A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing

Abstract

Purpose This systematic review summarizes the biomechanical and functional effects of the effortful swallow in adults with and without dysphagia, highlighting clinical implications and future research needs. Specifically, the effects of the effortful swallow on swallowing physiology, safety, and efficiency were identified, as well as the strengths and limitations of current research. Method Recommendations specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. A literature search of three databases and relevant articles cited in the searched studies was performed. Two evaluators independently analyzed the studies for eligibility criteria, and final inclusion of studies was decided by consensus. Evaluators also assessed each study for quality of evidence. Results Twenty-three studies were included in this systematic review. Main findings indicated that the effortful swallow generated greater pressures in the tongue-to-palate, pharynx, upper esophageal sphincter, and esophageal regions. Inconsistent results for hyolaryngeal excursion were reported, as well as for swallowing function. Instructions of the effortful swallow varied greatly across studies. Two of the 23 studies were judged to be of high quality, and the remaining studies were of medium quality based on the quality indicators of this review. Conclusions Biomechanical effects of the effortful swallow included increased pressures in the oral, pharyngeal, and esophageal regions. Future investigations should address the effects of the effortful swallow in individuals with dysphagia and its potential role as a rehabilitative maneuver. Moreover, standardization of the effortful swallow instructions based on its physiological and functional effects is essential.

Quantitative imaging of tongue kinematics during infant feeding and adult swallowing reveals highly conserved patterns

“…The tongue is a unique, single‐muscle organ of interdigitated muscle fibers (Takemoto, 2001) which plays essential roles in feeding and speech. The literature of the past decades presents an overwhelming need for novel protocols to evaluate irregularities in tongue function in both children and adults (Bahia & Lowell, 2020; Delaney & Arvedson, 2008). In the present work, we demonstrated how the objective and quantitative analysis of tongue motility (Elad et al, 2014) can be used to highlight differences in tongue motility during disease states, different methods of feeding, and before and after surgical interventions to improve tongue performance.…”

Characterizing Effortful Swallows from Healthy Community Dwelling Adults Across the Lifespan Using High-Resolution Cervical Auscultation Signals and MBSImP Scores: A Preliminary Study

“…Interestingly, in addition to these findings, we did not detect a statistically significant difference in MBSImP component scores (#9, #11, #14) between non-effortful and effortful swallows. These results contribute to the mixed evidence base examining differences between non-effortful and effortful swallows in healthy adults [ 29 , 30 ]. It is also possible that MBSImP ratings may not be sensitive enough to detect subtle changes in swallowing physiology because the MBSImP is a somewhat subjective, ordinal rating scale with a limited range of scores.…”

“…For example, one study in healthy adults found that effortful swallows led to longer durations for temporal swallow kinematic measurements (e.g., hyoid movement duration, duration of UES opening) and increased pyriform sinus residue [ 30 ]. Other studies in healthy adults have found no differences in airway protection or swallowing efficiency between non-effortful and effortful swallows [ 29 ]. While research studies have examined differences in temporal kinematic measurements between non-effortful and effortful swallows in healthy adults, no studies have examined differences between non-effortful and effortful swallows using a clinical rating tool (e.g., MBSImP), and few researchers have investigated non-invasive or non-imaging alternatives to VF that are capable of determining whether the effortful swallow maneuver is accurately performed once a patient has been properly trained.…”

“…The effortful swallow is one type of compensatory swallowing maneuver that is frequently deployed in clinical settings for patients with dysphagia and has been explored in research studies in both healthy adults and patients with dysphagia. Following dysphagia treatment targeting the effortful swallow, some patients with dysphagia have exhibited decreased pharyngeal residue and decreased penetration/aspiration, but no changes in upper esophageal sphincter (UES) opening diameter, duration of UES opening, laryngeal elevation, or hyoid movement [ 26 – 29 ]. In healthy adults, the research evidence is mixed regarding the impact of effortful swallows on swallowing physiology.…”

Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study

“…Despite the frequent use of effortful swallow, its evidence base remains limited. A recent systematic review elucidated the evidence base for the effortful swallow manoeuvre and found just two high quality studies (Bahia & Lowell, 2020). Most research evaluating the impact of effortful swallowing has been conducted within healthy populations (Bahia & Lowell, 2020;Langmore & Pisegna, 2015).…”