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This was followed by a study of the effect of the exercise in tube-fed patients with severe oropharyngeal dysphagia secondary to an abnormal UES opening. Application of this exercise in normal elderly resulted in a wider UES opening. The exercise was done over 6 weeks, 3 times per day, to strengthen muscles that pull the larynx and hyoid up and forward. Research on this exercise began with examining how the exercise improved the duration and the width of the UES opening in the normal elderly.

This information was used to develop an isometric and isotonic exercise to strengthen these muscles and thereby increase the opening width of the UES. The Shaker exercise is based on the upward and forward movement of the hyolaryngeal structures resulting from the pull of the thyrohyoid, mylohyoid, geniohyoid, and anterior belly of diagastric muscles contracting. Since this physiology was described, the Shaker exercise was defined. In all cases, the results were similar, i.e., the upward-forward movement of the hyoid pulls the upper sphincter open after the cricopharyngeal muscle relaxes, enabling the upward-forward movement of the larynx. Over the past 25 years, a number of laboratories around the world have studied and defined the factors responsible for the opening of the upper esophageal sphincter (UES). After both types of therapy there is a significant increase in UES opening width on 3-ml paste swallows. With traditional therapy, there were several significant increases from pre- to post-therapy, including superior laryngeal movement and superior hyoid movement on 3-ml pudding swallows and anterior laryngeal movement on 3-ml liquid boluses, indicating significant improvement in swallowing physiology. Residue in the various oral and pharyngeal locations did not differ between the groups. There was significantly less aspiration post-therapy in patients in the Shaker group. Fourteen patients received both pre-and post-therapy VFG studies. Each videofluorographic study was sent to a central laboratory and digitized in order to measure hyoid and larynx movement as well as UES opening. Each patient received a modified barium swallow pre- and post-therapy, including two swallows each of 3 ml and 5 ml liquid barium and 3 ml barium pudding. All patients were randomized to either traditional swallowing therapy or the Shaker exercise for 6 weeks.

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Seven institutions participated in this small clinical trial that included 19 patients who exhibited oropharyngeal dysphagia on videofluorography (VFG) involving the upper esophageal sphincter (UES) and who had a 3-month history of aspiration.