In this edition of the Newsletter NMT’s Role in #Swallowing, Drooling & Sialorrhea Management is discussed.
#NeuroMuscularTaping (#NMT) can significantly support the swallowing process (#deglutition), which involves voluntary and involuntary muscle activities. NMT can aid in an integrative #rehabilitation treatment approach for Sialorrhea and #Drooling caused by #neurological disorders, post #surgery, medication #sideeffects, and #trauma which is a significant concern for many patients and caregivers.
Drooling, scientifically termed sialorrhea or hypersalivation, refers to the unintentional leakage of saliva from the mouth. This phenomenon can have physiological origins, such as during certain stages of growth, or be associated with various medical conditions. For instance, drooling is common in infants and young children due to immature oral muscular control and an underdeveloped swallowing reflex. As motor control improves with age, this tendency usually decreases [van Hulst K et al., 2012].
Certain neurological disorders such as Parkinson’s disease, cerebral palsy, and facial paralysis (e.g., Bell’s palsy) can impair muscle control or disrupt the normal swallowing reflex, leading to drooling [Meningaud JP et al., 2006]. Additionally, conditions like teething or infections can increase salivation, which may manifest as drooling [Blasco PA & Stansbury JC, 1996].
Children, particularly those with developmental or neurological challenges, often experience oral motor dysfunction characterised by reduced muscle tone or coordination, making it difficult to manage saliva, which leads to drooling [Reid SM et al., 2010]. Furthermore, certain medications, such as clozapine or pilocarpine, can either stimulate excessive saliva production or hinder its management [Zorn SH et al., 1995].
Exposure to toxins, particularly organophosphate insecticides, can also cause excessive salivation [Costa LG, 2006]. In cases of Gastroesophageal Reflux Disease (GERD), heightened salivation may occur as the body’s defence against stomach acid reaching the esophagus and throat [Vakil N et al., 2006].
Obstructions or tumours in the oral or throat regions can also interfere with normal saliva flow and swallowing, contributing to drooling [Meningaud JP et al., 2006].
Sialorrhea caused by neurological disorders is a significant concern for many patients and caregivers, as it can lead to complications such as skin maceration, infections, aspiration pneumonia, and social stigmatisation. Understanding the causes and available treatment options is essential for effective management. Drooling in neurological conditions often stems from one or more of the following:
- Impaired Oral Motor Function: Neurological conditions can lead to poor coordination or weakness in the oral muscles, affecting saliva management.
- Swallowing Dysfunction (Dysphagia): Common in many neurological diseases, impaired swallowing allows saliva to pool in the mouth and spill out.
- Increased Saliva Production: Some neurological disorders may directly or indirectly stimulate excessive saliva production.
Neurological disorders commonly associated with sialorrhea include:
- Cerebral palsy
- Parkinson’s disease
- Cerebral developmental disorders
- Amyotrophic lateral sclerosis (ALS)
- Stroke
- Traumatic brain injury
- Multiple system atrophy
Treatment Prospects with NeuroMuscular Taping (NMT)
The NMT Institute has developed a treatment concept known as NeuroMuscular Taping (NMT), based on decompression taping methodology and techniques. This NMT concept is widely utilised in physical rehabilitation, sports medicine, nursing, speech therapy, language pathologies, and other healthcare fields. It serves as a therapeutic tool to enhance self-healing capabilities and is applied to conditions requiring active treatment and prevention.
NeuroMuscular Taping involves the application of non-stretched tape to the skin in an extended position, creating a decompressive effect. This approach originated in Italy in the early 2000s and is characterised by the formation of skin wrinkling, folds, or undulations. Over the past decade, various studies have explored the benefits of this taping method in providing skin, muscle, joint, sensory, vascular, and tactile stimulation. [Blow D, 2012].
NMT’s Role in Swallowing, Drooling and Sialorrhea Management
NeuroMuscular Taping (NMT) can significantly support the swallowing process (deglutition), which involves voluntary and involuntary muscle activities. NMT can aid in an integrative treatment approach:
- Muscle Activation and Coordination: NMT enhances the function of the 40 muscles involved in swallowing, including those in the oral cavity, pharynx, larynx, and esophagus. By applying decompression taping to specific areas, NMT can improve muscle tone, activity, and coordination—critical for smooth swallowing. The dilation, sensory, and oxygenation effects of NMT stimulate muscles controlled by cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), and XII (hypoglossal), improving their responsiveness.
- Improvement of Sensory Feedback and Proprioception: Swallowing requires precise coordination between sensory feedback and motor commands. NMT enhances proprioceptive feedback by stimulating the skin and underlying tissues, enabling the central nervous system (CNS) to process more accurate information about muscle movement. This can improve control over both voluntary and involuntary swallowing actions.
- Enhancing Blood Flow and Oxygenation: Proper blood flow is vital for maintaining muscle health and optimal nerve function. Decompression NMT applications promote increased blood flow and oxygenation to the muscles involved in swallowing, aiding efficient function. This is particularly beneficial in neurorehabilitation, where muscle weakness or poor coordination can impair swallowing.
- Reducing Inflammation and Swelling: In patients with conditions affecting swallowing, such as neurological disorders, trauma, medication side effects, or post-surgery recovery, inflammation and swelling in the neck and jaw muscles may exacerbate difficulties. NMT reduces inflammation and edema by promoting lymphatic drainage, relieving muscle tension, and enabling smoother swallowing movements.
- Facilitating Salivary Regulation in Sialorrhea: NMT can assist in regulating excessive saliva production in sialorrhea by improving the function of muscles involved in swallowing and stimulating nerves that control salivation. By enhancing muscle and nerve activity, NMT helps prevent saliva pooling in the mouth, reducing the risk of aspiration and improving oral health.
- Supporting CNS and Cortical Input in Swallowing: The brain’s cortical centers contribute to fine-tuning the swallowing process by adjusting sensory input from muscles and tissues. NMT stimulates sensory pathways, enhancing the brain’s ability to regulate motor commands, leading to better synchronization of swallowing movements. This is particularly beneficial for patients recovering from neurological injuries or strokes, where cortical control of swallowing may be impaired.
- Non-Invasive Support for Rehabilitation: NMT provides a non-invasive approach to improve muscle performance, sensory feedback, and motor control. In neurorehabilitation settings, where the swallowing mechanism may be compromised, NMT assists in retraining muscles and enhancing overall swallowing function. By facilitating voluntary and reflexive swallowing actions, NMT helps prevent complications such as aspiration, improving patients’ quality of life.
By integrating NeuroMuscular Taping (NMT) into the treatment of swallowing disorders and sialorrhea, healthcare professionals can offer a comprehensive, non-invasive approach that supports muscle coordination, nerve function, and overall rehabilitation. While more research is needed to fully elucidate NMT’s decompression mechanism, current clinical evidence strongly supports its use as part of an integrative treatment approach for managing complex symptoms.
Conclusion
NMT treatment protocols for addressing sialorrhea focus on the multitude of muscles involved in the swallowing process, particularly in the neck, mandibular, and oral regions. Treatment is consistently applied bilaterally, with multiple applications emphasising the synergy between various muscles to enhance blood flow and oxygen delivery to specific muscle groups and nerve terminals. The goal is to improve muscle performance, stimulate beneficial proprioceptive motor and sensory responses, and promote controlled voluntary and reflexive swallowing actions.
For more information on training modules for distinct NMT treatment protocols in addressing sialorrhea, contact: NMT Institute and authorised course providers
Bibliography
- van Hulst K, Lindeboom R, van der Burg J, Jongerius P. (2012). Accurate assessment of drooling severity with the 5-min drooling quotient in children with developmental disabilities. Dev Med Child Neurol. 54(12):1121-6.
- Meningaud JP, Pitak-Arnnop P, Chikhani L, Bertrand JC. (2006). Drooling of saliva: a review of the etiology and management options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 101(1):48-57.
- Blasco PA, Stansbury JC. (1996). Orofacial movement disorders. Semin Pediatr Neurol. 3(1):36-45.
- Reid SM, McCutcheon J, Reddihough DS, Johnson H. (2010). Prevalence and predictors of drooling in 7- to 14-year-old children with cerebral palsy: a population study. Dev Med Child Neurol. 52(11):1030-4.
- D. Blow. NeuroMuscular Taping: from theory to practice. Edi Ermes editor, Milano. 2012. ISBN 9781467530361
- Costa LG. (2006). Current issues in organophosphate toxicology. Clin Chim Acta. 366(1-2):1-13.
- Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. (2006). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 101(8):1900-20.
- Meningaud JP, Pitak-Arnnop P, Chikhani L, Bertrand JC. (2006). Drooling of saliva: a review of the etiology and management options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 101(1):48-57.
- Jean, A. (2001). Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiological Reviews, 81(2), 929-969.
- Ertekin, C., & Aydogdu, I. (2003). Neurophysiology of swallowing. Clinical Neurophysiology, 114(12), 2226-2244.
- Proctor, G. B., & Carpenter, G. H. (2014). Regulation of salivary gland function by autonomic nerves. Autonomic Neuroscience, 185, 20-25.
- Amerongen, A. V. N., & Veerman, E. C. I. (2002). Saliva–the defender of the oral cavity. Oral diseases, 8(1), 12-22.
- Agha-Hosseini, F., Mirzaii-Dizgah, I., & Mansourian, A. (2009). Age-related changes in salivary flow rate and composition in the elderly. Journal of Contemporary Dental Practice, 10(1), E049-E056.
- Breslin, P. A., & Huang, L. (2006). Human taste: peripheral anatomy, taste transduction, and coding. Advances in Otorhinolaryngology, 63, 152-190.
Keywords: #decompressiontaping, #Drooling, #sialorrhea, #rehabilitation, #bellspalsy, #facialparalysis, #CP, #NeuroMuscularTaping, #NMT, #chemiotherapy, #stroke, #neuropathy, #Parkinsons, #nursing, #speechtherapy, #languagepathology
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