Dysphagia Interventions
Study interventions and outcome measures are presented in Table 2. Of the 17 studies included, there were nine different interventions used for dysphagia rehabilitation.
Three RCTs and one PCT examined the use of neuromuscular electrical stimulation (NMES) versus sham stimulation in their study populations, which had either <50% ABI (31, 32), or the study authors did not specify the proportion (37, 40). A PCT with <50% ABI population examining the use of laryngopharyngeal NMES coupled with conventional swallowing therapy (CST) was compared to CST alone (25). An additional case report examined the use of a specific type of neuromuscular stimulation, VitaStim (VsT), versus CST (including swallowing exercises, shaker exercise, hyoid lift, compensation postures, and dietary changes) alone to manage dysphagia symptoms (34). A unique bilateral muscle stimulation intervention that targeted the “k-point” intraorally was examined by Kojima et al. (39), with an unknown proportion of participants having an ABI.
Three studies examined dysphagia-specific rehabilitation programs including combined muscle exercises and a prescribed swallowing routine, two of which had <50% ABI populations (24, 26); the remaining post-test conference abstract had >50% ABI population (35).
Swallowing therapies that involved manipulating participants’ diet and adjusting bolus viscosity and velocity were studied in two articles, including a TBI-specific case report (33) and a post-test study with 22% ABI population (24).
Single studies made up the remaining intervention types. Terre and Mearin (30) conducted a RCT with 37% ABI population, where patients either performed a chin-down maneuver compared to anatomical positioning while eating and drinking to investigate if there was improvement in swallowing ability or presence of aspiration. A PCT by Seedat and Penn (28) investigated the effect of scheduled oral care versus inconsistent oral care in relation to dysphagic symptoms in a 70% stroke and 30% TBI population. Facio-oral tract therapy, which used a combination of interventions targeting nutrition, oral hygiene, non-verbal communication, stimulation of the oral cavity, and speech therapy, was performed by Seidl et al. (29) on a study population of <50% TBI. A training program focused on improving tongue-pressure strength and accuracy (TPSAT) for improving dysphagia and aspiration outcomes was studied among six individuals who had a TBI (36). Finally, a unique program that offered a remote, online tele-dysphagia swallowing intervention compared to a traditional, in-person dysphagia management program was presented as a conference abstract (ABI % unknown) (38).