Top

Published in:

01-04-2016 | Original Paper

Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography—Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise

Authors: Wei Ping Sze, Wai Lam Yoon, Nicolas Escoffier, Susan J. Rickard Liow

Published in: Dysphagia | Issue 2/2016

Abstract

In this study, the efficacy of two dysphagia interventions, the Chin Tuck against Resistance (CTAR) and Shaker exercises, were evaluated based on two principles in exercise science—muscle-specificity and training intensity. Both exercises were developed to strengthen the suprahyoid muscles, whose contractions facilitate the opening of the upper esophageal sphincter, thereby improving bolus transfer. Thirty-nine healthy adults performed two trials of both exercises in counter-balanced order. Surface electromyography (sEMG) recordings were simultaneously collected from suprahyoid muscle group and sternocleidomastoid muscle during the exercises. Converging results using sEMG amplitude analyses suggested that the CTAR was more specific in targeting the suprahyoid muscles than the Shaker exercise. Fatigue analyses on sEMG signals further indicated that the suprahyoid muscle group were equally or significantly fatigued (depending on metric), when participants carried out CTAR compared to the Shaker exercise. Importantly, unlike during Shaker exercise, the sternocleidomastoid muscles were significantly less activated and fatigued during CTAR. Lowering the chin against resistance is therefore sufficiently specific and intense to fatigue the suprahyoid muscles.

Available only for authorised users

The term ‘suprahyoid muscles’ used in this paper refers to suprahyoid muscle group. For textual fluidity, ‘suprahyoid muscles’ is also used.

The electrode position for the sternocleidomastoid muscle is also generally consistent with Falla et al.’s (2002) recommendations [42]. The placement is perpendicular to the one-third distance from the sternal notch.

The use of a 50 Hz notch filter may shift the median frequency measures to slightly higher frequencies. However the filter was applied to all conditions and participants, making a potential frequency shift identical across conditions, and therefore would not affect differences between the conditions [43]. Previously published studies on muscle fatigue have also employed the 50 Hz notch filter [44, 45].

Burkhead LM. Applications of exercise science in dysphagia rehabilitation. In: SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), vol.18, 2009; pp. 43–8. doi:10.1044/sasd18.2.43.

Sargeant AJ. Human power output and muscle fatigue. Int J Sports Med. 1994;15(3):116–21. doi:10.1055/s-2007-1021031.CrossRefPubMed

Shaker R, Kern M, Bardan E, Taylor A, Stewart ET, Hoffmann RG, Arndorfer RC, Hoffmann C, Bonnevier J. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol. 1997;272(6 Pt 1):G1518–22.PubMed

Yoon WL, Khoo JKP, Rickard Liow SJ. Chin Tuck against Resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia. 2014;29(2):243–8. doi:10.1007/s00455-013-9502-9.CrossRefPubMed

Kern M, Hofmann C, Bardan E, Ren J, Arndorfer R, Shaker R. Comparison of upper esophageal sphincter opening in healthy asymptomatic young and elderly volunteers. Ann Otol Rhinol Laryngol. 1999;108(10):982–9. doi:10.1177/000348949910801010.CrossRefPubMed

Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, Brasseur JG, Hogan WJ. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol. 1989;257(5 Pt 1):G748–59.PubMed

Pearson WG Jr, Langmore SE, Zumwalt AC. Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid. Dysphagia. 2011;26(4):345–51. doi:10.1007/s00455-010-9315-z.CrossRefPubMedPubMedCentral

Crary MA, Carnaby GD, Groher ME. Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults. J Speech Lang Hear Res. 2006;49(1):186–93. doi:10.1044/1092-4388(2006/015).CrossRefPubMed

Perlman AL, Palmer PM, McCulloch TM, VanDaele DJ. Electromyographic activity from human laryngeal, pharyngeal, and submental muscles during swallowing. J Appl Physiol. 1999;86(5):1663–9.PubMed

10.

Goyal RK, Martin SB, Shapiro J, Spechler SJ. The role of cricopharyngeus muscle in pharyngoesophageal disorders. Dysphagia. 1993;8(3):252–8. doi:10.1007/BF01354547.CrossRefPubMed

11.

McConnel FMS, Cerenko D, Jackson RT, Hersh T. Clinical application of the manofluorogram. Larnygoscope. 1988;98(7):705–11. doi:10.1288/00005537-198807000-00003.

12.

Easterling C, Shaker R. UES opening muscle dysfunction. In: Shaker R, Belafsky PC, Postma GN, Easterling C, editors. Principles of deglutition: a multidisciplinary text for swallowing and its disorders. New York: Springer; 2013. p. 529–35.CrossRef

13.

Autunes EB, Lunet N. Effects of the head lift exercise on the swallow function a systematic review. Gerodontology. 2012;29(4):247–57. doi:10.1111/j.1741-2358.2012.00638.x.CrossRef

14.

Easterling C. Shaker exercise. In: Shaker R, Easterling C, Belafsky PC, Postma GN, editors. Manual of diagnostic and therapeutic techniques for disorders of deglutition. New York: Springer; 2013. p. 257–68.CrossRef

15.

Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(5):1314–21. doi:10.1053/gast.2002.32999.CrossRefPubMed

16.

Logemann JA, Rademaker A, Pauloski BR, Kelly A, Stangl-McBreen C, Antinoja J, Grande B, Farquharson J, Kern M, Easterling C, Shaker R. A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study. Dysphagia. 2009;24(4):403–11. doi:10.1007/s00455-009-9217-0.CrossRefPubMedPubMedCentral

17.

Ferdjallah M, Wertsch JJ, Shaker R. Spectral analysis of surface electromyography (EMG) of upper esophageal sphincter-opening muscles during head lift exercise. J Rehabil Res Dev. 2000;37(3):335–40.PubMed

18.

Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

19.

White KT, Easterling C, Roberts N, Wertsch J, Shaker R. Fatigue analysis before and after Shaker exercise: physiologic tool for exercise design. Dysphagia. 2008;23(4):385–91. doi:10.1007/s00455-008-9155-2.CrossRefPubMedPubMedCentral

20.

Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and maintaining isometric and isokinetic goals of the Shaker exercise. Dysphagia. 2005;20(2):133–8. doi:10.1007/s00455-005-0004-2.CrossRefPubMed

21.

Forsberg C-M, Hellsing E, Linder-Aronson S, Sheikholeslam A. EMG activity in neck and masticatory muscles in relation to extension and flexion of the head. Eur J Orthod. 1985;7(3):177–84. doi:10.1093/ejo/7.3.177.CrossRefPubMed

22.

Adler SS, Beckers D, Buck M. PNF in practice: an illustrated guide. 4th ed. Berlin: Springer Medizin; 2014.CrossRef

23.

Williams CA, Ratel S. Definitions of muscle fatigue. In: Williams CA, Ratel S, editors. Human muscle fatigue. Oxon: Routledge; 2009. p. 3–16.

24.

Burd NA, West DWD, Staples AW, Atherton PJ, Baker JM, Moore DR, Holwerda AM, Parise G, Rennie MJ, Baker SK, Phillips SM. Low-load high volume resistance exercise stimulates muscle protein synthesis more than high-load low volume resistance exercise in young men. PLoS One. 2010;5(8):e12033. doi:10.1371/journal.pone.0012033.CrossRefPubMedPubMedCentral

25.

Thought Technology. Basics of surface electromyography applied to physical rehabilitation and biomechanics. Montreal: Thought Technology Ltd; 2010.

26.

Thought Technology. BioGraph infiniti [computer software]. Montreal: Thought Technology Ltd; 2009.

27.

MathWorks. MATLAB [computer software]. Natick: MathWorks; 2014.

28.

Crary MA, Groher ME. Basic concepts of surface electromyographic biofeedback in the treatment of dysphagia: a tutorial. Am J Speech-Lang Pathol. 2000;9(2):116–25. doi:10.1044/1058-0360.0902.116.CrossRef

29.

Konrad P. The ABC of EMG: a practical introduction to kinesiological electromyography. Arizona: Noraxon; 2005.

30.

De Luca CJ. The use of surface electromyography in biomechanics. J Appl Biomech. 1997;13(2):135–63.

31.

Standards for Reporting EMG Data. J Electromyogr Kinesiol 2014; 24(3): I–II. doi:10.1016/S1050-6411(14)00082-0.

32.

Welch PD. The use of fast Fourier transform for the estimation of power spectra: a method based on time averaging over short, modified periodograms. IEEE Trans Audio Electroacoust. 1967;15(2):70–3. doi:10.1109/TAU.1967.1161901.CrossRef

33.

Basmajian JV, De Luca CJ. Muscles alive: their functions revealed by electromyography. 5th ed. Baltimore: Williams & Wilkins; 1985.

34.

Merletti R, Lo Conte LR, Orizio C. Indices of muscle fatigue. J Electromyogr Kinesiol. 1991;1(1):20–33. doi:10.1016/1050-6411(91)90023-X.CrossRefPubMed

35.

Marwan N, Romano MC, Thiel M, Kurths J. Recurrence plots for the analysis of complex systems. Phys Rep. 2007;438(5–6):237–329. doi:10.1016/j.physrep.2006.11.001.CrossRef

36.

Farina D, Fattorini L, Felici F, Filligoi G. Nonlinear surface EMG analysis to detect changes of motor unit conduction velocity and synchronization. J Appl Physiol. 2002;93(5):1753–63. doi:10.1152/japplphysiol.00314.2002.CrossRefPubMed

37.

Yassierli, Nussbaum MA. Utility of traditional and alternative EMG-based measures of fatigue during low-moderate level isometric efforts. J Electromyogr Kinesiol. 2008;18(1):44–53. doi:10.1016/j.jelekin.2006.08.003.CrossRefPubMed

38.

Ito K, Hotta Y, Abe T. Detection of muscle fatigue during low-level isometric contraction using recurrence quantification analysis. In: Long M, editor. World congress on medical physics and biomedical engineering, IFMBE Proceedings, vol. 39. Berlin: Springer; 2013. p. 509–12.

39.

Filligoi G, Felici F. Detection of hidden rhythms in surface EMG signals with a nonlinear time-series tool. Med Eng Phys. 1999;21(6):439–48.CrossRefPubMed

40.

Morana C, Ramdani S, Perrey S, Varray A. Recurrence quantification analysis of surface electromyographic signal: sensitivity to potentiation and neuromuscular fatigue. J Neurosci Methods. 2009;177(1):73–9. doi:10.1016/j.jneumeth.2008.09.023.CrossRefPubMed

41.

Cobos AR, Segade LAG, Feutes I. Muscle fibre types in the suprahyoid muscles of the rat. J Anat. 2001;198(3):283–94. doi:10.1046/j.1469-7580.2001.19830283.x.CrossRefPubMedPubMedCentral

42.

Falla D, Alba PD, Rainoldi A, Merletti R, Jull G. Location of innervation zones of sternocleidomastoid and scalene muscles—a basis for clinical and research electromyography applications. Clin Neurophysiol. 2002;113(1):57–63. doi:10.1016/S1388-2457(01)00708-8.CrossRefPubMed

43.

Szeto GPY, Straker LM, O’Sullivan PB. EMG median frequency changes in the neck–shoulder stabilizers of symptomatic office workers when challenged by different physical stressors. J Electromyogr Kinesiol. 2005;15(6):544–55. doi:10.1016/j.jelekin.2005.06.004.CrossRefPubMed

44.

Abdul-Latif AA, Cosic I, Kumar DK, Polus B and Da Costa C. Power changes of EEG signals associated with muscle fatigue: the root mean square analysis of EEG bands. In: Proceedings of the 2004 intelligent sensors, sensor networks and information processing conference 2004; pp. 531–4. doi:10.1109/ISSNIP.2004.1417517.

45.

Koumantakis GA, Arnall F, Cooper RG, Oldham JA. Paraspinal muscle EMG fatigue testing with two methods in healthy volunteers. Reliability in the context of clinical applications. Clin Biomech. 2001;16(3):263–6. doi:10.1016/S0268-0033(00)00113-3.CrossRef

Title: Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography—Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise
Authors: Wei Ping Sze
Wai Lam Yoon
Nicolas Escoffier
Susan J. Rickard Liow
Publication date: 01-04-2016
Publisher: Springer US
Published in: Dysphagia / Issue 2/2016
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-015-9678-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluating the Training Effects of Two Swallowing Rehabilitation Therapies Using Surface Electromyography—Chin Tuck Against Resistance (CTAR) Exercise and the Shaker Exercise

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2016

Observers’ Agreement on Measurements in Fiberoptic Endoscopic Evaluation of Swallowing

The Effect of Capsaicin-Containing Food on the Swallowing Response

Predictive Factors for Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement and Use in Head and Neck Patients Following Intensity-Modulated Radiation Therapy (IMRT) Treatment: Concordance, Discrepancies, and the Role of Gabapentin

The Physiology of Eructation

Swallowing Kinematics and Factors Associated with Laryngeal Penetration and Aspiration in Stroke Survivors with Dysphagia

Comments on Selected Recent Dysphagia Literature