Why Is Indirect Therapy Effective in Patients with Pharyngeal Dysphagia ?

Abstract

The effectiveness of indirect therapy was discussed with reference to patients with dysphagia.
The first patient was an 90-year-old male with lumbago due to fracture of the lumbar caused by collapsing. He had dysphagia four months before the accident. After the accident his dysphagia worsened. Ten months after the accident he underwent physical therapy. After four months he came to eat without aspiration. He acquired the Mendelsohn maneuver without instruction.
The second patient was a 73-year-old male who had had cerebral infarction twice; however, he was independent in ADL. He had dysphagia five years after his second cerebral infarction. He underwent physical therapy one year after the onset of dysphagia. After one month he came to eat without aspiration.
Indirect therapy such as adjustment of muscle tone, widening the range of motion in joints, relaxation training and oral massage improved the patient's condition. Indirect therapy changes the patient's condition in a way suitable to swallowing.
Swallowing without aspiration requires normal movements of muscles, as well as determination of the appropriate amount of bolus. Why is indirect therapy for the second phase of dysphagia, which is reflective, effective? This is because indirect therapy facilitates initiation of the swallowing reflex by changing the patients' condition in a way suitable to swallowing, like the Jendrássik maneuver which is used for inducing the patella tendon reflex. In conclusion, indirect therapy for dysphagia is effective. The indication of indirect therapy is reversible pharyngeal dysphagia.