Effects of Multidirectional Head Lift Exercise Based on Proprioceptive Neuromuscular Facilitation Techniques on Oropharyngeal Swallowing Muscles in Community-Dwelling Older Adults With Oral Frailty

J Oral Rehabil. 2025 Dec;52(12):2282-2290. doi: 10.1111/joor.70031. Epub 2025 Aug 6.

Abstract

Background: Dysphagia rehabilitation using proprioceptive neuromuscular facilitation (PNF) was recently introduced. However, the clinical evidence for this technique remains unclear.

Objective: This study aimed to investigate the effects of multidirectional head-lift exercise using PNF techniques for the oropharyngeal swallowing muscles in older adults with oral frailty.

Methods: Older adults with oral frailty were enrolled in this study and randomly assigned to the experimental or control group. The experimental group performed multidirectional head-lift exercises based on PNF techniques, whereas the control group performed conventional head-lift exercises (90 times/day, 5 days/week for 6 weeks). Tongue strength and thickness were measured using an Iowa Oral Performance Instrument and ultrasonography, respectively. Additionally, suprahyoid muscle activation and thickness were measured using surface electromyography and ultrasonography, respectively.

Results: The experimental group showed significant improvements in tongue strength and thickness compared to the control group, as well as significant improvements in suprahyoid muscle activation and thickness (all, p < 0.05).

Conclusion: This study demonstrates that multidirectional head-lift exercise based on PNF techniques is more effective than conventional head-lift exercise in increasing the strength and thickness of the oropharyngeal muscles related to swallowing in older adults.

Keywords: dysphagia; head lift exercise; proprioceptive neuromuscular facilitation; suprahyoid muscle; tongue.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Deglutition Disorders* / physiopathology
  • Deglutition Disorders* / rehabilitation
  • Deglutition* / physiology
  • Electromyography
  • Exercise Therapy* / methods
  • Female
  • Frail Elderly
  • Frailty* / physiopathology
  • Frailty* / rehabilitation
  • Humans
  • Independent Living
  • Male
  • Muscle Strength / physiology
  • Oropharynx / physiopathology
  • Pharyngeal Muscles* / physiopathology
  • Proprioception* / physiology
  • Tongue / diagnostic imaging
  • Tongue / physiopathology
  • Treatment Outcome
  • Ultrasonography