Evaluating Behavioural Interventions for Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-Analysis of Swallowing Manoeuvres, Exercises, and Postural Techniques

Journal of Clinical Medicine

Adzimová, S., Speyer, R., et al. (2025).

Journal of Clinical Medicine, 14(20), 7180.

<div>This systematic review with meta-analysis investigates the effects of swallowing maneuvers, exercises, and postural strategies on outcomes in adults with oropharyngeal dysphagia (OD).</div>

No funding received

From database inception to May 5, 2025

<div>Studies that include a comparison group, such as (pseudo) randomized controlled trials, comparative studies with concurrent controls, and within-subject or crossover study designs</div>

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<div>The effortful swallow maneuver consistently produced significantly greater submental muscle activity compared to normal swallowing (2/3 studies). The maneuver significantly increased global pharyngeal contractility when swallowing thin liquids, indicating that an effortful swallow generates higher pharyngeal pressure. When applied with surface electromyography (sEMG) biofeedback, muscle activity significantly increased, and the majority (86%) of stroke and healthy participants reported found the additional sEMG biofeedback to be helpful and acceptable.</div> <div>&nbsp;</div> <div>Limitations of this review included the potential exclusion of relevant non-English studies, the concentration on only the most prevalent behavioral interventions for dysphagia, the variability in study design, the small sample sizes, heterogeneous patient populations, and the wide array of outcome measures. Additional research is needed to investigate the effects of standalone behavioral interventions, while accounting for heterogeneity in patient characteristics and outcome measures in adults with oropharyngeal dysphagia.</div>

<div>Shaker or head-raising exercises significantly improved oral feeding and swallow function. After 6-weeks of head-raising exercise treatment, all patients demonstrated significant improvement in Upper Esophageal Sphincter (UES) opening and anterior laryngeal excursion, which led to the resolution of post-deglutitive aspiration. This suprahyoid muscle strengthening exercise program showed the ability to restore oral feeding in some patients with deglutitive failure due to abnormal UES opening.</div> <div>&nbsp;</div> <div>Limitations of this review included the potential exclusion of relevant non-English studies, the concentration on only the most prevalent behavioral interventions for dysphagia, the variability in study design, the small sample sizes, heterogeneous patient populations, and the wide array of outcome measures. Additional research is needed to investigate the effects of standalone behavioral interventions, while accounting for heterogeneity in patient characteristics and outcome measures in adults with oropharyngeal dysphagia.</div>

<div>Training the volitional laryngeal vestibule closure (vLVC) maneuver resulted in significantly greater patient performance accuracy when using videofluoroscopic visual biofeedback (46% accuracy) or mixed biofeedback (43% accuracy) compared to submental sEMG biofeedback alone (2% accuracy).</div> <div>&nbsp;</div> <div>Limitations of this review included the potential exclusion of relevant non-English studies, the concentration on only the most prevalent behavioral interventions for dysphagia, the variability in study design, the small sample sizes, heterogeneous patient populations, and the wide array of outcome measures. Additional research is needed to investigate the effects of standalone behavioral interventions, while accounting for heterogeneity in patient characteristics and outcome measures in adults with oropharyngeal dysphagia.</div>

<div>The modified jaw-opening exercise improved anterior hyoid displacement during swallowing compared to controls.</div> <div>&nbsp;</div> <div>Limitations of this review included the potential exclusion of relevant non-English studies, the concentration on only the most prevalent behavioral interventions for dysphagia, the variability in study design, the small sample sizes, heterogeneous patient populations, and the wide array of outcome measures. Additional research is needed to investigate the effects of standalone behavioral interventions, while accounting for heterogeneity in patient characteristics and outcome measures in adults with oropharyngeal dysphagia.</div>

<div>Intensive use of the Mendelsohn maneuver improved hyoid duration during treatment; however, these improvements declined during no-treatment weeks. This maneuver also improved upper esophageal sphincter opening.</div> <div>&nbsp;</div> <div>Limitations of this review included the potential exclusion of relevant non-English studies, the concentration on only the most prevalent behavioral interventions for dysphagia, the variability in study design, the small sample sizes, heterogeneous patient populations, and the wide array of outcome measures. Additional research is needed to investigate the effects of standalone behavioral interventions, while accounting for heterogeneity in patient characteristics and outcome measures in adults with oropharyngeal dysphagia.</div>

<div>The chin tuck maneuver demonstrated a significant, moderate positive intervention effect (Hedges&rsquo; g = 0.672) on swallowing compared to a head-neutral position, though, effect sizes varied considerably across studies, ranging from small (Hedges' g 0.266) to large (Hedges' g 1.049). Subgroup analysis indicated that insufficient laryngeal closure due to inadequate laryngeal elevation showed a greater likelihood of responding favorably to the chin-down maneuver. One study found that the chin-down position improved airway protection when cup drinking thin liquids, but did not when administering teaspoon-sized boluses.</div> <div>&nbsp;</div> <div>Limitations of this review included the potential exclusion of relevant non-English studies, the concentration on only the most prevalent behavioral interventions for dysphagia, the variability in study design, the small sample sizes, heterogeneous patient populations, and the wide array of outcome measures. Additional research is needed to investigate the effects of standalone behavioral interventions, while accounting for heterogeneity in patient characteristics and outcome measures in adults with oropharyngeal dysphagia.</div>