Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilisation.

Objective: To investigate the feasibility of cervical spine mobilisation in elderly dementia patients presenting dysphagia, and its effects on swallowing capacity.
Methods: Fifteen nursing home residents (9 female, 6 male, aged 77-98 years) with severe dementia (median Mini Mental State Examination score = 8/30, Percentile (P)25-75 = 4-13) and known dysphagia participate in a randomized controlled trial with cross-over design. Cervical spine mobilisations were administered by trained physical therapists and control sessions consisted in socializing visits. Feasibility (attendance, hostility, complications) and maximal swallowing volume (water bolus 1-20ml) were assessed following one session and one week (3 sessions) of treatment and control.
Results: 90% of the cervical spine mobilisation sessions were successful (3 sessions were impossible due to patient's hostility and 2 due to illness) and no complications were observed. Swallowing capacity improved significantly after cervical spine mobilisation (from 3ml (P25-75=1-10) to 5ml (P25-75=3-15) after one session p=0.01 and to 10ml (P25-75=5-20) [+230%] after 1 week treatment p=0.03) compared to control (no significant changes, difference in evolution after one session between treatment and control p=0.03).
Conclusion: Cervical spine mobilisations are feasible and can improve swallowing capacity in cognitively impaired nursing home residents. Given the acute improvements following treatment, these are probably best provided before mealtime.