Wada, S., Tohara, H., Iida, T., Inoue, M., Sato, M., & Ueda, K. (2012). Jaw-Opening exercise for insufficient opening of upper esophageal sphincter. Archives of Physical Medicine and Rehabilitation, 93(11), 1995-1999.

The outcome of this no named new Dysphagia exercise is increasing hyoid elevation, Upper Esophageal Sphincter (UES) opening, pharynx passage time, and decreasing pharyngeal residue after swallowing at preexercise and postexercise evidenced by VFSS.

As per Dr. James Coyle this exercise is also designed to increase UES opening by using strengthening the anterior muscles of the floor of the mouth (submandibular suprahyoid) muscles. It exercises these muscles by depressing the mandible. We do it with gentle resistance and use the same schedule that is published in the studies on tongue strengthening. Coyle


During a swallow, the UES is open, and works closely b/c of the location of the cricopharyngeal muscle. The cricopharyngeal muscle is attached to the cricoid cartilage and is relaxed upon swallowing as it is pulled by the hyoid laryingeal structures. "The UES does not open automatically. Successful opening of the UES requires an anterior-superior traction of the hyoid and larynx and further UES relaxation and hyoid traction on the larynx precedes UES opening" Wade.   Further described, when the hyoid decreases laryngeal elevation can cause dysphagia resulting from UES opening.


This exercise involves jaw opening and multiple muscles therefore during ones' Oral Periphieral Exam Jaw as well as Labial muscles must be assessed for this exercise. It doesn't mean they have to have within normal limits, but it must be documented. The suprahyoid muscle group including mylohiyoid muscle, the anterior belly of the digastric muscles and the geniohyoid muscles are also involved in hyoid elevation and some in jaw opening. These muscles include the mylohyoid muscle, the anterior belly of the digastric muscles, and the geniohyoid muscle.

Given the above mechanisms, the authors performed a jaw-opening/strenghening exercise among patients with UES dysfunction and assessed the effect of this exercise on swallowing function with a videofluorographic swallowing study (VFSS).

Evidence has shown that there was significant improvements when you compare swallow functions pre-exercise and post-exercise.  Advances were demonstrated in the extent of upward movement of the hyoid bone, the amount of UES opening, and the timing of pharyeal passage.  Four (4) weeks after initiating the exercise. Some subjects evidenced decreased pharyngeal residue. No increases were noted in any subjects.

The conclusion demonstrated that this jaw-opening exercise is an effective treatment for dysphagia; caused by dysfunction of hyoid elevation and UES opening.

Everyone should take a look at this. Unfortunately this kind of behavior occurrs on a nearly regular basis in SNFs & LTCs.  No one should have to go through or even watch this subhuman conduct. 

I assure you, I haven't personally witnessed this kind of disgust or any evidence that it may have it occurred.  I also know a lot A LOT of therapists who say the same thing.  For the most part your loved ones are in good hands.

However, there are no excuses, if you suspect one little thing is off, you talk to management.  If it keeps happening, you get your loved one into another facility if you have to. 

Please click on the link below, read the article, and watch the video.  If you find any of the information presented in the article familiar, either bring it to your management's attention (by-passing the nursing staff), or feel free to contact me & I'd be happy to assist if I can.  

http://m.bbc.co.uk/news/health-24958181

The National Institute on Aging revised the diagnostic criteria for Alzheimer's disease also endorsed by the Alzheimer's Association, published in the May 2011 issue of Alzheimer's and Dementia: The Journal of the Alzheimer's Association. The introduction and three articles can be accessed at http://www.alz.org/research/diagnostic_criteria/. Drafts of the revised criteria for Alzheimer's disease (AD) were initially released for discussion and review at the Alzheimer's Association International Conference on Alzheimer's Disease in July 2010. Similar to the old criteria, the revised are aimed primarily at researchers, to help improve the characterization of research volunteers and set a scientific framework for defining the key elements of the disease process. Nonetheless, just like their predecessors, they are sure to cross over into clinical practice.  This is the first major update for Alzheimer's diagnostic criteria since 1984.

Perhaps the most important conceptual change in the criteria is a journey even further into the past, beyond 1984, to a time when the lexicon more clearly separated the clinical state of dementia from the pathological process of Alzheimer's disease. Before the new criteria, the pre-1984 terminology "Dementia of the Alzheimer type," was - if not extinct - certainly close to the brink.

Echoing the old way of thinking, the new criteria lay out broad three phases of AD, 1) Dementia due to AD, 2) Mild Cognitive Impairment due to AD, and 3) Preclinical stages of AD. The role of biomarkers to identify underlying AD pathophysiology increases in importance for the more mild MCI and preclinical phases.

Again click on the link below to access all articles:

http://www.alz.org/research/diagnostic_criteria/