Impact of Dysphagia Rehabilitation in Adults on Swallowing Physiology Measured With Videofluoroscopy: A Mapping Review

American Journal of Speech-Language Pathology

Namasivayam-MacDonald, A., Rapley, M., et al. (2022).

American Journal of Speech-Language Pathology, 31(5), 2195–2228.

This systematic review explores the effect of various swallowing rehabilitation approaches on specific swallowing impairments utilizing elements of the Modified Barium Swallow Impairment Profile.

National Institutes of Health

From database inception to March 24, 2021

Prospective or retrospective designs

43

Limited findings supported the following effects for oropharyngeal exercises on swallowing impairments:<br /> <ul> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Chin tuck against resistance </strong></span>demonstrated a large and significant effect on epiglottic inversion, a medium and significant effect on laryngeal elevation, and small and non-significant effects on lip closure, bolus preparation, and initiation of pharyngeal swallow (Level 1B Evidence);</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Dry swallow after suction</strong></span> demonstrated a large and significant effect on soft palate elevation (Level 4 Evidence);</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Effortful swallow</strong></span> demonstrated a small to medium and non-significant effect on bolus preparation, a small and significant effect on laryngeal elevation, and small and non-significant effects on lip closure and initiation of pharyngeal swallow (Level 1B Evidence);</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Jaw opening exercises</strong></span> demonstrated a small and significant effect on pharyngoesophageal segment opening and positive effects ranging from small and non-significant to large and significant for anterior hyoid excursion (Level 2B and 4 Evidence);</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Mendelsohn maneuver</strong></span> demonstrated small and non-significant effects for lip closure, bolus preparation, initiation of pharyngeal swallow, soft palate elevation, and epiglottic movement (Level 2 B Evidence);</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Shaker or head lift exercise&nbsp;</strong></span>demonstrated a large and significant effect for epiglottic movement, positive effects ranging from small and non-significant to large and significant for laryngeal elevation and anterior hyoid excursion, a large and non-significant effect for pharyngoesophageal segment opening, a medium and significant effect for initiation of pharyngeal swallow, and a small and non-significant effects for bolus preparation and soft palate elevation (Level 2B and 4 Evidence); and</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Tongue resistance training</strong></span> demonstrated improvements for anterior hyoid excursion, mixed findings regarding pharyngoesophageal segment opening and esophageal clearance, and no improvement for initiation of pharyngeal swallow. No effect sizes were measured for this intervention (Level 2B and 4 Evidence).&nbsp;</span></li> </ul> Limitations include small sample sizes, overall paucity of evidence measuring each intervention and/or impairment, and heterogeneity between studies.

Limited findings supported the following effects for respiratory training exercises on swallowing impairments:<br /> <ul> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Expiratory muscle strength training </strong></span>demonstrated a large and significant effect on anterior hyoid excursion (Level 2B Evidence); and</span></li> <li><span style="color: #333333;"><span style="text-decoration: underline;"><strong>Respiratory swallow training </strong></span>demonstrated improvements were noted in soft palate elevation, laryngeal vestibular closure, tongue base retraction, and esophageal clearance. No evidence for improvement was noted in any additional area of swallowing function. No effect sizes were measured for this intervention (Level 2B Evidence).</span></li> </ul> <span style="color: #333333;"> Limitations to this review include heterogeneity between studies, small sample sizes, and an overall paucity of evidence investigating each intervention and/or impairment.</span>

Limited findings supported that effortful swallow demonstrated a small to medium and non-significant effect on bolus preparation, a small and significant effect on laryngeal elevation, and small and non-significant effects on lip closure and initiation of pharyngeal swallow (Level 1B Evidence).

Limited evidence found that proprioceptive neuromuscular facilitation demonstrated large and significant effects for laryngeal elevation and epiglottic movement, a medium and significant effect for initiation of pharyngeal swallow, a medium and non-significant effect for bolus preparation, and a small and non-significant effect for lip closure. No effect was noted for bolus transport (Level 2 B Evidence).