dysPhagia- The “P” really stands for postural compliance!

I recently discarded files from my computer, when I came across the first paper where I was the lead writer in 2014. It stemmed from a flyer I had received in the mail advertising a new liquid “thickening” agent. The flyer promoted diligence in keeping the “taste” discreet in order not to compromise its function. Something about that flyer fired me up so!

I remember sitting down and writing out thoughts I had about how current practices address dysphagia. The paper was entitled, “DysPhagia- Postural Compliance Highlighting the “P” in dysphagia management practices”. 

The stance of the 2014 paper suggested that a critical piece was missing in dysphagia assessment and rehabilitation. I understood current practices for treating signs/symptoms of dysphagia (e.g., using thickening agents), but had questions as to why dysphagia symptoms were present in the first place. In my opinion, there appeared to be more to swallowing behavior than what was occurring in the head and neck area alone. I also felt that treatment strategies, like using thickening agents or modified diet textures, were overriding methods to identify and address the underlying factors contributing to poor swallowing function. Last, I felt as if we went straight to treating the signs and symptoms of dysphagia, but bypassed identifying and resolving factors attributing to dysphagia. 

I understand dysphagia to be a disruption in the “pressure-driven” relationship between what occurs above the neck (supraglottic) and below the neck (subglottic). The question I posed was this: To what degree of “supra/subglottic” symptoms of dysphagia, i.e., aspiration, penetration, is associated with postural malalignments?

So why postural malalignments? Because of the jaw (mandible). Jaw stability is the foundation for speech production and feeding management (Johnson and Gray, 2008). To maintain TMJ/mandibular alignment and stability, cervical and submental muscles (foundational muscles of the tongue) must be able to work interactively with the ligaments, tendons, and muscles of the trunk, pelvis, and upper/lower extremities.

It is all about the jaw!

The jaw bone (mandible) is one of two suspended bones in the body. The other is the hyoid bone. Both are not connected to any other bony structure. The jaw, TMJ joint, and hyoid bone are suspended structures supported by a series of ligaments, muscles, and cartilages. Jaw stability is contingent on its supporting structures! If there is a change in the musculoskeletal system, there will be a direct impact on how the jaw and hyoid interact.

It is also about the TMJ Joint!

Traditionally, the focus of "strengthening" the muscles of the oral cavity or pharynx has overshadowed the need to keep the TMJ condyle aligned and stable. I have learned the oral cavity is intimately affiliated with the temporomandibular joint. Picture a door on a hinge. Trying to strengthen the door, which has come unhinged, will not cause improved function – which is our goal. However, keep the door hinged (aligned and stable), and see the improvement in function. Muscle strength improves by 30% when the joint is stabilized (Kase, 2014). For me, the essence of oral motor and other exercises supported by literature (e.g., Shaker, CTAR), appear beneficial, however, until the muscles, ligaments and tendons that support the TMJ joint are addressed, everything else in the oral cavity (tongue, lips) will be limited in providing the synergistic movement and strength necessary for optimal function.  

Read more on this here: http://www.swallowstudy.com/got-tape-elastic-therapeutic-taping/

Through a combination of education and clinical experiences, I have come to learn swallowing as an intricate act, contingent on delicate and systematic neuromusculoskeletal relationships from head to toe. I believe each “link” must work in synchrony so swallowing behavior performs naturally, efficiently and effectively. I have also observed when there is a “break in the link”, i.e., a combination of behavioral, sensory, structural conditions, then a condition known as “dysphagia” may exist.

In 2014, I felt compelled to write about this point of view. Today, I find myself still interested in using dynamic approaches to assess dysphagia, as well as understanding dysphagia as a "global" vs "localized" disorder. What are your thoughts?

Looking forward to sharing more on this topic in future blogs!!

Best, J

For more information on upcoming Kinesio Taping Seminars, click here!

References:

Johnson, S.R. and Gray, J. (2008). Role of the Jaw. Advanced Healthcare Network for Speech and Hearing, 18(35), 13.

Kanapkey, B., MA, CCC-SLP. (2016, October 22). Neurology of the Jaw: Ignoring it Doesn’t Seem to Help. Lecture presented at ARK-J Program in UNC Friday Center, Chapel Hill, NC.

Kase, K. (2014). K1-K3 Instructor’s Manual. Kinesio IP, LLC.

Macias-Harris, J. and Hernandez-McManus, M. (2014). Expanding the “SLP Toolbox”- postural rehabilitation in dysphagia management using Kinesioâ Tape, excerpt from full article entitled, “DysPhagia-Postural Compliance, Highlighting the “P” in dysphagia management practices”, Advanced Healing, Summer2014, 23.

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