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Cervical isometric exercises improve dysphagia and cervical spine malalignment following stroke with hemiparesis: a randomized controlled trial [with consumer summary]
Ploumis A, Papadopoulou SL, Theodorou SJ, Exarchakos G, Givissis P, Beris A
European Journal of Physical and Rehabilitation Medicine 2018 Dec;54(6):845-852
clinical trial
8/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Hemiparesis following stroke can cause cervical spine scoliosis, kyphosis or hyperlordosis. These abnormal cervical alignments can contribute to dysphagia. The benefit of cervical isometric exercises to improve swallowing has not been previously studied. AIM: To evaluate the use of cervical isometric exercises in dysphagic adult patients with cervical spine alignment disorders due to hemiparesis after stroke. DESIGN: A randomized controlled trial. SETTING: University Hospital, PMR Department. POPULATION: Dysphagic adult patients with hemiparesis after stroke in the rehabilitation phase. METHODS: In addition to the standard physical and speech therapy therapeutic approach for 12 weeks, cervical isometric exercises were conducted by a group of patients (experimental group). Patients had cervical spine radiographs in erect (sitting or standing) position coronal and sagittal C2 to C7 Cobb angle and a videofluoroscopic swallowing study to evaluate deglutition (0 = normal, 1 = penetration, 2 = aspiration) at 2 time points (at the beginning and at the end of the therapeutic program). RESULTS: Seventy consecutive patients with hemiparesis of a mean (SD) age of 52 +/- 15 years were included in the study and were randomized in 2 groups. Thirty-seven of them (experimental group) conducted cervical isometric exercises in addition to their therapeutic program. At the last follow-up, patients had improved (p < 0.001) cervical alignment, in both coronal and sagittal plane, and deglutition. Patients who conducted cervical isometric exercises (experimental group) had more pronounced correction (p < 0.001) of cervical alignment in both planes and achieved greater improvement (p < 0.05) of deglutition too, than patients who did not conduct such exercises (control group). CONCLUSIONS: Dysphagic adult patients with hemiparesis after stroke in the rehabilitation phase who underwent cervical isometric strengthening exercises showed more significant correction of cervical alignment and more pronounced improvement in deglutition compared to patients who did not include cervical isometric exercises in their therapeutic program.

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