Therapeutic Exercises for Strengthening Suprahyoid Muscles

박지수,장문영,황나경,Dong-Hwan Oh 대한연하장애학회 2018 대한연하장애학회지 Vol.8 No.1

Suprahyoid muscles play an important role in normal swallowing by providing muscle contractions involved in airway protection and upper esophageal sphincter opening. However, these muscles can be weakened by neurological disease or aging, which can result in pharyngeal dysphagia. Therefore, strengthening of the suprahyoid muscles is a clinically important treatment. In addition, it is important to know exactly how and which method is optimal. Many therapeutic exercise methods have been reported to strengthen the suprahyoid muscles, and new methods related to this have recently been reported. Therefore, this study will briefly summarize the representative traditional methods and the recently reported, relatively new methods for strengthening the suprahyoid muscles.

Effect of Suprahyoid Muscle Resistance Exercise Using Kinesio Taping on Suprahyoid Muscle Thickness in Patients with Dysphagia after Subacute Stroke

Myunglyeol Lee,Jinuk Kim,Donghwan Oh,Kuija Lee 국제물리치료연구학회 2020 Journal of International Academy of Physical Ther Vol.11 No.3

Background: Recently, a new method of dysphagia rehabilitation using Kinesio taping (KT) has been attempted and demonstrated an immediate increase in the activation of the suprahyoid muscle during swallowing in healthy adults. Objectives: To investigate the effect of dysphagia rehabilitation using KT on the thickness change of the suprahyoid muscle in patients with dysphagia after stroke. Design: Two-group pre-post design. Methods: In this study, 20 patients with dysphagia after stroke were enrolled and assigned to the experimental and control groups. The experimental group applied KT to the front of the neck and repeatedly swallowed against the tension of the tape. On the other hand, the control group performed repeated swallowing without applying KT. Patients in both groups had swallowed 50 times a day/5 times a week for 4 weeks. For evaluation, the volume of the geniohyoid, mylohyoid, and digastric muscle was measured before and after the intervention using portable ultrasound equipment. Results: As a result of comparing the two groups after the intervention, the experimental group showed more volume increase in mylohyoid (P<.05) and digastric muscle (P<.05) than the control group. Conclusion: This study proved that suprahyoid muscle resistance exercise using KT is effective in increasing the volume of the suprahyoid muscle.

근긴장성 발성장애 환자의 후두마사지 효과: 표면근전도 활동 변화

김보겸,최성희,이경재,최철희 한국언어청각임상학회 2023 Communication Sciences and Disorders Vol.28 No.3

Objectives: Laryngeal massage has been used as a major voice therapy technique in patients with muscle tension dysphonia, which results in voice changes due to excessive tension in the intrinsic or extrinsic laryngeal muscles. This study aims to explore the effect of laryngeal massage by changing the activity potentials of paralaryngeal muscles through laryngeal massage. Methods: A total of 15 adults diagnosed with muscle tension dysphonia participated in this study. Laryngeal massage was performed for 15-20 minutes. To measure surface electromyography (sEMG), the surface electrodes were attached to the suprahyoid muscle and sternocleidomastoid (SCM) muscles of each patient and the sEMG activity of the paralaryngeal muscles was measured before and after laryngeal massage. In addition, a patient-based pain scale was also completed by laryngeal palpation before and after laryngeal massage. Results: Significantly lower sEMG amplitudes yielded in the suprahyoid muscle and SCM muscles during sustained /a/ vowel phonation and connected speech following laryngeal massage. Moreover, pain scores also reduced after laryngeal massage in both the suprahyoid and sternocleidomastoid muscles. Conclusion: Laryngeal massage was immediately beneficial in reducing tension and pain in the paralaryngeal muscles for muscle tension dysphonia. In addition, sEMG proved the effect of laryngeal massage alone without other interventions as an objective indicator. Hence, it can be useful to measure the therapeutic effect of laryngeal massage for muscle tension dysphonia with laryngeal palpation in the clinical field.

The effects of head rotation and tilt on oral pressure and muscle activity

Tae-Hoon Kim,Da-Hye Kim 대한해부학회 2019 Anatomy & Cell Biology Vol.52 No.4

We present basic data on head positions that can serve as compensatory interventions for patients with weak tongue and buccinator muscles. We studied 30 Korean adults (15 males, 15 females; mean age, 23 years; range, 20–30 years). A TPS- 100 instrument was used to measure tongue and cheek pressures and suprahyoid and buccinator muscle activities at various head rotations and tilts, as independent variables. The data were subjected to one-way analysis of variance and post-hoc (linear contrast) testing. Tongue elevation pressures differed significantly when the head was flexed or extended compared to the neutral position (P<0.01). Suprahyoid muscle activity varied significantly when the head was rotated left or right compared to neutral, or tilted with the tongue elevated (P<0.01). Cheek pressure varied significantly when the head was rotated left or right compared to neutral, or tilted (P<0.01). Both tongue and cheek pressures increased significantly when the head was extended or rotated contralaterally compared to the neutral position. Suprahyoid muscle activity increased when the head was flexed or extended, or contralaterally or ipsilaterally rotated compared to the neutral position. Therefore, we suggest that head rotation or tilting could be used to vary oral pressure and muscle activity.

건강한 성인의 Shaker 운동과 수정된 Shaker 운동 동안 목뿔위근, 목빗근, 전사각근, 머리널판근의 활성 차이

유동완 ( Dong-wan Yoo ),정혜지 ( Hye-ji Jeong ),문종훈 ( Jong-hoon Moon ),원영식 ( Young-sik Won ) 대한신경치료학회 2021 신경치료 Vol.25 No.2

Purpose The purpose of this study is to investigate the effects of Shaker exercise (SE) and modified Shaker exercise (MSE) on the activity of the suprahyoid (SH), Sternocleidomastoid (SCM), anterior scalene (AS), splenius capitis muscles (SC). In addition, we want to investigate whether there is a difference in muscle activity and fatigue during SE and MSE according to forward head posture (FHP). Methods Thirty-nine healthy adults participated in this study. All subjects performed SE and MSE isometric exercise, and the exercise sequence was counterbalanced. SE and MSE measured the mean, maximum, and fatigue levels of SH, SCM, AS, and SC muscles using surface electromyography. All exercises were repeated 5 times and were performed isometrically for 20 seconds, with an interval of 30 seconds between exercises. A 20-minute break was provided between the two exercises. For reference voluntary contraction, 90˚ abduction was performed 3 times based on the middle deltoid muscle. The craniovertebral angle was measured to determine the FHP. Results SH and AS, SC muscles activation was significantly higher in MSE than in SE (p<.05). There was no significant difference in SCM muscle activity and fatigue between the two exercises. In SE, the group with FHP less than 50 degrees showed significantly lower activity in SH and SC muscles than the group with 50 degrees or more. Conclusion These findings suggest that MSE can be used as a more effective method for enhancing SH muscles than conventional SE.

설골상근의 과도수축을 동반한 변성발성장애환자에 대한 보툴리눔 독소 주입 치료 1례

최홍식,정유삼,김원석,표화영,이경아 대한후두음성언어의학회 1997 대한후두음성언어의학회지 Vol.8 No.1

The mutational falsetto is failure to change from the higher pitched voice of preadolescence to the lower pitched voice of adolescence and adulthood. The one of characteristic findings is contraction of suprahyoid muscles. The large majority of young men with inappropriately high voice have excellent voice therapy prognosis. We have experienced one case of mutational falsetto treated with botulinum toxin injection on suprahyoid muscles. His suprahyoid muscles are contracted markedly simultaneously with each phonation. fundamental frequency$(F_0)$ of his vowel phonation was 332Hz. Extensive voice therapy including manual compression of thyroid notch was ineffective. Forty units of Botox$^{\circledR}$ was injected under the EMG-guidance(20U bilaterally). At seven days post-injection, his voice changed lower than before and at 40 days after procedure, his $F_0$ was 126Hz.

저항성 턱 열기 운동과 저항성 턱 당기기 운동 수행 시 목뿔위근과 목뿔아래근의 근 활성도 차이 비교

윤영식(Yeong-Sik Yun),장기연(Ki-Yeon Chang),심선화(Sun-Hwa Shim),우희순(Hee-Soon Woo) 인문사회과학기술융합학회 2018 예술인문사회융합멀티미디어논문지 Vol.8 No.11

본 연구는 저항성 턱 열기 운동과 저항성 턱 당기기 운동 수행에 따른 목뿔위근과 목뿔아래근의 근 활성도를 확인하고 그 차이를 비교하기위해 시행되었다. D광역시에 거주 중인 건강한 성인 48명을 대상으로 두 운동을 적용하였으며 운동 수행에 따른 목뿔위근과 목뿔아래근의 근 활성도는 표면 근전도를 사용하여 측정하였다. 운동 수행 간 측정된 목뿔위근과 목뿔아래근의 근 활성도는 대응표본 T 검정을 통해 차이를 비교하였다. 연구결과 두 운동 간 목뿔위근의 근 활성도에 있어서 통계학적 차이를 보였으며(p<.01), 목뿔아래근의 근 활성도에서는 통계학적인 차이를 보이지 않았다(p=1.00). 본 연구결과 저항성 턱 열기 운동과 저항성 턱 당기기 운동 모두 목뿔위근의 근 수축을 유도할 수 있으며 목뿔위근의 보다 많은 근 수축을 유도할 수 있는 운동은 저항성 턱 열기 운동인 것으로 확인되었다. 목뿔아래근의 근 수축은 통계학적인 차이는 보이지 않았으나, 이러한 결과는 두 운동간 목뿔아래근의 유사한 근 수축을 유도할 수 있을 것으로 생각할 수 있겠다. 추후 목뿔위근과 목뿔아래근의 근약화를 가지고 있는 환자를 대상으로 다음의 두 운동의 효과를 비교한다면 명확한 이론적 근거가 될 것이다 This study was conducted to review the muscle activity of the supra-hyoid muscle and infra-hyoid muscle during Jaw Opening Agasinst Resistance Exercise and Chin-Tuck Against Resistance Exercise. The two exercises were applied to 48 adults living in City D. The surface electromyogram of the supra-hyoid muscle and infra-hyoid muscle were measured. The muscle activity of the the supra-hyoid muscle and infra-hyoid muscle in accordance with the exercises were compared using a corresponding sample t test. The study showed a statistically significant difference in the muscle activity of the supra-hyoid muscle (p<.01), while there was no such difference in the muscle activity of the infra-hyoid muscle (p=1.00). The findings show that both resistant lower Jaw Opening Agasinst Resistance Exercise and Chin-Tuck Against Resistance Exercise can lead to muscle activation in the supra-hyoid muscle and the infra-hyoid muscle. Jaw Opening Agasinst Resistance Exercise was found to encourage more muscle activation in the supra-hyoid muscle. While there was no statistcial difference in the muscle activation of the infra-hyoid muscle, the findings indicate that the two exercise can encourage similar muscle activation in the infra-hyoid muscle. A more clear theoretical basis can be provided if the the effects of the two exercises are compared in patients with muscular weaknesses in the supra-hyoid muslce and infra-hyoid muscle.

삼킴 장애가 있는 뇌졸중 노인 환자에서 저항성 고개 숙이기 운동과 Shaker 운동의 목뿔위 및 목빗근 활성 비교

김본이(Bon Yi Kim),이 슬(Seul Lee),문종훈(Jong Hoon Moon),원영식(Young Sik Won) 한국장애인재활협회 2016 재활복지 Vol.20 No.3

저항성 고개 숙이기 운동과 shaker 운동은 목뿔위근의 강화를 사용되는 중재법이다. 이전의 연구들에서는 삼킴 장애가 있는 환자들 대상으로 두 운동을 비교하지 않았다. 본 연구는 삼킴장애를 가진 뇌졸중 노인 환자에게 저항성 고개 숙이기 운동과 shaker 운동이 목뿔위근, 목빗근에 미치는 효과를 알아보고자 하였다. 10명의 삼킴 장애가 있는 뇌졸중 노인 환자가 자발적으로 연구에 참가하였다. 모든 대상자들은 저항성 고개 숙이기 운동(등척성, 등속성), shaker 운동(등척성, 등속성)을 순서대로 수행하였으며, 10회 반복하였다. 저항성 고개 숙이기를 수행한 후, 대상자들은 근피로를 최소화하기 위하여 5분간 휴식을 하였다. 두 운동 동안 목뿔위근과 목빗근의 활성을 표면 근전도를 이용하여 분석하였다. 윌콕슨 부호 순위 검정은 그룹 내 저항성 고개 숙이기와 shaker 운동에서 근활성에 대한 차이를 평가하기 위하여 사용하였다. 저항성 고개 숙이기 운동과 shaker 운동은 목뿔위근에서 유의한 차이를 보이지 않았다(p>.05). 저항성 고개 숙이기 운동은 shaker 운동보다 목빗근에서 유의하게 낮은 활성을 보였다(p<.05). 삼킴 장애가 있는 뇌졸중 노인 환자에게 저항성 고개 숙이기 운동이 shaker 운동보다 삼킴 기능 향상을 위한 더 효과적인 치료 방법으로 사용될 수 있을 것이다. Chin Tuck Against Resistance Exercise(CTARE) and Shaker exercise is used to common for strengthening of suprahyoid muscle. No previous studies was compare of two exercises for patients with dyaphagia. This study investigated the effects of CTARE and Shaker exercise on suprahyoid, sternocleidomastoid muscle activity in stroke older patients with dysphagia. Ten stroke patients with dyaphagia voluntarily participated in this study. All subjects was performed in the order in the CTARE (isometric, isokinetic), Shaker (isometric, isokinetic), and repeated each ten trials. After CTARE was performed, subjects took a 5 min wash out period to minimize muscle fatigue. Activity of suprahyoid and sternocleidomastoid muscle during two training was analyzed using surface electromyography(sEMG). Wilcoxon signed rank test was used to assess differecences for muscles activity between the effects of the CTAR and Shaker exercise within group. CTARE and Shaker exercise showed no significant difference activity in suprahyoid muscle(p > .05). CTARE showed significantly lower muscle activity in sternocleidomastoid muscle than Shaker exercise(p < .05). CTARE in stroke older patients with dysphagia may be a effective intervention to improve swallowing function than Shaker exercise.

뇌졸중으로 인한 목뿔위근의 근 약화가 동반된 연하장애환자를 위한 근거 기반 운동 방법에 대한 고찰

윤영식 대한연하재활학회 2020 Swallowing Rehabilitation Vol.3 No.1

구인두연하장애를 가지고 있는 뇌졸중 환자들의 경우 삼킴 근육의 약화로 목뿔후두복합체의 움직임에 관여하는 목뿔 위근의 약화로 음식물이 기도로 침습 또는 흡인이 될 수 있는 상황을 초래할 수 있다. 때문에 구인두연하장애환자들의 삼킴 기능을 향상시키기 위한 다양한 보상적 기법, 메뉴버 및 재활치료 접근법들이 폭 넓게 사용되어지고 있다. 이 중 근력 강화 를 위한 재활 운동방법경우 현재 임상에서의 필요성과 중요성이 꾸준히 늘고 있으나 실제 적용할 수 있는 방법이 제한되어 있다. 최근의 경우 운동에 기반을 둔 재활치료 접근 방법에 초점이 맞추어져 있으며, 이와 관련한 기존의 운동 방법들을 보 완하거나, 연구를 통해 새롭게 제안된 운동방법들이 소개되고 있다. 본 고찰에서는 현재 연구되고 있는 근거 기반 연하재활 운동방법에 대해 고찰함으로써 목뿔위근의 약화가 동반된 구인두연하장애를 가진 뇌졸중 환자들의 삼킴 기능 향상에 도움 을 줄 수 있는 방법으로 고려될 수 있음을 제안 하고자 한다. Patients of stroke with oropharyngeal dysphagia can face the situation that foods may be aspirated or infiltrated to the airway upon decreased movement of hyolaryngeal complex involved in hyoid bone due to the weakened swallowing muscle. Multiple compensation and rehabilitation approaches and maneuvers are widely used to enhance the swallowing function in the patients with oropharyngeal dysphagia. Out of these, the needs and importance of rehabilitation approaches have been continuously increased while the methods of practical applications are limited. Recently, rehabilitation approaches based on the exercise are focused and complemented methods related to these or new methods have been studied and introduced. In this article, it is suggested that evidence-based rehabilitation approaches for swallowing can be considered as the methods to assist to enhance the swallowing function in the patient with oropharyngeal dysphagia related on suprahyoid muscle weakness due to stroke.

물의 양과 온도가 목뿔위근육과 목뿔아래근육의 근활성도에 미치는 영향

김태훈,김다혜 대한지역사회작업치료학회 2017 대한지역사회작업치료학회지 Vol.7 No.2

목적 : 본 연구는 정상 성인을 대상으로 삼킴 시 물의 온도와 양에 따른 목뿔위근육과 목뿔아래근육의 활성도를 측정하 여, 임상에서 삼킴장애를 평가하기 위한 기초자료로 활용하고자 하였다. 연구 방법 : 건강한 성인 27명을 대상으로 물의 양과 온도에 따른 목뿔위근육과 목뿔아래근육의 근활성도를 비교하기 위하여 양은 3 mL, 20 mL로, 온도는 4 ℃, 22 ℃, 40 ℃로 각각 설정하였고, 대상자별로 기준값(reference voluntary contraction, %RVC)을 설정하기 위하여, 침을 삼키는 동안 오른쪽 및 왼쪽 목뿔위근육과 목뿔아래근육의 활성도를 3회 측정하여 평균값을 사용하였다. 연구 장비는 안드로이드 기반 근전도 측정 장비인 2EM(4D-MT, Relive, Gimhae, Korea)을 이용하여 자료를 수집, 처리하였다. 결과 : 양을 기준으로 비교했을 때 왼쪽 목뿔아래근육은 4 ℃, 22 ℃, 40 ℃에서 (p=.00; p=.00; p=.00), 오른쪽 목뿔아래근 육은 22 ℃와 40 ℃에서 (p=.01; p=.01), 왼쪽 목뿔위근육은 4 ℃에서 (p=.03), 3 mL 물보다는 20 mL 물을 삼킬 때 근활성도가 증가하였다. 온도를 기준으로 분석한 결과 20 mL의 물을 삼킬 때 4 ℃, 22 ℃ 보다는 40 ℃ 조건에서 오른쪽 목뿔위근육의 근활성도가 유의하게 감소하였다 (p=.04). 결론 : 20 mL가 3 mL보다 오른쪽 및 왼쪽 목뿔아래근육, 왼쪽 목뿔위근육에서 근활성도가 유의하게 증가하였고, 40 ℃가 4 ℃, 22 ℃보다 오른쪽 목뿔위근육에서 근활성도의 유의한 감소를 보였으나, 양과 온도를 모두 고려한 일부 조건에서만 의미가 있었다. 추후에는 점도, 맛 등의 다른 변수를 고려하여 건강한 대상자 뿐 아니라 신경계 손상환자 를 대상으로 한 임상연구가 더 필요할 것이다. Objectives : This study was conducted to investigate the activity of the supra and infrahyoid muscles according to the temperature and the amount of water in healthy adults. Methods : The amount of water was set to 3 mL and 20 mL, and the temperature was subdivided into 4 ℃, 22 ℃, and 40 ℃ in order to compare the activity of the supra and infrahyoid muscles in twenty-seven healthy adults. We used the mean value of the activity of the supra and infrahyoid muscles while they were swallowing saliva in order to set the reference voluntary contraction (%RVC). Results : Muscle activity was significantly increased when they swallowed 20 mL of water rather than 3 mL in the left infrahyoid muscles at 4 ℃, 22 ℃ and 40 ℃ (p=.00; p=.00; p=.00), the right infrahyoid muscles at 22 ℃and 40 ℃ (p=.01; p=.01), the left suprahyoid muscles at 4 ℃ (p=.03). Muscle activity of the right suprahyoid muscles was significantly decreased at 40 ℃ compared to 4 ℃ and 22 ℃ when they swallowed 20 mL of water (p=.04). Conclusion : In the future, other variables such as viscosity and taste should be considered, and further studies on patients with impaired nervous system as well as healthy subjects will be needed.