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.