Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review

Renée Speyer, Laura Baijens, Mariëlle Heijnen, Iris Zwijnenberg, Renée Speyer, Laura Baijens, Mariëlle Heijnen, Iris Zwijnenberg

Abstract

Medical and paramedical treatments should be evaluated according to current standards of evidence-based medicine. Evaluation of therapy in oropharyngeal dysphagia fits into this growing interest. A systematic review is given of the literature on the effects of therapy in oropharyngeal dysphagia carried out by speech therapists. Thus, the review excludes reports of surgical or pharmacological treatments. The literature search was performed using the electronic databases PubMed and Embase. All available inclusion dates up to November 2008 were used. The search was limited to English, German, French, Spanish, and Dutch publications. MESH terms were supplemented by using free-text words (for the period after January 2005). Fifty-nine studies were included. In general, statistically significant positive therapy effects were found. However, the number of papers was rather small. Moreover, diverse methodological problems were found in many of these studies. For most studies, the conclusions could not be generalized; comparison was hindered by the range of diagnoses, types of therapies, and evaluation techniques. Many questions remain about the effects of therapy in oropharyngeal dysphagia as performed by speech and language therapists. Although some positive significant outcome studies have been published, further research based on randomized controlled trials is needed.

References

    1. McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins JA, Chignell K, Logemann JA, Clarke C. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: I Conceptual foundation and item development. Dysphagia. 2003;15(3):115–121.
    1. Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M.D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870–876.
    1. Kahrilas PH, Lin S, Rademaker AW, Logemann JA. Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism. Gastroenterology. 1997;113(5):1457–1464. doi: 10.1053/gast.1997.v113.pm9352847.
    1. AHCPR. Diagnoses and treatment of swallowing disorders (Dysphagia) in acute-care stroke patients, U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 1999. Available at .
    1. Bath PMW, Bath-Hextall FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev. 1999;4:1–22.
    1. Foley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing. 2008;37:258–264. doi: 10.1093/ageing/afn064.
    1. Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based clinical review article. Am Fam Physician. 2002;65(2):251–259.
    1. Jüni P, Altman DG, Egger M. Assessing the quality of randomised controlled trials. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: Meta-analysis in context. 2. Cornwall: BMJ Publishing Group; 2006.
    1. Khan KS, Kunz R, Kleijnen J, Antes G. Systematic reviews to support evidence-based medicine. How to review and apply findings of healthcare research. Oxford: Royal Society of Medicine Press; 2003.
    1. Murry T, Carrau RL. Clinical management of swallowing disorders. 2. San Diego, CA: Plural Publishing; 2006.
    1. Logemann J. Evaluation and treatment of swallowing disorders. 2. Austin, TX: Pro-Ed; 1998.
    1. Groher ME. Bolus management and aspiration pneumonia in patients with pseudobulbar dysphagia. Dysphagia. 1987;1:215–216. doi: 10.1007/BF02406920.
    1. Groher ME, McKaig TN. Dysphagia and dietary levels in skilled nursing facilities. J Am Geriatr Soc. 1995;43:528–532.
    1. Bhattacharyya N, Kotz T, Shapiro J. The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 2003;129(6):632–636. doi: 10.1016/S0194-5998(03)00633-8.
    1. Clavé P, De Kraa M, Arreola V, Girvent M, Palomera E, Serra-Prat M. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment Pharmacol Ther. 2006;24:1385–1394. doi: 10.1111/j.1365-2036.2006.03118.x.
    1. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, temperature in patients with dysphagia resulting from neurologic impairment, in normal subjects. J Speech Hear Res. 1994;37:1041.
    1. Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujiu M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38:556–563.
    1. Hamdy S, Jilani S, Price V, Parker C, Hall N, Power M. Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterol Motil. 2003;15:69–77. doi: 10.1046/j.1365-2982.2003.00390.x.
    1. Bülow M, Speyer R, Baijens L, Woisard V, Ekberg O. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia. 2008;23:302–309. doi: 10.1007/s00455-007-9145-9.
    1. Power ML, Fraser CH, Hobson A, Singh S, Tyrrell P, Nicholson DA, Turnbull I, Thompson DG, Hamdy S. Evaluating oral stimulation as a treatment for dysphagia after stroke. Dysphagia. 2006;21(1):49–55. doi: 10.1007/s00455-005-9009-0.
    1. Rosenbek JC, Robbins J, Fishback B, Levine RL. Effects of thermal application on dysphagia after stroke. J Speech Hear Res. 1991;34:1257–1268.
    1. Rosenbek JC, Roecker EB, Wood JL, Robbins J. Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia. 1996;11:225–233. doi: 10.1007/BF00265206.
    1. Blumenfeld L, Hahn Y, Lepage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study. Otolaryngol Head Neck Surg. 2006;135(5):754–757. doi: 10.1016/j.otohns.2006.04.016.
    1. Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia. 2007;22(1):1–10. doi: 10.1007/s00455-006-9029-4.
    1. Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Ann Otol Rhinol Laryngol. 2007;116(1):36–44.
    1. Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope. 2002;112:2204–2210. doi: 10.1097/00005537-200212000-00015.
    1. Lazzara G, Lazarus C, Logemann JA. Impact of thermal stimulation on the triggering of the swallowing reflex. Dysphagia. 1986;1:73–77. doi: 10.1007/BF02407117.
    1. Shaker R, Easterling C, Kern M. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–1321. doi: 10.1053/gast.2002.32999.
    1. Logemann JA, Kahrilas PJ, Kobara M, Vakil NB. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil. 1989;70:767–771.
    1. Logemann JA, Roa Pauloski B, Rademaker AW, Colangelo LA. Super supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19:535–540. doi: 10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>;2-4.
    1. Bülow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia. 2001;16:190–195. doi: 10.1007/s00455-001-0065-9.
    1. Shanahan TK, Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Chin-down posture effect on aspiration in dysphagic patients. Arch Phys Med Rehabil. 1993;74:736–739. doi: 10.1016/0003-9993(93)90035-9.
    1. Lewin JS, Hebert TM, Putnam JB, DuBrow RA. Experience with the chin tuck maneuver in postesophagectomy aspirators. Dysphagia. 2001;16:216–219. doi: 10.1007/s00455-001-0068-6.
    1. Bogaert E, Goeleven A, Dejaeger E. Effectmeting van therapeutische interventies tijdens radiologisch slikonderzoek. Tijdschr Geneeskd. 2003;59(22):1410–1414. doi: 10.2143/TVG.59.22.5001738.
    1. Zuydam AC, Rogers SN, Brown JS, Vaughan ED, Magennis P. Swallowing rehabilitation after oro-pharyngeal resection for squamous cell carcinoma. Br J Oral Maxillofac Surg. 2000;38(5):513–518. doi: 10.1054/bjom.2000.0482.
    1. Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg. 1994;110(2):222–227.
    1. Logemann JA, Gibbons P, Rademaker AW, Pauloski BR, Kahrilas PJ, Bacon M, Bowman J, McCracken E. Mechanisms of recovery of swallow after supraglottic laryngectomy. J Speech Hear Res. 1994;37(5):965–974.
    1. El Sharkawi A, Ramig L, Logemann JA, Roa Pauloski B, Rademaker AW, Smith CH, Pawlas A, Baum S, Werner C. Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study. J Neurol Neurosurg Psychiatry. 2002;72:31–36. doi: 10.1136/jnnp.72.1.31.
    1. Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150–158. doi: 10.1016/j.apmr.2006.11.002.
    1. Hwang CH, Choi KH, Ko YS, Leem CM. Pre-emptive swallowing stimulation in long-term intubated patients. Clin Rehabil. 2007;21:41–46. doi: 10.1177/0269215506071286.
    1. Robbins JA, Gensler G, Hind J, Logemann JA, Lindblad AS, Brandt D, Baum H, Lilienfeld D, Kosek S, Lundy D, Dikeman K, Kazandjian M, Gramigna GD, McGarvey-Toler S, Miller Gardner PJM. Comparison of 2 interventions for liquid aspiration on pneumonia incidence. Ann Intern Med. 2008;148(7):509–518.
    1. Rosenbek JC, Robbins J, Willford WO, Kirk G, Schiltz A, Sowell TW, Deutch SE, Milanti FJ, Ashford J, Gramigna GD, Fogarty A, Dong K, Rau MT, Prescott TE, Lloyd AM, Sterkel MT, Hansen JE. Comparing treatment intensities of tactile-thermal application. Dysphagia. 1998;13:1–9. doi: 10.1007/PL00009542.
    1. Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol. 2006;5:31–37. doi: 10.1016/S1474-4422(05)70252-0.
    1. Lin L, Wang S, Chen S, Wang T, Chen M, Wu S. Efficacy of swallowing training for residents following stroke. J Adv Nurs. 2003;44(5):469–478. doi: 10.1046/j.0309-2402.2003.02830.x.
    1. Martens L, Cameron T, Simonsen M. Effects of a multidisciplinary management program on neurologically impaired patients with dysphagia. Dysphagia. 1990;5:147–151. doi: 10.1007/BF02412638.
    1. Kasprisin AT, Clumeck H, Nino-Murcia M. The efficacy of rehabilitative management of dysphagia. Dysphagia. 1989;4:48–52. doi: 10.1007/BF02407403.
    1. Denk DM, Kaider A. Videoendoscopic biofeedback: a simple method to improve the efficacy of swallowing rehabilitation of patients after head and neck surgery. ORL J Otorhinolaryngol Relat Spec. 1997;59:100–105.
    1. Huckabee M, Cannito M. Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: a retrospective evaluation. Dysphagia. 1999;14:93–109. doi: 10.1007/PL00009593.
    1. Crary MA, Carnaby GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia. 2004;19:160–164.
    1. Carnaby-Mann GD, Crary MA. Adjunctive neuromuscular electrical stimulation for treatment-refractory dysphagia. Ann Otol Rhinol Laryngol. 2008;117(4):279–287.
    1. Elmståhl S, Bülow M, Ekberg O, Petersson M, Tegner H. Treatment of dysphagia improves nutritional conditions in stroke patients. Dysphagia. 1999;14:61–66. doi: 10.1007/PL00009588.
    1. Seidl RO, Nusser-Müller-Busch R, Hollweg W, Westhofen M, Ernst A. Pilot study of a neurophysiological dysphagia therapy for neurological patients. Clin Rehabil. 2007;21:686–697. doi: 10.1177/0269215507076393.
    1. Nagaya M, Kachi T, Yamada T. Effect of swallowing training on swallowing disorders in Parkinson’s disease. Scand J Rehabil Med. 2000;32:11–15. doi: 10.1080/003655000750045677.
    1. Prosiegel M, Heintze M, Wagner-Sonntag E, Hannig C, Wuttge-Hannig A, Yassouridis A. Deglutition disorders in neurological patients. A prospective study of diagnosis, pattern of impairment, therapy and outcome. Nervenarzt. 2002;73:364–370. doi: 10.1007/s00115-002-1284-5.
    1. Prosiegel M, Höling R, Heintze M, Wagner-Sonntag E, Wiseman K. Swallowing therapy: a prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis’ syndrome, Wallenberg’s syndrome, posterior fossa tumours and cerebellar hemorrhage. Acta Neurochir (Wien) 2005;93(Suppl):35–37. doi: 10.1007/3-211-27577-0_4.
    1. Logemann JA, Gensler G, Robbins J, Lindblad AS, Hind JA, Kosek S, Dikeman K, Kazandjian M, Gramigna GD, Lundy D, McGarvey-Toler S, Miller Gardner PJ. A randomised study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson’s disease. J Speech Hear Res. 2008;51:173–183. doi: 10.1044/1092-4388(2008/013).
    1. Horner J, Buoyer FG, Alberts MJ, Helms MJ. Dysphagia following brain-stem stroke: clinical correlates and outcome. Arch Neurol. 1991;48:1170–1173.
    1. Nagaya M, Kachi T, Yamada T, Sumi Y. Videofluorographic observations on swallowing in patients with dysphagia due to neurodegenerative diseases. Nagoya J Med Sci. 2004;67:17–23.
    1. Rasley A, Logemann JA, Kahrilas PJ, Rademaker AW, Pauloski BR, Dodds WJ. Prevention of barium aspiration during videofluoroscopic swallowing studies: Value of change in posture. AJR Am J Roentgenol. 1993;160:1005–1009.
    1. Bartolome G, Neumann S. Swallowing therapy in patients with neurological disorders causing cricopharyngeal dysfunction. Dysphagia. 1993;8:146–149. doi: 10.1007/BF02266995.
    1. Neumann S. Swallowing therapy with neurologic patients: results of direct and indirect therapy methods in 66 patients suffering from neurological disorders. Dysphagia. 1993;8:150–153. doi: 10.1007/BF02266996.
    1. Neumann S, Bartolome G, Buchholz D, Prosiegel M. Swallowing therapy of neurologic patients: correlation of outcome with pre-treatment variables and therapeutic methods. Dysphagia. 1995;10:1–5. doi: 10.1007/BF00261272.
    1. Masiero S, Previato C, Addante S, Grego F, Armani M. Dysphagia in post-carotid endarterectomy: a prospective study. Ann Vasc Surg. 2007;21(3):318–320. doi: 10.1016/j.avsg.2006.10.023.
    1. Denk DM, Swoboda H, Schima W, Eibenberger K. Prognostic factors for swallowing rehabilitation following head and neck cancer surgery. Acta Otolaryngol. 1997;117(5):769–774. doi: 10.3109/00016489709113476.
    1. Schurr MJ, Ebner KA, Maser AL, Sperling KB, Helgerson RB, Harms B. Formal swallowing evaluation and therapy after traumatic brain injury improves dysphagia outcomes. J Trauma. 1999;46(5):817–823. doi: 10.1097/00005373-199905000-00009.
    1. Barbiera F, Condello S, De Palo A, Todaro D, Mandracchia C, De Cicco D. Role of videofluorography swallow study in management of dysphagia in neurologically compromised patients. Radiol Med (Torino) 2006;111:818–827. doi: 10.1007/s11547-006-0075-7.
    1. Hägg M, Larsson B. Effects of motor and sensory stimulation in stroke patients with long-lasting dysphagia. Dysphagia. 2004;19(4):219–230.
    1. Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Nguyen PD, Nguyen LM, Dutta S, Lemanski C, Sallah S. Impact of swallowing therapy on aspiration rate following treatment for locally advanced head and neck cancer. Oral Oncol. 2007;43:352–357. doi: 10.1016/j.oraloncology.2006.04.002.
    1. Kiger M, Brown CS, Watkins L. Dysphagia management: An analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy. Dysphagia. 2006;21(4):243–253. doi: 10.1007/s00455-006-9056-1.
    1. Crary MA. A direct intervention program for chronic neurogenic dysphagia secondary to brainstem stroke. Dysphagia. 1995;10:6–18. doi: 10.1007/BF00261273.
    1. Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, Van De Heyning P, Remacle M, Woisard V, Committee on Phoniatrics of the European Laryngological Society (ELS) A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Eur Arch Otorhinolaryngol. 2001;258:77–82. doi: 10.1007/s004050000299.
    1. Speyer R. Effects of voice therapy: a systematic review. J Voice. 2008;22(5):565–580. doi: 10.1016/j.jvoice.2006.10.005.

Source: PubMed

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