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Neuromuscular Treatments for Speech and Swallowing: A Tutorial

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Heather Clark at Mayo Foundation for Medical Education and Research
Heather Clark
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Abstract

Despite the proliferation of oral motor therapies, much controversy exists regarding the application and benefit of neuromuscular treatments (NMTs) such as strength training for alleviating dysarthria and/or dysphagia. Not only is limited empirical support available to validate the use of NMTs, but clinicians may also lack the foundational information needed to judge the theoretical soundness of unstudied treatment strategies. This tutorial reviews the theoretical foundations for several NMTs, including active exercises, passive exercises, and physical modalities. It highlights how these techniques have been used to address neuromuscular impairments in the limb musculature and explores potential applications to the speech and swallowing musculature. Key issues discussed in relation to active exercise are the selection of treatment targets (e.g., strength, endurance, power, range of motion), specificity of training, progression, and recovery. Factors influencing the potential effectiveness of passive exercises and physical modalities are presented, along with discussion of additional issues contributing to the controversy surrounding oral motor therapies.
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Neuromuscular treatments for speech and swallowing: A tutorial
Heather M Clark
American Journal of Speech - Language Pathology; Nov 2003; 12, 4; ProQuest Psychology Journals
pg. 400
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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... Strength based rehabilitation aims to increase force generating capacity of peripheral muscles through targeted exercise programs (7). These programs are typically prescribed for airway protection impairments that are due to underlying peripheral muscle weakness and are heavily dependent on sports medicine principles (61,62) such as progressive overload, intensity, frequency of exercise, and specificity of movement type (59-61, 63, 64). In turn, it is hypothesized that peripheral neuromuscular adaptations including motor unit recruitment, muscle fiber type shift, and myofiber hypertrophy may be observed (60,61,(64)(65)(66). ...
... These programs are typically prescribed for airway protection impairments that are due to underlying peripheral muscle weakness and are heavily dependent on sports medicine principles (61,62) such as progressive overload, intensity, frequency of exercise, and specificity of movement type (59-61, 63, 64). In turn, it is hypothesized that peripheral neuromuscular adaptations including motor unit recruitment, muscle fiber type shift, and myofiber hypertrophy may be observed (60,61,(64)(65)(66). In contrast, skill-based or task-specific rehabilitation aims to increase the coordination and sequence involved in the central mechanisms that execute airway protective behaviors (58,59,67,68). ...
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  • Jun 2024
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Article
Full-text available
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... For younger children, words with meaning are more indicated because it will increase their level of motivation for learning them, assimilating them with objects and phenomena in their lives, and being able to practice and use them outside the speech therapy office as well (Ballard et al., 2010). In any case, experts believe that task specificity must be respected, suggesting that the movements to be learned and practiced must be "speech" movements and not lip or tongue movements in the absence of speech (Clark, 2003). ...
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Full-text available
  • Dec 2023
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Article
Full-text available
  • Nov 2023
  • Dysphagia
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Article
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Ramp-and-Hold Force Control in the Upper and Lower Lips
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  • Dec 1990
The relation among several parameters of the ramp-and-hold force contraction and target force level was quantified for the upper and lower lip in 40 normal adults and in 4 young adults who had sustained traumatic brain injury (TBI). Using visual feedback, subjects produced ramp-and-hold compression lip forces as rapidly and accurately as possible to end-point target levels ranging from 0.25 to 2.00 newtons. In normal adults, significant positive linear relations were found between the parameters of the ramp-and-hold lip force task and target force level, including the peak rate of force change, peak force, and the mean and standard deviation of force during the hold phase. Though males and females have been shown to differ greatly on absolute maximum force-generating capabilities, they are virtually identical on the measures used to quantify the lip force ramp-and-hold task over the range of compression forces studied. Preliminary investigation of lip force control in 4 TBI subjects suggests that these quantitative measures are useful in determining the distribution and nature of motor impairment between the upper and lower lips during a dynamic force control task.
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Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition
Article
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Effects of a tongue-holding maneuver on anterior bulging of the posterior pharyngeal wall (PPW) during swallowing were investigated in 10 young adult normal subjects. Videofluorographic images of 3-ml liquid barium swallows were digitized to quantify the extent of anterior bulge of the PPW with and without the maneuver at the mid and the inferior levels of the second cervical vertebra. A significant increase in PPW bulging was seen with the maneuver at both pharyngeal levels. These findings indicate potential for developing new treatment techniques to facilitate compensatory anterior movement of the PPW, which has not been a target for direct treatment in the past. At present, the tongue-holding maneuver can be employed clinically as an easy method for testing the compliance of the PPW videofluorographically. However, the use of the maneuver per se, which inhibits posterior retraction of the base of tongue (BOT), resulted in increasing the pharyngeal (specifically vallecular) residue after the swallow. The results also indicate the importance of tongue movement in triggering the pharyngeal swallow.
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