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Visit our office for speech, language, swallowing, memory, and/or voice therapy:

760 S. Volusia Avenue, Suite 200 Orange City, FL 32763 baselinetherapies@yahoo.com

"As a physician I see many patients who are unable to swallow safely due to strokes or other brain injuries. My heart really goes out to anyone who can no longer enjoy the simple pleasure of eating. I know that exercising the muscles of the throat with an ISO will help lots of people to be able to swallow safely and resume eating."

Steve Blackburn, M.D.

Testimonial: "I want to congratulate you on the ISO. It has done wonders for my wife, who had acute dysphagia problems due to radiation treatments. It has helped to greatly improve her swallowing, and her doctor is very pleased with her progress. She is also pleased, considering the fact that her first Speech Therapist wanted to put in a feeding tube. Her doctor told her to do two things going forward -- Do her exercises regularly and eat! We highly recommend the use of the ISO device as an essential device to regain the ability to swallow properly."

DCP

Atlanta, GA

"In my practice as a speech-language pathologist, I have had very good results using the ISO-SED with my dysphagia patients with a wide variety of diagnoses, including: stroke (CVA), Parkinson's Disease, Traumatic Brain Injury, Alzheimer's Disease, Muscular Dystrophy, and generalized weakness. Many of my patients who have tried other dysphagia exercises and NMES in the past without success, have improved swallow function with the ISO-SED."

Jolie Parker, M.S. CCC-SLP

The ISO Swallowing Exercise Device was invented by an ASHA certified speech language pathologist. It provides smooth, flexible resistance to strengthen the muscles in the throat that are responsible for swallowing.

The ISO-SED is an easy and convenient way to do a Shaker-like chin tuck against resistance exercise movement for dysphagia, but in an upright position. It can also be used to do the Jaw Opening exercise with the added benefit of resistance.

See the video below for a brief overview, demonstration, and discussion of relevant research.



The Shaker Exercise was developed by Dr. Reza Shaker, a gastroenterologist at the Medical College of Wisconsin. The exercise is completed by having the patient lie in a supine position and lift his head, so that he can look at his toes. The force of gravity provides the resistance. The purpose of this exercise is to strengthen the suprahyoid muscles to improve UES opening during the swallow. In a study conducted in the year 2002, by Dr. Shaker, 27 out of 27 patients who were tube-fed before the study and performed the Shaker exercise three times a day for six weeks, were able to tolerate a soft p.o. diet by the end of the six weeks of treatment. Etiology and duration of dysphagia did not affect the outcome.

In 2009, seven institutions participated in a clinical trial to compare the Shaker exercise with traditional therapy. Each patient received a modified barium swallow study pre- and post-therapy. The authors concluded that although there were several improvements in the traditional therapy group, there was significantly less aspiration post-therapy in patients in the Shaker group.

In the year 2000 a study was conducted to evaluate surface EMG activities in the suprahyoid, infrahyoid, and sternocleidomastoid muscles groups during the Shaker exercise. The findings suggested that all three muscle groups were fatigued during the Shaker exercise. A similar study in 2008 indicated that the Shaker exercise fatigued all three muscle groups.

In 2013 Watts used surface EMG to compare the Shaker exercise to a jaw opening exercise. For the jaw opening exercise, he had participants open the jaw for 10 seconds against the resistance of a chin brace secured against the upper torso. He measured the activation of the geniohyoid, mylohyoid, and anterior digastric muscles. He concluded that activation in these muscles was significantly greater when participants performed the jaw opening exercise than when participants performed the head-lift (Shaker) exercise. This study indicates that the jaw opening exercise may be even more effective than the Shaker exercise and it supports further research in this area.

A study conducted in 2012 by Satoko Wada investigated the effects of the jaw opening exercise. The exercise consisted of participants opening the jaw to its maximum and maintaining it for 10 seconds, with 5 repetitions and 2 sets daily for 4 weeks. Pre- and post-therapy videofluoroscopy swallow studies were used to measure effectiveness. Significant improvements were observed in the upward movement of the hyoid bone, the amount of upper esophageal opening, and the time of pharyngx passage. Pharyngeal residue also decreased in some subjects.

In a 2013 study, the surface EMG activity of the suprahyoid muscles was compared between the Chin Tuck Against Resistance exercise and the Shaker exercise. During the Chin Tuck Against Resistance exercise, the participant tucked the chin against the resistance of an inflatable rubber ball while in a seated position. There were 40 participants in this study, 20 males and 20 females. The results showed significantly greater maximum SEMG values during the Chin Tuck Against Resistance isokinetic and isometric exercises than during the equivalent Shaker exercises. The authors concluded that Chin Tuck Against Resistance exercises appear to be effective in exercising the suprahyoid muscles and therapeutic effects could be comparable to those of the Shaker exercise. They also found that clients reported the Chin Tuck Against Resistance exercises were less strenuous than the Shaker exercise and these exercises therefore have the potential for greater compliance by patients than the Shaker exercise.

References:

Wai Lam Yoon, Jason Kai Peng Khoo, Susan J. Rickard Liow. Chin Tuck Against Resistance (CTAR): New Method for Enhancing Suprahyoid Muscle Activity Using a Shaker-type Exercise. Dysphagia. DOI 10.1007/s00455-013-9502-9; 2013 Watts, CR. Archives of Physical Medicine and Rehabilitation. 2013 Dec;94(12):2542-8.

Satoko Wada, Haruka Tohara, Takatoshi Iida, Motoharu Inoue, Mitsuyasu Sato, Koichiro Ueda, Jaw-Opening Exercise for Insufficient Opening of Upper Esophageal Sphincter, Archives of Physical Medicine and Rehabilitation, Available online 10 May 2012, ISSN 0003-9993, 10.1016/j.apmr.2012.04.025.

Mohammed Ferdjallah, PHD; Jacqueline J. Wertsch, MD; Reza Shaker, MD. Spectral analysis of surface electromyography (EMG) of upper esophageal sphincter-opening muscles during head lift exercise. Journal of Rehabilitative Research & Development. 2000; 37(3): May/June.

Kevin T. White, Caryn Easterling, Niles Roberts, Jacqueline Wertsch, Reza Shaker. Fatigue Analysis Before and After Shaker Exercise: Physiologic Tool for Exercise Design. Dysphagia. 2008; 23: 385-391

Shaker, R., Easterling, C., Kern, M., Nitschke, T., Massey, B., Daniels, S., Grand, B., Kazandjiam, M., Dikeman, K.. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002 May; 122(5): 1314-21

Jeri A. Logemann; Alfred Rademaker; Barbara Roa Pauloski; Amy Kelly; Carrie Stangl-Mcbreen; Jodi Antinoja; Barbara Grande; Julie Farquharson; Mark Kern; et al. (Profiled Authors: Jerilyn A Logemann; Barbara Roa Pauloski; Alfred W Rademaker) A randomized study comparing the Shaker exercise with traditional therapy: A preliminary study. Dysphagia. 2009;24(4):403-411.