Yutma Bozukluklarında Ekspiratuar Kas Kuvvet Eğitimi

Öz

Yutma ve solunum koordineli olarak çalışan hayati fonksiyonlardır. Yutma solunum koordinasyonun bozulması kişileri hava yolu aspirasyonuna açık hale getirmektedir. Yutma rehabilitasyonunda temel amaç aspirasyonu önlemek ve hava yolu koruması sağlamaktır. Ekspiratuar kas kuvvet eğitimi (EMST), ekspiratuar kasları kuvvetlendirmek ve solunum fonksiyonlarını iyileştirmek için tasarlanmış bir tedavi yöntemidir. Yutma bozukluklarında solunum temelli yaklaşımlar nispeten yeni olmakla birlikte fizyoterapi ve rehabilitasyon tekniği olan EMST yutma literatüründe hızlı bir ilerleme kaydetmektedir ve en çok kullanılan teknik olarak karşımıza çıkmaktadır. Literatüre bakıldığında EMST’nin yutma rehabilitasyonunda kullanılmaya başlanması 2000’li yılların başına dayanmaktadır. Süreçte EMST ile ilgili çalışmalar yoğunlaşmış ve sıklıkla nörolojik hastalık gruplarında çalışmalar yapılmıştır. EMST’nin suprahyoid kas aktivasyonunu artırarak hava yolu kapanışını sağlaması ve aspirasyonu önlemek için kuvvetli bir öksürük oluşumunu kolaylaştırması yutma rehabilitasyonundaki etki mekanizmaları olarak düşünülmektedir. EMST yutma rehabilitasyonu için umut verici bir yaklaşımdır. Etki mekanizmasının daha iyi tanımlanması için daha büyük örneklem gruplarında ve farklı hastalık gruplarında yapılacak çalışmalara ihtiyaç olduğu düşünülmüştür.

Anahtar Kelimeler

• Yutma bozukluğu
• Solunum
• Rehabilitasyon
• Disfaji
• yutma

Expiratory Muscle Strength Training in Swallowing Disorders

Öz

Swallowing and breathing are vital functions that work in coordination. Impaired coordination of swallowing and breathing makes people vulnerable to airway aspiration. The main aim of swallowing rehabilitation is to prevent aspiration and provide airway protection. Expiratory muscle strength training (EMST) is a treatment method designed to strengthen expiratory muscles and improve respiratory function. Although respiratory-based approaches in swallowing disorders are relatively new, EMST, a physiotherapy and rehabilitation technique, is making rapid progress in the swallowing literature and is the most widely used technique. Looking at the literature, the use of EMST in swallowing rehabilitation dates back to the early 2000s. In the process, studies on EMST have intensified and studies have often been conducted in neurological disease groups. The mechanisms of action of EMST in swallowing rehabilitation are thought to be that it provides airway closure by increasing suprahyoid muscle activation and facilitates the formation of a strong cough to prevent aspiration. EMST is a promising approach for swallowing rehabilitation. It was thought that studies on larger sample groups and different disease groups were needed to better define the mechanism of action.

Anahtar Kelimeler

• Swallowing disorder
• Respiration
• Rehabilitation
• Dysphagia
• swallowing

Kaynakça

1. 1.Mayerl CJ, Gould FDH, Adjerid K, Edmonds C, German RZ. The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia 2023; 38:33-41.
2. 2. Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory- swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2011; 26:218-24.
3. 3. Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol 2016; 13:49-59.
4. 4. Nativ-Zeltzer N, Nachalon Y, Kaufman MW, Seeni IC, Bastea S, Aulakh SS, Makkiyah S, Wilson MD, Evangelista L, Kuhn MA, Sahin M, Belafsky PC. Predictors of Aspiration Pneumonia and Mortality in Patients with Dysphagia. Laryngoscope 2022; 132:1172-6.
5. 5. Mancopes R, Smaoui S, Steele CM. Effects of Expiratory Muscle Strength Training on Videofluoroscopic Measures of Swallowing: A Systematic Review. Am J Speech Lang Pathol 2020; 29:335-56.
6. 6. Pitts T, Bolser D, Rosenbek J, Troche M, Okun MS, Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest 2009; 135:1301-8.
7. 7. Arıkan H, Kütükcü EÇ, Çakmak A, Özkal Ö. Kistik fibroziste pulmoner rehabilitasyon. Turkiye Klinikleri Physiotherapy and Rehabilitation-Special Topics 2016; 2:22-8.
8. 8. Gross RD, Trapani-Hanasewych M. Breathing and Swallowing: The Next Frontier. Semin Speech Lang 2017; 38:87-95.

9. 9. Bautista TG, Sun QJ, Pilowsky PM. The generation of pharyngeal phase of swallow and its coordination with breathing: interaction between the swallow and respiratory central pattern generators. Prog Brain Res 2014; 212:253-75.
10. 10. Yılmaz C. Yutma ve Solunum İlişkisi: Genel Bilgiler. Dil Konuşma ve Yutma Araştırmaları Dergisi 2018; 1:127-41.
11. 11. van der Heijden ME, Zoghbi HY. Development of the brainstem respiratory circuit. Wiley Interdiscip Rev Dev Biol 2020; 9:e366.
12. 12. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg 2005; 131:762-70.
13. 13. Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology 2017; 34:121-8.
14. 14. Cvejic L, Harding R, Churchward T, Turton A, Finlay P, Massey D, Bardin PG, Guy P. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology 2011; 16:269-75.
15. 15. Nguyen NP, Moltz CC, Frank C, Millar C, Smith HJ, Dutta S, Nguyen PD, Nguyen LM, Lemanski C, Ludin A, Jo BH, Sallah S. Effectiveness of the cough reflex in patients with aspiration following radiation for head and neck cancer. Lung 2007; 185:243-8.
16. 16. Zhang W, Pan H, Zong Y, Wang J, Xie Q. Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2022; 103:1179-91.
17. 17. Fujiwara S, Ono T, Minagi Y, Fujiu-Kurachi M, Hori K, Maeda Y, Boroumand S, Nitschke I, Ursula V, Bohlender J. Effect of supraglottic and super-supraglottic swallows on tongue pressure production against hard palate. Dysphagia 2014; 29:655- 62.
18. 18. Wheeler Hegland K, Troche MS, Brandimore AE, Davenport PW, Okun MS. Comparison of voluntary and reflex cough effectiveness in Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1226-30.
19. 19. Troche MS, Okun MS, Rosenbek JC, Musson N, Fernandez HH, Rodriguez R, Romrell J, Pitts T, Wheeler-Hegland KM, Sapienza CM. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology 2010; 75:1912-9.
20. 20. Cinel G, Demir N, Özçelik U, Karaduman AA. Çocuklarda yutma disfonksiyonu. Çocuk Sağlığı ve Hastalıkları Dergisi 2013; 56:89-96.
21. 21. Jeong JH, Yoo WG. Effects of pulmonary rehabilitation education for caregivers on pulmonary function and pain in patients with lung cancer following lung resection. J Phys Ther Sci 2015; 27:489-90.
22. 22. Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010; 65 Suppl 1:i1-58.
23. 23. Plowman EK, Tabor-Gray L, Rosado KM, Vasilopoulos T, Robison R, Chapin JL, Gaziano J, Vu T, Gooch C. Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham-controlled trial. Muscle Nerve 2019; 59:40-6.
24. 24. Troche MS, Rosenbek JC, Okun MS, Sapienza CM. Detraining outcomes with expiratory muscle strength training in Parkinson disease. J Rehabil Res Dev 2014; 51:305-10.
25. 25. Suzuki S, Sato M, Okubo T. Expiratory muscle training and sensation of respiratory effort during exercise in normal subjects. Thorax 1995; 50:366-70.
26. 26. Chiara T, Martin D, Sapienza C. Expiratory muscle strength training: speech production outcomes in patients with multiple sclerosis. Neurorehabil Neural Repair 2007; 21:239-49.
27. 27. Saleem AF, Sapienza CM, Okun MS. Respiratory muscle strength training: treatment and response duration in a patient with early idiopathic Parkinson's disease. NeuroRehabilitation 2005; 20:323-33.
28. 28. Hutcheson KA, Hammer MJ, Rosen SP, Jones CA, McCulloch TM. Expiratory muscle strength training evaluated with simultaneous high-resolution manometry and electromyography. Laryngoscope 2017; 127:797-804.
29. 29. Sapienza CM, Davenport PW, Martin AD. Expiratory muscle training increases pressure support in high school band students. J Voice 2002; 16:495-501.
30. 30. Sapienza C, Troche M, Pitts T, Davenport P. Respiratory strength training: concept and intervention outcomes. Semin Speech Lang 2011; 32:21-30.
31. 31. Reyes A, Castillo A, Castillo J, Cornejo I. The effects of respiratory muscle training on peak cough flow in patients with Parkinson's disease: a randomized controlled study. Clin Rehabil 2018; 32:1317-27.
32. 32. Reyes A, Castillo A, Castillo J, Cornejo I, Cruickshank T. The Effects of Respiratory Muscle Training on Phonatory Measures in Individuals with Parkinson's Disease. J Voice 2020; 34:894-902.
33. 33. Kuo YC, Chan J, Wu YP, Bernard JR, Liao YH. Effect of expiratory muscle strength training intervention on the maximum expiratory pressure and quality of life of patients with Parkinson disease. NeuroRehabilitation 2017; 41:219-26.
34. 34. van Sluis KE, Kornman AF, Groen WG, van den Brekel MWM, van der Molen L, Hoffman-Ruddy B, Stuiver MM. Expiratory Muscle Strength Training in patients After Total Laryngectomy; A Feasibility Pilot Study. Ann Otol Rhinol Laryngol 2020; 129:1186-94.
35. 35. Reyes A, Cruickshank T, Thompson J, Ziman M, Nosaka K. Surface electromyograph activity of submental muscles during swallowing and expiratory muscle training tasks in Huntington's disease patients. J Electromyogr Kinesiol 2014; 24:153-8.
36. 36. Wheeler KM, Chiara T, Sapienza CM. Surface electromyographic activity of the submental muscles during swallow and expiratory pressure threshold training tasks. Dysphagia 2007; 22:108-16.
37. 37. Pearson WG, Jr., Langmore SE, Zumwalt AC. Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid. Dysphagia 2011; 26:345-51.
38. 38. Liaw MY, Hsu CH, Leong CP, Liao CY, Wang LY, Lu CH, Lin MC. Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine (Baltimore) 2020; 99:e19337.
39. 39. Moon JH, Jung JH, Won YS, Cho HY, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phys Ther Sci 2017; 29:609-12.
40. 40. Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil 2016; 43:364-72.
41. 41. Arnold RJ, Bausek N. Effect of respiratory muscle training on dysphagia in stroke patients-A retrospective pilot study. Laryngoscope Investig Otolaryngol 2020; 5:1050-5.
42. 42. Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil 2017; 31:761-71.
43. 43. Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of Swallowing and Cough Functions Following Stroke: An Expiratory Muscle Strength Training Trial. Arch Phys Med Rehabil 2016; 97:1345-51.
44. 44. Suttrup I, Warnecke T. [Dysphagia in Parkinson's Disease: Pathophysiology, Diagnosis and Therapy]. Fortschr Neurol Psychiatr 2016; 84 Suppl 1:S18-23.
45. 45. Byeon H. Effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by parkinson's disease. J Phys Ther Sci 2016; 28:1840- 3.
46. 46. Saleem S, Miles A, Allen J. A systematic review of behavioural therapies for improving swallow and cough function in Parkinson's disease. Int J Speech Lang Pathol 2024; 26:457-74.
47. 47. Troche MS, Curtis JA, Sevitz JS, Dakin AE, Perry SE, Borders JC, Grande AA, Mou Y, Vanegas-Arroyave N, Hegland KW. Rehabilitating Cough Dysfunction in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2023; 38:201-11.
48. 48. Plowman EK, Watts SA, Tabor L, Robison R, Gaziano J, Domer AS, Richter J, Vu T, Gooch C. Impact of expiratory strength training in amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:48-53.
49. 49. Ansari NN, Tarameshlu M, Ghelichi L. Dysphagia In Multiple Sclerosis Patients: Diagnostic And Evaluation Strategies. Degener Neurol Neuromuscul Dis 2020; 10:15-28.
50. 50. Chiara T, Martin AD, Davenport PW, Bolser DC. Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough. Arch Phys Med Rehabil 2006; 87:468-73.
51. 51. Silverman EP, Miller S, Zhang Y, Hoffman-Ruddy B, Yeager J, Daly JJ. Effects of expiratory muscle strength training on maximal respiratory pressure and swallow- related quality of life in individuals with multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 3:2055217317710829.
52. 52. Hutcheson KA, Barrow MP, Plowman EK, Lai SY, Fuller CD, Barringer DA, Eapen G, Wang Y, Hubbard R, Jimenez SK, Little LG, Lewin JS. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series. Laryngoscope 2018; 128:1044-51.
53. 53. Reyes A, Cruickshank T, Nosaka K, Ziman M. Respiratory muscle training on pulmonary and swallowing function in patients with Huntington's disease: a pilot randomised controlled trial. Clin Rehabil 2015; 29:961-73.
54. 54. Miles A, Connor NP, Desai RV, Jadcherla S, Allen J, Brodsky M, Garand KL, Malandraki GA, McCulloch TM, Moss M. Dysphagia care across the continuum: a multidisciplinary dysphagia research society taskforce report of service-delivery during the COVID-19 global pandemic. Dysphagia 2021; 36:170-82.
55. 55. Guillen-Sola A, Ramírez C, Nieto S, Duarte E, Tejero M, Grillo C, Bel H, Boza R. Therapeutic approach to dysphagia in post-COVID patients in a rehabilitation unit: a descriptive longitudinal study. Eur J Phys Rehabil Med 2024; 60:373-81.
56. 56. Orr E, Perera R, Sayner A, Thompson A, Pang M, Entesari-Tatafi D, Dalgleish G, Nguyen L, Cliffe L, McDonald I, Than K, Keage M, Clapham RP. Impacts of a Dysphagia Screening Questionnaire on Speech Pathology Input Using a Transdisciplinary Approach for Patients with Chronic Obstructive Pulmonary Disease in a Pulmonary Rehabilitation Program. Dysphagia 2025; 40:152-61.
57. 57. Laciuga H, Rosenbek JC, Davenport PW, Sapienza CM. Functional outcomes associated with expiratory muscle strength training: narrative review. J Rehabil Res Dev 2014; 51:535-46.
58. 58. Kojima H, Yamada T, Takeda M, Itou Y, Yoshida M, Kimura M. Effectiveness of cough exercise and expiratory muscle training: a meta-analysis. Journal of Physical Therapy Science 2006; 18:5-10.
59. 59. Niederman MS, Cilloniz C. Aspiration pneumonia. Rev Esp Quimioter 2022; 35 Suppl 1:73-7.
60. 60. Wheeler-Hegland KM, Rosenbek JC, Sapienza CM. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. J Speech Lang Hear Res 2008; 51:1072-87.