Literature: Submental sEMG and Hyoid Movement During Mendelsohn Maneuver, Effortful Swallow, and Expiratory Muscle Strength Training

文獻探討了三種吞嚥訓練方式的比較
除了臨床語言治療師所熟悉的 effortful swallow 與 Mendelsohn maneuvern 
還有一個近幾年較新的吞嚥訓練方法
expiratory muscle strength training [EMST]
也就是透過呼吸肌力訓練 增加其吞嚥動作的相關肌力能力
原文有提及這三種吞嚥方法的原理以及在喉部動作的比較
具備詳細的臨床實驗設計說明
以下僅提供重點整理
the source from:http://jslhr.pubs.asha.org/article.aspx?articleid=1781747


摘要

研究同時使用生物力學機轉及肌電圖特性去檢測健康成人在執行effortful swallow,Mendelsohn maneuver及expiratory muscle strength training [EMST]動作時，舌骨和連結下頦肌群的活動特性。整體目標在找出各吞嚥作業執行時的特徵及在每一種作業上的過載特質。

研究對象為25位健康成年男性及女性，平均年齡25歲。所有的研究對象都完成所有研究吞嚥作業（包含normal swallow, Mendelsohn maneuver swallow, effortful swallow, and EMST task)並隨機安排順序,同時使用videofluoroscopy及表面肌電圖做紀錄。

研究結果顯示在舌骨動作的軌跡呈現顯著的差異，即舌骨的位移程度和上抬的角度。在各作業間其舌骨動作的時機點和強度也有所不同，此與下頦肌群的動作有關。

研究結果證實這三種不同的吞嚥訓練作業原理的效果有所不同的特性及過載原理，這些原則對於發展臨床復健療程是重要的，也提供未來的研究方向。

Abstract

Purpose This study investigated the concurrent biomechanical and electromyographic properties of 2 swallow-specific tasks (effortful swallow and Mendelsohn maneuver) and 1 swallow-nonspecific (expiratory muscle strength training [EMST]) swallow therapy task in order to examine the differential effects of each on hyoid motion and associated submental activation in healthy adults, with the overall goal of characterizing task-specific and overload properties of each task.

Method Twenty-five healthy male and female adults (M = 25 years of age) participated in this prospective, experimental study with 1 participant group. Each participant completed all study tasks (including normal swallow, Mendelsohn maneuver swallow, effortful swallow, and EMST task) in random order during concurrent videofluoroscopy and surface electromyography recording.

Results Results revealed significant differences in the trajectory of hyoid motion as measured by overall displacement and angle of elevation of the hyoid bone. As well, timing of hyoid movement and amplitude differences existed between tasks with regard to the activation of the submental musculature.

Conclusions Study results demonstrated differential effects of the 3 experimental tasks on the principles of task specificity and overload. These principles are important in the development of effective rehabilitative programs. Subsequent direction for future research is suggested.

*以下關於EMST的補充資料來源:

https://dysphagiacafe.com/2016/10/01/take-breath-away-expiratory-muscle-strength-training-improve-deglutition-cough-functions/

EMST 呼吸肌力訓練是respiratory muscle strength training (RMST) 呼氣肌力訓練的一種，RMST也包含inspiratory muscle strength training  (IMST)  吸氣肌力訓練 

而EMST對於應用在Parkinson Disease & Stroke Population之吞嚥障礙的個案

在臨床研究已經證實是有所改善其吞嚥功能。

更重要的是雖然EMST 對於吞嚥復健及改善咳嗽能力有所助益,

但並非適用於所有吞嚥障礙的個案，若有必要應藉由儀器進行吞嚥評估及肺部功能評估。

*認識呼吸肌訓練器

   一開始是運用在特定職類的一般人員(如:運動員/歌者..)

  相關資料可參考以下連結的介紹:

  (1)https://www.mr-sport.com.tw/product-test/breathe-training-machine-bravo-open.html

  (2)呼吸訓練器使用示範影片: https://www.youtube.com/watch?v=PXq1p3c6kt4

*PS.若是用於吞嚥訓練的個案 應謹慎使用

       非用一般人的標準的方式做訓練

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