Table 2.

Summary of published research detailing functional and physiologic outcomes associated with four exercise based dysphagia therapies. These summaries are descriptive only and do not evaluate the scientific rigor or evidence level of each listed study. The reference number is provided for each study.

Therapy	Sample [study reference]	Study Design	Sample Size	Outcome Measures	Results of Therapy
Lingual Resistance	Older healthy adults [24]	Prospective cohort with intervention	10	Lingual pressures during swallowing and maximum tongue push task, swallow timing and bolus flow measures, lingual MRI (4 subjects only)	Lingual pressures (swallow and maximum) increased post therapy, swallow measures did not improve, lingual volume increased (MRI)
	Stroke patients [20]	Prospective Cohort with intervention	10	Lingual pressures during swallowing and maximum tongue push task, swallow timing and bolus measures, lingual MRI (3 subjects only), quality of life and dietary intake	Lingual pressures (swallow and maximum) increased post therapy, mixed results regarding reduced post swallow residue and penetration/aspiration (only for some materials), few changes in swallow timing measures, two of three subjects increased lingual volume
	Progressive disease [25]	Case report	1	Lingual pressure during maximum push task, penetration/aspiration scores, residue	Posterior lingual pressure and penetration/aspiration scores maintained over course of study, no change in residue
	Head / Neck cancer [26]	RCT Comparing Lingual exercise plus traditional therapy vs traditional therapy along	23	Tongue strength (maximum pressure), OPSE, salivary flow, quality of life	No change in tongue strength or OPSE, no significant differences in quality of life
Head Lift	Older healthy adults [21]	Age-matched with Random Assignment to sham vs. head lift	31	UES opening, Hyolaryngeal excursion, pharyngeal swallowing pressures	Increased UES opening, increased anterior laryngeal excursion, reduced pharyngeal swallowing pressures
	Pharyngeal dysphagia [22]	Cross over design	27	Swallow function, UES opening, Hyolaryngeal excursion, aspiration	Improved swallow function, increased UES opening, reduced aspiration
	Older healthy adults [27]	Pre/Post comparison	2	sEMG evaluation of muscle fatigue	Initial fatigue in SCM with Subsequent strengthening, increase strength in supra/infrahyoid muscles
	Head/Neck cancer and stroke [28]	Pre/Post Comparison with random assignment to traditional therapy vs. head lift	11	Thyrohyoid shortening during swallow	Post therapy Thyrohyoid shortening was greater in head lift subgroup
	Older healthy adults [29]	Prospective cohort with intervention	26	adherence to exercise program	50% to 70% adherence
MDTP	Chronic Pharyngeal dysphagia: Head/Neck Cancer and Stroke [23,30,31, 32]	Case series [23,32]	9 [23] 6 [32]	Clinical and functional change in swallowing, patient perception of swallowing, hyolaryngeal excursion, lingual swallowing pressure, pharyngeal swallowing pressure, sEMG amplitude during swallowing	Clinical and Functional swallowing, and patient perception scores improved significantly, increased hyolaryngeal excursion, increased lingual pressure and sEMG amplitude for pudding swallows, after treatment
		Parallel arm Comparison (patients with dysphagia vs. healthy controls) [31]	42 (8 patients and 34 controls)	Timing of Physiologic pressure points during swallowing	Physiologic timing of swallow events improved following therapy becoming equivalent to healthy controls, effect most noted for thin liquids
		Case-Control : MDTP vs. Traditional therapy plus sEMG biofeedback[30]	24 (8 cases and 16 controls)	Clinical and functional change in swallowing, presence of feeding post therapy, presence of aspiration post therapy	Enhanced clinical and functional outcomes, greater feeding tube removal, greater aspiration reduction, following MDTP
	Stroke (subacute rehabilitation) [33]	RCT (MDTP with sham TES, MDTP with motor level TES, traditional therapy	53	Clinical and Functional swallowing ability, change in body weight, dysphagia-related complications, return to pre-stroke diet, patient perception of swallow, proportion of treatment responders	Clinical and Functional measures of swallowing, proportion of treatment responders and number returning to pre-stroke diet significantly improved for the sham arm (MDTP) greater than experimental (MDTP + TES) or control arms (traditional therapy).
Pharyngocise	Head/Neck cancer treated during chemoradiotherapy [6,34]	RCT: Pharyngocise vs. usual care [6]	58 [6]	Lingual, Suprahyoid muscle size and composition – measured by MRI, Functional swallowing ability, mouth opening, taste/smell function, salivation, nutritional status, occurrence of dysphagia – related complications.	Pharyngocise Group Demonstrated superior muscle preservation, functional swallowing, mouth opening, taste and salivation.
		RCT: Therapist Directed Pharyngocise vs. Patient directed Pharyngocise vs. usual care (control) [34]	130 [34]	Maintenance of swallow muscle composition (MRI), functional swallowing ability, mouth opening, psycho-social adaptation, exercise compliance.	Less swallow Muscle deterioration, less functional swallow change and greater compliance identified in the therapist directed arm compared to patient directed or control

MRI: magnetic resonance imaging; RCT: randomized controlled trial; OPSE: oropharyngeal swallow efficiency; UES: upper esophageal sphincter; sEMG: surface electromyography; SCM: sternocleidomastoid; MDTP: McNeill Dysphagia Therapy Program; TES: transcutaneous electrical stimulation