteroposterior diameter of the UES (*P < 0.01). This was accompanied by a significant increase in maximum anterior excursion of the larynx (*P < 0.05). Changes in other biomechanical parameters did not reach statistical significance. Gastroenterology 2002 122, 1314-1321DOI: (10.1053/gast.2002.32999) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 4 Effect of exercise on FOAMS. Following 6 weeks of exercise, the FOAMS score increased significantly (*P < 0.001), and all 27 patients achieved a safe swallow. Two with a score of 5, i.e., functional with modified diet, 5 achieved a score of 6, and 20 achieved a score of 7. Tube feeding was discontinued in all patients. The 3 patients who were enrolled within 21 days of their cerebrovascular accident are identified by the open triangle. Gastroenterology 2002 122, 1314-1321DOI: (10.1053/gast.2002.32999) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 5 Effect of exercise on height and width of pyriform sinus residue. After 6 weeks of exercise, both the height and width of the pyriform sinus residue, after 5 mL barium bolus swallows, decreased significantly (*P < 0.01). This was associated with elimination of postdeglutitive aspiration. Gastroenterology 2002 122, 1314-1321DOI: (10.1053/gast.2002.32999) Copyright © 2002 American Gastroenterological Association Terms and Conditions

Fig. 6 Effect of exercise on FOAMS among patients with different duration of dysphagia. In all categories, the performance of 6 weeks of exercise increased the FOAMS score significantly (P < 0.001) and resulted in achievement of functional and safe swallow. The 3 patients who were enrolled within 21 days of their stroke are identified by the open triangle. Gastroenterology 2002 122, 1314-1321DOI: (10.1053/gast.2002.32999) Copyright © 2002 American Gastroenterological Association Terms and Conditions