Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults

Objective: To assess the effects of effortful swallowing, a common compensatory strategy for dysphagia, on the bolus and swallowing mechanism of middle-aged and older men and women. Design: Case-controlled design in which subjects completed both the intervention technique and the control behavior. Setting: A university hospital. Participants: Sixty-four healthy men and women between 45 and 93 years of age from the community. Interventions: Participants swallowed 3-mL thin liquid boluses both normally and using the effortful swallow strategy. Main Outcomes Measures: The biomechanics and bolus flow patterns of swallows were analyzed from videofluoroscopic and simultaneous oral pressure data. Results: Subjects at all ages generated significantly increased oral pressures at each sensor location using the effortful swallow (p = .0001), with the pressure increase greater for the middle-aged subjects compared with older subjects. Several durational measures were significantly longer with the effortful swallow including: hyoid maximum anterior excursion (p < .04), laryngeal vestibule closure (p < .0001), and duration of the upper esophageal sphincter opening (p =.0001). The hyoid bone moved further in the superior direction with the effortful swallow (p = .002). There was a trend of decreased oral residue with the effortful swallow (p = .06). Conclusion: Biomechanical and bolus flow aspects of swallowing changed when healthy individuals performed effortful swallows with 3-mL boluses.