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Volume 46 Number 2, 2009
   Pages 185 — 194

Abstract - Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part II-Impact of dysphagia treatment on normal swallow function

Karen Wheeler-Hegland, PhD;1 John Ashford, PhD;2 Tobi Frymark, MA;3* Daniel McCabe, DMA;4 Robert Mullen, MPH;3 Nan Musson, MA;1 Carol Smith Hammond, PhD;5-6 Tracy Schooling, MA3

1Malcom Randall Department of Veterans Affairs Medical Center (VAMC), Gainesville, FL; 2Tennessee State
University/Vanderbilt University, Nashville, TN; 3American Speech-Language-Hearing Association, Rockville, MD; 4Davenport and Taylor Memorial Hospital, Bath, NY; 5Durham VAMC, Durham, NC; 6Duke University, Durham, NC

Abstract — This article is the second in a series of evidence-based systematic reviews. Data reported cover the impact of dysphagia behavioral interventions on swallow physiology in healthy adults. The behavioral treatments investigated were three postural interventions-side lying, chin tuck, and head rotation-and four swallowing maneuvers-effortful swallow, the Mendelsohn maneuver, supraglottic swallow, and super-supraglottic swallow. A systematic search of the dysphagia litera-ture was conducted in 14 electronic databases. Seventeen studies meeting the inclusion criteria were evaluated for methodological quality with the American Speech-Language-Hearing Association's levels-of-evidence scheme and were characterized by research stage (i.e., exploratory, efficacy, effectiveness, cost-benefit/public policy research). Effect sizes were calculated when possible. All studies were exploratory research ranging from two to five of seven possible quality markers. The majority of studies (8 of 17) investigated effortful swallow. Three studies examined the Mendelsohn maneuver, chin tuck, supraglottic swallow, and super-supraglottic swallow and two studies addressed head rotation. No study addressed side lying. For nondisordered populations, the existing evidence demonstrates differential effects of postural changes and maneuvers on swallowing physiology. Some effects reinforced existing recommendations for the applications of the interventions, while others suggested new ways that the treatments may impact swallow function. Avenues for future research are suggested.

Key words: chin-tuck posture, dysphagia, effortful swallow maneuver, evidence-based practice, evidence-based systematic review, head-rotation posture, Mendelsohn maneuver, rehabilitation, side-lying posture, super-supraglottic swallow maneuver, supraglottic swallow maneuver, treatment.


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