Clinicians are constantly bombarded with information. Journals, blogs, websites, and fellow clinicians all provide us with suggestions for therapy interventions. With all this information, it becomes difficult to sort out and identify the most appropriate, impairment-based, interventions.
Defaulting to “Everything but the Kitchen Sink”
Carnaby and Harenberg (2013) asked clinicians to review a case study and recommend interventions based on the impairments described. The results?
- More than 40 different interventions were recommended.
- No single combination of therapies was chosen exactly across participants.
- Less than 4% of the participants reported choosing their recommendations based on a specific physiologic abnormality.
- More than half of the recommendations did not match the specific dysphagia symptoms.
We often take the “everything but the kitchen sink” approach to therapy, asking our clients to use a variety of strategies and perform a number of exercises, without much thought to the specific impairment that needs to be addressed.
Targeting Your Approach with Exercise Physiology Ideals
How can we be more targeted in our approach? How can we be sure that our strategies and exercises are really doing what we need them to do? What is it that we’re really trying to accomplish? These general principles of exercise physiology can help focus your approach:
- Are you trying to strengthen? Then your activity needs to include resistance.
- Are you trying to increase endurance? Then you have to increase the frequency and repetitions.
- Are you trying to train or retrain a specific movement sequence? Then you have to include that sequence in your exercise.
By using these ideas when selecting a dysphagia treatment plan, we can be sure the exercises are working as intended.
Knowing Why We Do, What We Do
Dysphagia is a collection of symptoms that presents differently depending on a patient’s diagnosis, age, and comorbidities. An assessment process that helps us to identify the specific impairments – weak tongue propulsion, reduced pharyngeal motility, slowed laryngeal closure, incomplete laryngeal elevation – will lead to a targeted, intervention-specific treatment plan. You wouldn’t want your physician to prescribe ten medications when one will do. Similarly, you wouldn’t expect your physician to prescribe blood pressure medications to treat diabetes. Let’s take these ideas to dysphagia treatment and start asking ourselves, “Why are we doing what we’re doing?”.
- Burkhead, L, et al, “Strength training exercise in dysphagia rehabilitation: Principles, procedures and directions for future research”, Dysphagia, 22(3), 251-65, 20007
- Carnaby, G., and Harenberg, L., “What is ‘usual care’ in dysphagia rehabilitation: A survey of USA dysphagia practices” , Dysphagia, 28(4), 567-74, 2013.