Introduction
Methods
Search Strategies and Inclusion Criteria
Search terms used across the databases | ||
---|---|---|
Relevant to ‘Swallowing Disorders’ | Relevant to ‘Behavioral Therapy’ | Relevant to the BOT-PPW approximation |
Deglutition disorder* | Exercise therapy/program | Oropharyngeal pressure |
Pharyngeal pressure | ||
Swallow* | Rehabilitat* | Base of tongue pressure |
Tongue base pressure | ||
Dysphagia* | Non-surgical therapy | Posterior pharyngeal wall pressure |
Bolus driving pressure | Tongue-hold | Base of tongue to posterior pharyngeal contact duration |
Tongue-hold | ||
Tongue-hold | ||
Pharyngeal constrict* | Masako exercise | Approximation |
Masako maneuver | Contact | |
Masako maneuver | Duration | |
Deglutitive failure | Lingual exercise | |
Lingual strengthening | ||
Tongue exercise | ||
Tongue strengthening | ||
Base of tongue | Surface EMG activity | |
Deglutition | Rehabilitative exercise | |
Sarcopenia | Effortful swall* | |
Tongue base | Tongue-hold* | |
Pharyngeal tongue | Hyolaryngeal muscle activat* | |
Posterior pharyngeal wall | Age-related muscle weakness strength training exercise | |
Base on tongue to posterior pharyngeal wall contact | Strength training* | |
Base of tongue to posterior pharyngeal wall approximation | Treatment | |
Tongue base retraction | Muscle stretching exercise | |
Posterior pharyngeal wall pressure | ||
Posterior pharyngeal wall approximation |
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Review Part 1 focused on publications that (i). reported on outcome measures specifically representing BOT-PPW approximation, (ii). reported on a behavioral intervention, and (iii). that behavioral intervention had been implemented over a period of time in a rehabilitative approach (i.e., cumulative, long-term effects).
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Review Part 2 focused on inclusion of publications that (i). reported on outcome measures specifically representing BOT-PPW approximation, (ii). reported on a behavioral intervention, and (iii). the effects of that behavioral intervention were investigated during performance of that intervention in a one-off session (i.e., immediate effects).
Data Extraction
Authors | Study design | Intervention | Intervention protocol | Assessment tool | outcomes measures at level of BOT-PPW | Population | Age range (mean age) | Key findings | GRADE level of evidence |
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Juan, [22] | Single case study | I-PRO training | 8 weeks of training, 5 weeks of de-training, 9 weeks of maintenance training | HRM | Peak pressure | Dysphagia following multiple embolic strokes (n = 1) | 59 years | Post I-Pro therapy (week 8) increased peak tongue- pressures and decreased vallecular and PPW residue, but increased cricopharyngeal residue | Very low |
Greig, [23] | Single case study | BiSSkiT protocol followed by HRM based biofeedback training | BiSSkiT: 2 weeks, 2 × 1 h per day, 5 days per week; HRM based training (45 min/day, 4–5 days/week for approx. 2 months) | HRM | Peak pressure | Dysphagia following multiple strokes (n = 1) | 70 years | HRM training increased peak pressures | Very low |
Oh, [24] | Randomized controlled trial | TH swallow protocol | 4 weeks of TH training, daily for 20 min, every 5 s | VFSS | PCR and PPW anterior movement | Healthy (n = 20) | 22–33 years (26.4) | PCR and PPW anterior movement unchanged | Moderate |
Author | Study design | Intervention | Assessment tool | Outcome measure at level of BOT-PPW | Sample | Age range (mean age) | Key findings | GRADE level of evidence |
---|---|---|---|---|---|---|---|---|
Intervention 1—effortful swallow | ||||||||
Pouderoux, [14] | Quasi-experimental | ES v Normal | Strain gauge manometry | Peak pressure | Healthy (n = 8) | 21–35 years (not stated) | ES increased pharyngeal peak pressure | Low |
Lazarus, [25] | Quasi-experimental | ES v Normal | LRVM | Peak pressure on manometry and contact duration on VFSS | HNC (n = 3) | 65 years, 73 years, 72 years | ES increased pharyngeal peak pressure and increased contact duration on VFSS and nominally decreased upper pharyngeal residue | Low |
Hiss, [26] | Quasi-experimental | ES v Normal | LRM | Contact pressure duration | Healthy (n = 18) | Not stated (27.9) | ES increased pressure duration | Low |
Huckabee, [27] | Quasi-experimental | ES v Normal | LRM | Peak pressure | Healthy (n = 22) | Not stated (27.9) | ES increased peak pressure | low |
Huckabee, [28] | Quasi-experimental | ES v Normal 1/Tongue emphasis 2/No tongue emphasis | LRM | Peak pressure | Healthy (n = 20) | 20–35 years (not stated) | ES with “tongue to palate” increased peak pressure more than “no tongue emphasis” | Low |
Steele, [29] | Quasi-experimental | ES v Normal 1/Tongue emphasis 2/No tongue emphasis | LRM | Contact pressure duration | Healthy (n = 20) | 20–35 years (not stated) | Earlier and longer pharyngeal pressure during both ES types indicative of higher velocity bolus driving forces | Low |
Witte, [30] | Quasi-experimental | ES v Normal | LRM | Peak pressure | Healthy (n = 40) | 20–43 years (25.8) | No change in pharyngeal peak pressure and pressure duration during ES | Low |
Takasaki, [31] | Quasi-experimental | ES v Normal | HRM | Peak pressure | Healthy (n = 18) | 23–28 years (not stated) | ES increased pharyngeal peak pressure | Low |
Hoffman, [15] | Quasi-experimental | ES v Normal | HRM | Maximum pressure at tongue base, contact pressure duration at tongue base, area integral of pressure at tongue base | Healthy (n = 14) | 19–25 years (21.2) | No change in pharyngeal pressure, pressure duration and pressure integral | Low |
Fritz, [32] | Quasi-experimental | ES v Normal | MRI | Duration of pharyngeal closure (ms) during swallow, AP length (mm) during swallow, transverse length (mm) and area (mm2) during swallow | Healthy (n = 20) | 18–30 years (not stated) | ES increased pharyngeal closure duration. All other metrics unchanged | Low |
Lenius, [33] | Quasi-experimental | ES (described as increased lingual force during swallow) v Normal | LRVM | Peak pressure | HNC (n = 20) (range = 3–179 months post radion therapy) | 41–80 years (62) | Increased lingual effort increased peak pharyngeal pressure | Low |
Doeltgen, [34] | Quasi-experimental | ES v Normal | HRM | VCI | Healthy (n = 12) | 21–48 years (28.6) | VCI increased during ES | Low |
Jones, [35] | Quasi-experimental | ES v Normal | HRM | Peak pressure at velopharynx, tongue base, and hypopharynx | Healthy (n = 9) | 21–69 years (42) | ES increased peak pressure at all three levels | Low |
Heslin, [36] | Quasi-experimental | ES v normal | HRM | Peak pressure | mixed etiology dysphagia (n = 15) | 45–86 years (63) | ES increased upper pharyngeal pressure | Very low |
Teplansky, [37] | Quasi-experimental | ES v normal | HRM | Peak pressure variability at velopharynx, tongue base, and hypopharynx | Healthy (n = 51) | not stated (31.5) | ES increased variability of peak pressure at all three levels | Low |
Intervention 2—Mendelsohn Maneuver | ||||||||
Lazarus, [25] | Quasi-experimental | MM v Normal | LRVM | Peak pressure on manometry and contact duration on VFSS | HNC (n = 3) | 65 years, 73 years, 72 years | MM increased pharyngeal peak pressure and increased contact duration on VFSS and nominally decreased upper pharyngeal residue | Low |
Hoffman, [15] | Quasi-experimental | MM v Normal | HRM | Peak pressure, pressure integral and pressure duration | Healthy (n = 14) | 19–25 years (21.2) | MM decreased pharyngeal pressure. Pressure duration and pressure integral were unchanged | Low |
Doeltgen, [34] | Quasi-experimental | MM v Normal | HRM | VCI | Healthy (n = 12) | 21–48 years (28.6) | MM increased VCI | Low |
Teplansky, [37] | Quasi-experimental | MM v normal | HRM | Peak pressure variability at velopharynx, tongue base, and hypopharynx | Healthy (n = 28) | not stated (22.4) | MM increased variability of peak pressure at all three levels | Low |
Intervention 3—tongue hold swallow | ||||||||
Fijiu, [40] | Quasi-experimental | TH v Normal | VFSS | 1. extent of PPW bulging during BOT-PPW contact; 2. duration of BOT-PPW contact. 3. vallecular residue (3 ml barium swallows) | Healthy (n = 10) | 19–26 years (23) | TH increased anterior PPW bulge but BOT-PPW approximation did not last longer. TH increased vallecular residue | Low |
Lazarus, [25] | Quasi-experimental | TH v Normal | LRVM | Peak pressure on manometry and contact duration on VFSS | HNC (n = 3) | 65 years, 73 years, 72 years | TH increased pharyngeal peak pressure and increased contact duration on VFSS and nominally decreased upper pharyngeal residue | Low |
Doeltgen, [41] | Quasi-experimental | TH v Normal | LRM | Peak pressure, pressure duration | Healthy (n = 40) | 20–45 years (not stated) | TH swallows decreased peak pharyngeal pressure; TH swallows did not change pressure duration | Low |
Doeltgen, [42] | Quasi-experimental | TH v Normal | LRM | Peak pressure, pressure duration | Healthy (n = 68) Y (n = 34) O (n = 34) | Y 18–40 years (26.8) O 60–84 years (72.6) | In both age groups, TH decreased peak pharyngeal pressure, but did not change pressure duration | Low |
Hammer, [43] | Quasi-experimental | TH v Normal (1. tongue at lips; 2. tongue-hold maneuver) | EMG, HRM | SPC EMG, peak pressure | Healthy (n = 8) | 20–27 years (not stated) | Both maneuvers increased EMG of SPC before and during the swallow; TH prolonged SPC EMG. Neither maneuver affected peak pharyngeal pressure | Low |
Teplansky, [37] | Quasi-experimental | TH v normal | HRM | Peak pressure variability at velopharynx, tongue base, and hypopharynx | Healthy (n = 35) | Not stated (34.4) | TH increased variability of peak pressure at all three levels | Low |
Intervention 4—super supraglottic maneuver | ||||||||
Ohmae, [45] | Quasi-experimental | SSG v Normal | VFSS and video-endoscopy | Onset of contact relative to UES opening and contact duration | Healthy (n = 8) | 20–28 years (not stated) | SSG resulted in later BOT-PPW contact. SSG did not change contact duration | Low |
Lazarus, [25] | Quasi-experimental | SSG v Normal | LRVM | Peak pressure on manometry and contact duration on VFSS | HNC (n = 3) | 65 years, 73 years, 72 years | SSG increased peak pharyngeal pressure and contact duration and nominally decreased upper pharyngeal residue | Low |
Intervention 5—tasks imitating BOT to PPW approximation | ||||||||
Veis, [46] | Quasi-experimental | 1. Tongue pull back 2. yawn + tongue pull back 3. Gargle + tongue pull back | VFSS | Distance between BOT and mid or inferior C2 | Mixed etiology dysphagia (n = 20) | 38–89 years (61) | Gargle resulted in the shortest mean distance between BOT and mid C2. All three tasks increased BOT retraction | Low |