DYSPHAGIA IN ELDERLY NURSING HOME RESIDENTS WITH SEVERE COGNITIVE IMPAIRMENT CAN BE ATTENUATED BY CERVICAL SPINE MOBILIZATION

Objective: To investigate the feasibility of cervical spine mobilization in elderly dementia patients with dysphagia, and its effect on swallowing capacity. Methods: Fifteen nursing home residents (9 women, 6 men, age range 77-98 years) with severe dementia (median Mini Mental State Examination score = 8/30, percentile (P)25-75 = 4-13) and known dysphagia participated in a randomized controlled trial with cross-over design. Cervical spine mobilization was administered by trained physiotherapists. Control sessions consisted of socializing visits. Feasibility (attendance, hostility, complications) and maximal swallowing volume (water bolus 1-20 nil) were assessed following one session and one week (3 sessions) of treatment and control. Results: Ninety percent of cervical spine mobilization sessions were completed successfully (3 sessions could not be carried out due to the patient's hostility and 2 due to illness) and no complications were observed. Swallowing capacity improved significantly after cervical spine mobilization (from 3 nil (P25-75 = 1-10) to 5 ml (P25-75 = 3-15) after one session p = 0.01 and to 10 ml (P25-75 = 5-20) (+230%,) after one week treatment p = 0.03) compared with control (no significant changes, difference in evolution after one session between treatment and control, p = 0.03). Conclusion: Cervical spine mobilization is feasible and can improve swallowing capacity in cognitively impaired residents in nursing homes. Given the acute improvements following treatment, it is probably best provided before meals.