Comparison of three different types of exercises for selective contractions of supra- and infrahyoid muscles

Several exercise methods, such as the Shaker exercise, tongue press exercise, chin tuck against resistance (CTAR) exercise, and submandibular push exercise, have been introduced to strengthen the muscles involved in swallowing. In this study, we compared the effectiveness of the CTAR, submandibular push, and Shaker exercises for the induction of selective supra- and infrahyoid muscle contractions using surface electromyography (EMG). This study is a prospective non-randomized controlled study. Twenty-five healthy subjects and 20 patients experiencing swallowing difficulty were enrolled. During the three different types of exercises, the root mean square (RMS) values of the sternocleidomastoid (SCM), suprahyoid (anterior belly of the digastric and mylohyoid muscles), and infrahyoid (sternothyroid and thyrohyoid muscles) muscles were analyzed using surface EMG. Differences in the activity of swallowing muscles among the three different exercises were analyzed using one-way repeated measured analysis of variance. In terms of both the maximum and mean RMS values of the suprahyoid muscle, the submandibular push exercise showed a larger RMS value than the CTAR and Shaker exercises in healthy subjects (p < 0.05). In terms of both the maximum and mean RMS values of the suprahyoid muscle, the Shaker exercise and submandibular push exercise showed a larger RMS value than the CTAR exercise in patients with swallowing difficulty (p < 0.05). The submandibular push exercise may be effective as a swallowing muscle exercise owing to its superiority in inducing selective contractions of the supra- and infrahyoid muscles. The CTAR and Shaker exercises are also effective in this regard.

PENGARUH AKUPRESUR DAN SHAKER EXERCISE TERHADAP KEMAMPUAN MENELAN PASIEN STROKE AKUT DENGAN DISFAGIA

Disfagia merupakan permasalahan pasien stroke akut yang disebabkan oleh gangguan saraf dan terjadi pada pasien usia dewasa dan lanjut. Hal ini berdampak pada risiko pneumonia, malnutrisi, dehidrasi dan menurunnya kualitas hidup. Akupresur merupakan terapi dengan stimulasi pada acupoint dan memberikan manfaat terhadap proses penyembuhan penyakit. Shaker exercise merupakan latihan menelan yangbanyak digunakan pada pasien disfagia. Penelitian ini bertujuan untuk mengetahui adanya pengaruh akupresur dan shaker exercise terhadapkemampuan menelan pasien stroke akut dengan disfagia. Penelitian ini menggunakan desain eksperimen pretest-postest dengan kelompok kontrol. Sampel dipilih menggunakan stratified random sampling dengan jumlah 17 responden masing-masing di kelompok kontrol dan intervensi yang disesuaikan dengan kriteria inklusi dan ekslusi. Pada kelompok intervensi diberikan oral care, pengaturan posisi, akupresur dan shaker exercise selama 5 hari dalam satu minggu, akupresur satu kali sehari dan shaker exercise tiga kali sehari. Pada kelompok kontrol diberikan oral care dan pengaturan posisi tiga kali sehari selama 5 hari.Penilaian kemampuan menelan dilakukan menggunakan Gugging Swallowing Severity Scale (GUSS) sebelum dan setelah intervensi selama dua minggu. Data dianalisa dengan uji Friedman. Hasil penelitian menunjukkan nilai p<0,05 pada minggu kedua evaluasi. Kemampuan menelan pada kelompok intervensi meningkat 4,69 poin sedangkan pada kelompok kontrol meningkat 2,13 poin. Akupresur dan Shaker exercise pada kelompok intervensi terbukti meningkatkan kemampuan menelan pasien stroke akut dengan disfagia dan peningkatan kemampuan menelan pasien dapat dilihat pada minggu kedua. Intervensi akupresur dan Shaker exercise dapat digunakan sebagi alternatif tindakan dalam asuhan keperawatan untuk pasien yang mengalami disfagia. Penelitian selanjutnya diharapkan dapat menambah jumlah titik akupresur dan lama waktu intervensi Kata Kunci: akupresur, disfagia, shaker exercise, stroke

PENGARUH SHAKER EXERCISE TERHADAP KEMAMPUAN MENELAN PADA PASIEN STROKE DENGAN DISFAGIA DI RUMAH SAKIT KOTA MEDAN

Stroke adalah kumpulan gejala klinis akibat hilangnya fungsi otak sebagian atau keseluruhan. Salah satu penyebab kematian pasien stroke adalah aspirasi pneumonia yang berhubungan dengan disfagia. Penelitian ini bertujuan mengidentifikasi pengaruh shaker exercise terhadap kemampuan menelan pada pasien stroke dengan disfagia di Rumah Sakit Kota Medan. Desain penelitian ini adalah quasy eksperiment, khususnya pretest-posttest design withtout control. Pengambilan sampel dengan metode consecutive sampling. Sampel berjumlah 24 orang, kelompok intervensi ini diberikan shaker exercise selama 6 hari berturut-turut dan dilakuan tiga kali sehari. Hasil penelitian dinyatakan ada perbedaan yang signifikan kemampuan menelan pada pasien stroke dengan disfagia setelah diberikan shaker exercise, dengan p value 0,000 (α =0,05). Manfaat penelitian ini nantinya dapat dijadikan sebagai salah satu intervensi mandiri keperawatan dalam menangani pasien stroke dengan disfagia sehingga meningkatkan mutu asuhan keperawatan, mempercepat penyembuhan, serta mencegah komplikasi. Stroke is a group of clinical symptoms due to partial or complete brain function loss. One of the causes of death of stroke patients is the aspiration of pneumonia associated with dysphagia. This study aims to identify the effect of shaker exercise on swallowing ability in stroke patients with dysphagia at Rumah Sakit Kota Medan. This research used Quasy experimental with pretest-posttest without control group design. As samples, there were 24 respondents for intervention group with consecutive sampling method. The intervention group was given shaker exercise for 3 times a day and it was done continued for 6 days. The results revealed that there was a significant difference in swallowing ability in stroke patients with dysphagia after being given shaker exercise, with p value 0,000 (α = 0.05). The research can be used as a nursing intervention in stroke patients with dysphagia that improve the quality of nursing care, promote healing, and prevent complications.

Forehead against Resistance (FAR): Preliminary Findings from A Clinical Alternative to Shaker’s Type of Exercise

Background. Reduced UES opening is a well-known risk factor for dysphagia. The Shaker exercise and the CTAR are the widely used intervention strategies to bring about effective UES opening. But there are well-known difficulties with the clinical use of these two exercise regimes. The present study proposes a clinical alternative to Shaker’s exercise and CTAR called the forehead against resistance (FAR) and its variants without altering the central principles of these two regimes. The aim of the present study was to investigate the efficacy of FAR and its variants in bringing about UES opening. Method. The study used a comparative cross-sectional study design, with the nonrandomized convenient sampling that included 27 healthy adults. MBS was carried out in the anterior-posterior and lateral views, while the participants performed FAR and its variants. The UES diameter was measured in the baseline and with the subjects performing FAR maneuver and its variants. Results. The result revealed that the participants had greater UES opening on FAR and its variant than the baseline swallow. Also, mean values of UES opening were greater for FAR with chin tuck when compared to FAR alone, although there was no significant main effect with exercise. Conclusion. FAR and its variant could be one of the options for increasing UES opening in individuals with dysphagia.