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

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 literature 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 non-disordered 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.