Dysphagia Rehabilitation Interventions in Moderate-Severe Acquired Brain
Injury: A Scoping Review
Abstract
Objectives: To conduct a scoping review of the available literature and
identify existing interventions for dysphagia rehabilitation among
individuals with moderate to severe ABI during the acute and chronic
phases of recovery. Design: Scoping review involving a literature search
of multiple databases for studies published in English up to July 2018.
Inclusion criteria: (1) moderate-severe ABI, (2) participants aged 18+
years, and (3) a dysphagia rehabilitation intervention was provided. The
Physiotherapy Evidence Database (PEDro) tool was used to determine
methodological quality. Results: 17 studies met inclusion criteria; nine
of which had <50% ABI participants, four had
>50% ABI, and four did not specify ABI percentage. Twelve
studies were published between 2012-2018, and five were published
between 1990-2007. Fifteen journal articles and two conference abstracts
met inclusion. Five randomized controlled trials (RCTs) were included,
two level 1b evidence, two level 2 evidence, and one was of unknown
quality. Four prospective controlled trials (PCTs) provided level 2
evidence. Three post-test and three pre-post studies provided level 4
evidence, and two case reports provided level 5 evidence. Nine different
interventions were investigated, with electrical stimulation,
individualized management programs, and diet manipulation being the most
common. Eleven unique outcome measures were used overall, which crossed
several domains. Conclusions: The literature investigating dysphagia
rehabilitation interventions for ABI, the vast majority of which are
traumatic brain injury is limited, with wide variability in intervention
type, study design, injury etiology, and outcome assessment across
studies. There remains an important evidence gap for ABI dysphagia
rehabilitation.