Immediate Effects of the Forehead Exercise for Suprahyoid Muscles: A Case Series
Abstract
Introduction Dysphagia is common in older adults and individuals with neurological disorders and is often associated with aspiration pneumonia and reduced quality of life. The Forehead Exercise for Suprahyoid Muscles (FESM, also known as Enge-Odeko-Taiso) is a simple, non-invasive technique aimed at strengthening the suprahyoid muscles. However, its immediate effect on swallowing function is not well understood. We aimed to determine whether a single session of FESM, performed during a videofluoroscopic swallowing study (VFSS), could immediately reduce the risk of penetration and aspiration, as measured by the Penetration-Aspiration Scale (PAS). Methods This small retrospective case series included 12 patients (mean age 76.6 ± 11.3 years) who underwent VFSS at Hamamatsu City Rehabilitation Hospital between December 1, 2024, and April 1, 2025. Patients were included if they had a baseline PAS score ≥2 and performed the FESM during the same VFSS session. Patients performed at least five repetitions of the FESM, which involved isometric chin-tuck contractions, immediately before the post-intervention swallow. Body position, bolus type, and imaging parameters were kept consistent before and after the exercise. Pre- and post-FESM PAS scores were compared using the Wilcoxon signed-rank test (significance set at p < 0.05). Results The median PAS score significantly decreased from 3.5 (interquartile range (IQR), 2.75-8.00) to 1.0 (IQR, 1.00-2.25) following FESM (p = 0.025). Among…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 12 participants or records.
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