The Role of Oral Sensorimotor Therapy in the Treatment of Pediatric Dysphagia .. 9 Perspectives on Swallowing Disorders and Their Treatment in Parkinson’s Disease With Emphasis on the Lee Silverman Voice Treatment

Exercise to improve swallowing has included range of motion, strengthening, control, and volitional alteration of the pharyngeal phase Recently, attention has focused on the effects of lingual exercise on oral and pharyngeal phase swallow functioning. This article reviews the current literature on resistance exercise and swallow functioning. The tongue plays a major role in propulsion of the bolus of food or liquid through the oral cavity into the pharynx and through the pharynx (Ce-renko, McConnel, & Jackson, 1989). Once a bolus of food or liquid is sealed against the palate, the midline portion of the tongue elevates to contact the palate in a sequential anterior to posterior fashion to provide a driving force for bolus propulsion into the pharynx (Kahrilas, Lin, Logemann, Ergun, & Facchini, 1993). The lingual driving force creates pressure on the bolus (Pouderoux & Kahrilas, 1995). Increased muscular activity is required to propel fi rmer food boluses through the oral cavity in healthy individuals (Reimers-Neils, Logemann, & Larson, 1994). Tasks used to investigate non-speech performance of the tongue in normal and abnormal populations have included maximum isometric pressure or force generation (i.e., strength). In healthy individuals, tongue strength has been found to decline with age Reduced fi ne force stability for tongue strength tasks has been observed in patients with amyo-trophic lateral sclerosis (ALS), Parkinson's disease, ataxic dysarthria, spastic cerebral palsy, and closed Reduced tongue strength has also been observed in patients with oral and oropha-ryngeal cancer treated with radiotherapy (Lazarus et al, 2000, 2001). In addition, pilot data by this author (Lazarus, 2005) examining tongue strength in patients with head and neck cancer long after treatment has found impairment in tongue strength following chemo-radiotherapy to the head and neck for tumor sites other than oral or oropharyn-geal. Radiation treatment volume in these patients included the oropharynx because of neck disease. Therefore, it is not surprising to see decrements in lingual strength, as radiotherapy likely resulted in lingual tissue fi brosis. Oral phase swallowing impairment has been observed in a number of patient populations, often demonstrate impairment in tongue strength, as described previously, as well as in individuals treated with radiotherapy for oral and oropharyn-geal cancer (Lazarus et al., 2000). Meyers (1986) found that tongue weakness correlates with increased oral transit times during paste swallows in individuals with ALS. In addition, these same patients demonstrated adequate tongue-to-palate contact during the swallow, but demonstrated oral residue after the …