Multiple Sclerosis, Dysphagia, Deglutition Disorders
Conditions
Keywords
Multiple Sclerosis, Dysphagia, Deglutition Disorders
Brief summary
This study compares two exercise programs for people with multiple sclerosis (MS) who have trouble swallowing. One group did chin exercises against resistance (CTAR), and the other group did neck exercises based on a technique called proprioceptive neuromuscular facilitation (PNF). Both groups also received a sensory technique to help trigger swallowing. The study tested whether these exercises could improve swallowing ability, swallowing speed, and quality of life related to eating and drinking. Participants were randomly assigned to one of the two exercise groups and were treated for 8 weeks, three times per week. Swallowing was assessed before and after treatment using validated questionnaires and a water-swallow test.
Detailed description
Multiple sclerosis (MS) is a chronic, immune-mediated disease of the central nervous system that frequently causes dysphagia (swallowing difficulty), which can lead to aspiration pneumonia and reduced quality of life. Exercise-based interventions targeting the suprahyoid and infrahyoid muscles are commonly used in dysphagia rehabilitation, but comparative evidence between Chin Tuck Against Resistance (CTAR) exercises and cervical Proprioceptive Neuromuscular Facilitation (PNF) exercises in MS patients is lacking. This randomized, controlled, single-blind (outcome assessor blinded) trial enrolled adults aged 18-65 with a confirmed diagnosis of MS (per 2017 McDonald criteria), a DYMUS score ≥1, and no relapse in the preceding 6 months. Participants were allocated 1:1 to either the CTAR group or the PNF group using a computer-generated randomization sequence (minimization method, balanced for sex and disease course), with allocation concealed via sequentially numbered, sealed, opaque envelopes. Both groups received Thermal-Tactile Stimulation (TTS) as a shared baseline treatment. The CTAR group performed isometric chin-tuck exercises against a resistance ball (2-3 sets x 8-12 repetitions per session). The PNF group performed cervical combined isotonic contraction techniques using diagonal movement patterns (30 repetitions per session). Both groups trained 3 sessions per week for 8 weeks (24 sessions total), with total session duration equalized between groups (approximately 30 minutes, including rest periods and TTS). The primary outcome was change in DYMUS total score from baseline to week 8. Secondary outcomes included the Eating Assessment Tool (EAT-10), 100 mL Water Swallow Test parameters (swallowing duration, speed, and volume), the Functional Oral Intake Scale (FOIS), and the Swallowing Quality of Life Questionnaire (SWAL-QOL). Adverse events related to exercise (pain, fatigue, choking sensation) were systematically monitored at each session
Interventions
BEHAVIORALCTAR exercise
Participants performed isometric chin-tuck exercises against resistance using a ball positioned under the chin. Each session consisted of 2-3 sets of 8-12 repetitions, with each isometric contraction sustained for 5-10 seconds and 30-60 seconds of rest between sets. Sessions were conducted 3 times per week for 8 weeks (24 sessions total), supervised by a physiotherapist certified in swallowing rehabilitation.
BEHAVIORALPNF exercises
Participants received cervical proprioceptive neuromuscular facilitation using a combined isotonic contraction technique with diagonal movement patterns. Each repetition involved movement from an extension-left rotation position to a flexion-right rotation position against manual resistance, followed by a 6-second isometric hold and controlled eccentric return; the pattern was also performed in reverse diagonal direction. A total of 30 repetitions were completed per session without rest between repetitions. Sessions were conducted 3 times per week for 8 weeks (24 sessions total), supervised by a physiotherapist certified in swallowing
Sponsors
Sanko University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The outcome assessor was a physiotherapist not involved in intervention delivery and unaware of group allocation. Participants were asked not to disclose their group assignment during assessment sessions
Intervention model description
Participants were randomly assigned in a 1:1 ratio to one of two parallel exercise arms (CTAR or PNF), both receiving a shared baseline sensory intervention (thermal-tactile stimulation).
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* \- Confirmed diagnosis of multiple sclerosis according to the 2017 McDonald criteria * DYMUS (Dysphagia in Multiple Sclerosis) questionnaire score ≥1 * Age between 18 and 65 years * No relapse within the preceding 6 months
Exclusion criteria
* \- Pregnancy or breastfeeding * Presence of another neurological disease that could cause dysphagia * Presence of pneumonia * History of head-neck surgery or head-neck cancer * Persistent neck pain and/or radiculopathy * Inadequate head control * Inability to understand or follow verbal commands
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in DYMUS (Dysphagia in Multiple Sclerosis Questionnaire) Total Score | Baseline and week 8 (post-treatment) | The DYMUS is a 10-item self-report questionnaire assessing oropharyngeal dysphagia in multiple sclerosis patients, scored 0 (no) to 1 (yes) per item, yielding a total score range of 0-10. Higher scores indicate greater dysphagia severity. A score ≥3 indicates severe swallowing difficulty. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in EAT-10 (Eating Assessment Tool-10) Score | Baseline and week 8 | A 10-item self-report questionnaire assessing dysphagia symptom severity, each item scored 0 (no problem) to 4 (severe problem), total score range 0-40. Higher scores indicate greater |
| Change in FOIS (Functional Oral Intake Scale) Level | Baseline and week 8 | A 7-point ordinal scale classifying functional oral intake ability; levels 1-3 represent tube dependency, levels 4-7 represent oral intake. Higher levels indicate better oral intake |
| Change in SWAL-QOL (Swallowing Quality of Life) Score | Baseline and week 8 | A patient-reported outcome measure assessing dysphagia-related quality of life across 11 subdomains, scored 0-100 |
| Change in 100 mL Water Swallow Test Parameters (Swallowing Speed, Volume per Swallow, Duration) | Baseline and week 8 | An objective clinical test measuring swallowing speed (mL/sec), volume per swallow (mL), and total swallowing duration (sec) during ingest |
Countries
Turkey (Türkiye)
Outcome results
None listed