Usefulness of ice massage in triggering the swallow reflex.

In Japan, ice massage is widely used as the prefeeding technique to facilitate dry swallowing, to improve swallowing apraxia for initiating the swallowing action, and in daily swallowing training. In a crossover study, we evaluated the usefulness of ice massage for eliciting the swallowing response. The subjects were 24 dysphagic patients with stroke and cerebrovascular disease. We measured the latency between the command of dry swallowing and the triggering of the swallow reflex by videofluoroscopic examination of swallowing, with and without ice massage. When a subject could not swallow all the 4 trials we recorded whether he or she could swallow or not. And we counted how many times he or she could swallow with and without ice massage. Our results suggest that ice massage significantly shortened the latency to triggering of the swallow reflex and often initiated swallowing even in those subjects who could not swallow without the massage. These results demonstrate that ice massage has an immediate effect on triggering of the swallow reflex. The effect of ice massage was especially remarkable in the 15 subjects who had supranuclear lesions compared with the subjects with nuclear lesions. Thus, ice massage could activate the damaged supranuclear tract and/or the normal nucleus and subnuclear tract for swallowing. Ice massage has proven useful in many clinical dysphagia training sessions.